Treating Social Phobias and Social Anxiety

Shyness And Social Anxiety System

The Shyness and Social Anxiety System is just as its name says. It is an e-book wherein in-depth discussions about the symptoms, causes and treatment for shyness and social anxiety are made. It is then written for individuals whose extreme shyness or social anxiety prevent them from enjoying a full life filled with social interactions among their family, friends and acquaintances in gatherings during holidays, outings and parties. The author Sean Cooper also suffered from shyness and social anxiety disorder so much so that he tried every trick in the book yet to no avail. And then he set out to conquer his own fears by researching into the psychology, principles and practices behind these two debilitating mental health issues. Continue reading...

Shyness And Social Anxiety System Summary


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Dissolve Social Anxiety Home Recovery Program

Here are the benefits youll receive when you sign up for the Dissolve Social Anxiety Program: Get to the Root of your Social Anxiety so you can fully recover. Find out why its Not You thats the cause of your Social Anxiety Disorder. Breakdown Beliefs that fuel social anxiety, to start making changes immediately. Discover how emotions are controlling you, and learn how to stop emotions from controlling your life. Create a new belief system and life story that will become an unshakable foundation so social anxiety never controls you, ever again. Develop new Life Skills, not only to conquer social anxiety, but dissolve virtually Any chronic anxiety or depression that comes along with your social phobia. Get Social Confidence in the way that works best for you, not someone else (this is not a cookie cutter approach Im teaching here). Learn and sharpen social skills to have great social interactions with anyone. Program Features: Instant Access to Twelve (12) life-changing modules to build the skill set to finally dissolve your social anxiety. Practical & Experiential Learning guided exercises to help create new awareness, anxiety reduction/elimination, and new possibilities for Self-Confidence And Social Action. Each module has homework to help reinforce the learning, along with practices to support you in your recovery and transforming your life. Customization for Your specific social anxiety issues and recovery goals. Complete with streaming Video Modules, downloadable MP3 Audio files, Pdf handouts (Just your web browser and Adobe Reader are required) Immediately delivery with a personal membership login for the modules (and question submissions if you purchase a higher level package) Continue reading...

Dissolve Social Anxiety Home Recovery Program Summary

Contents: Online Course
Author: David Hamilton

Social Isolation Model

The post-weaning social isolation of rats produces a model that exhibits behavioral abnormalities with some potential relevance to schizophrenia, including hyperactivity in response to novelty and amphetamine, disruption in PPI, and decreased social interactions. These abnormal behaviors are at least partially responsive to atypical antipsychotics.50 Social isolation is known to produce a variety of alterations in biochemical, electrophysiological, and anatomical measures. For example, stimulation of the ventral tegmental area in rats subjected to post-weaning social isolation produces typical evoked plateau depolarizations in prefrontal cortex that is accompanied by an abnormal firing or a short hyperpolarization that is not observed in control animals.51 This suggests that social isolation may alter mesocortical dopaminergic modulation of the prefrontal cortex. While social isolation produces an interesting behavioral model with some face validity, there are clear issues regarding...

Social Anxiety Disorder

SAD or social phobia is a common anxiety disorder often associated with serious role impairment. The 12-month prevalence rate for all types of SAD was estimated to be 8 with a lifetime prevalence of 13 . SAD is a chronic disease with a slightly higher prevalence in females than males (15 versus 11 , respectively), with retrospective studies showing an average duration of 25 years. Overall, females with poor baseline functioning at the time of diagnosis have the greatest risk of disease chronicity. DSM IV-TR defines SAD as a marked and persistent fear of social or performance situations in which embarrassment may occur. The diagnosis of SAD is only made when the fear, avoidance, or anxious anticipation of the event persists for at least 6 months and the phobia directly interferes with daily function or when the individual is distressed about having the phobia. Although SAD can relate to a specific set of circumstances (i.e., public speaking), there are cases in which there can be a...

Disease State Diagnosis

More recently, it has been argued that comorbid mood disorders are sufficiently common in schizophrenic patients to justify a fourth set of characteristic symptoms. Depression and bipolar disorder are highly comorbid in schizophrenia and are one of the key factors contributing to the increased risk for suicide in this disorder. Individuals with schizophrenia attempt suicide more often than people in the general population, and a high percentage, in particular younger adult males, succeeds in the attempt. Controversy remains over whether these mood disorders are in fact a manifestation of the disorder (i.e., share a common etiology), or an epiphenomenon associated with either the disease state or treatment. Regardless of the actual cause, comorbid mood disorders represent a clear risk in treating the schizophrenic patient population and are carefully considered along with the more traditional positive, negative, and cognitive symptoms. Schizophrenia is usually diagnosed in adolescence...

Attending To Interpersonal Processes In Treatment

Behavioral psychology has, of course, a rich history of attention to the interpersonal context of behavior problems, a focus that is seeing increasing development related to PTSD. In this book, interventions that focus on couples concerns are described in Chapter Fourteen by Leonard, Follette, and Compton. Deblinger, Thakkar-Kolar, and Ryan in Chapter Sixteen describe interventions that work conjointly with both children and parents in addressing child traumatic experiences. Group psychotherapy, an important component of treatment for many trauma survivors, is reviewed in Chapter Fifteen by Foy and Larsen. The latter authors point to the advantages for trauma survivors, whose experiences so commonly involve social isolation, social alienation, perceptions of being ostracized from the larger society, shame, and diminished feelings for others, of working toward recovery with other survivors.

Historical and Social Context of Psychoactive Substance Use Disorders

Psychoactive substances subserve several human functions that can enhance both individual and social existence. On the individual level, desirable ends include the following relief of adverse mental and emotional states (e.g., anticipatory anxiety before battle and social phobia at a party), relief of physical symptoms (e.g., pain and diarrhea), stimulation to function despite fatigue or boredom, and time-out from day-to-day existence through altered states of consciousness. Socially, alcohol and drugs are used in numerous rituals and ceremonies, from alcohol in Jewish Passover rites and the Roman Catholic Mass, to peyote in the Native American Church and the serving of opium at certain Hindu marriages. To a certain extent, the history of human civilization parallels the development of psychoactive substances (Westermeyer, 1999).

Variations on a Theme Studies of Other Exposure Protocols

In sum, although PE has not been tested directly in samples of combat veterans, studies using variations of exposure therapy with veterans have consistently revealed significant benefits for this treatment approach. However, the magnitude of the improvement has been somewhat limited. Furthermore, the benefits of exposure treatment appear to be greater for symptoms of intrusion and arousal than for avoidance and numbing. These studies represent very strict tests of exposure therapy. In all of the trials, exposure was compared to other treatments focused on PTSD symptoms either a continuation of treatment that the veterans were already receiving or focused PTSD interventions. An important consideration in evaluating the results of these studies is the well-recognized reality that there are incentives for veterans to emphasize their symptoms and to minimize treatment gains (e.g., gaining or losing service-connected disability compensation for additional discussion, see Frueh, Hamner,...

Persistent Avoidance of Stimuli Associated with the Trauma

The types of avoidance described above could have serious impact on the development of relationship skills involved in ordinary, day-to-day, social interactions as well as those required for intimate relationships, including therapy relationships. Healthy adult functioning involves being able to describe and identify the behavior of others as well as one's own internal reactions. Coping with trauma in a manner that involved externally focused perceptual avoidance could lead to problems such as revictimization. Perceptual avoidance that is directed inward distorts the ability to experience, identify, and describe internal states and may lead to problems of the self and personality disorders (primarily borderline personality disorder Kohlenberg & Tsai, 1991, Ch. 6 Kohlenberg & Tsai, 1993). Finally, the ability to tolerate the arousal that is required for exposure might also be affected, because the person would simply avoid the exposure experience.

Childhood Disorders Pervasive Developmental Disorders

The pervasive developmental disorders (PDDs) have been more recently conceptualized as the autism spectrum disorders (ASDs) in order to recognize the commonality of these conditions with the paradigmatic disorder, autistic disorder. The ASDs are a group of neurodevelopmental syndromes characterized by disturbances in social interactions, language and communication, and the presence of stereotyped behaviors and interests. Diagnoses subsumed under the category of the ASDs (and PDDs) include Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS). A comparison of the definitions of the ASDs is shown in Table 5-1. More recently, the ASDs have been conceptualized as a spectrum of conditions that are related by the common features of the disorders difficulties in social interactions and use of language, and restricted interests and repetitive behaviors. The term spectrum implies that...

Four Content Areas Cognitive Behavioral Interpersonal and Case Management

CBT is the basis for this treatment, because it so directly meets the needs of first-stage treatment through its high degree of structure, focus on problem solving in the present, educational emphasis, and time-limited framework. Moreover, in outcome studies CBT has been found to be one of the most promising approaches for the treatment of each of the disorders (PTSD and substance abuse) when treated separately (Najavits et al., 1996). The cognitive domain of Seeking Safety addresses beliefs and meanings associated with PTSD and SUD and explores how to rethink these in an adaptive way. The behavioral domain addresses how to take concrete actions in one's life, such as taking good care of one's body. The interpersonal domain is an area of special need because most PTSD arises from trauma inflicted by others (e.g., in contrast to natural disasters or accidents Kessler et al., 1995). Whether the trauma involved childhood physical or sexual abuse, combat, or crime victimization, all have...

Experimental Disease Models

Many of the measures used to evaluate human obesity, such as BMI or waist-to-hip ratio, are not useful to evaluate small-animal obesity. However, recent advances have allowed the measurements of body composition in small animals using dual-energy x-ray absorptiometry (DEXA) scanning or nuclear magnetic resonance (NMR), allowing a sensitive measure of adiposity and lean mass in living animals. Using rats and mice, a number of laboratories have sought to mimic the western diet by using chow consisting of highly palatable, energy-dense foods which can also induce obesity in these species. In addition, the sedentary lifestyles that are also believed to be an important contribution to the obesity epidemic can be easily attained in rodents. What is not accurately mimicked are the heterogeneous genetics, lifestyles, and schedules of human obesity. Rats and mice are typically from controlled strains and specific breeders and are individually housed in small cages that preclude social...

And Significant Others

In a study of 61 family members of people with terminal cancer, Chapman and Pepler (1998) found that those family members who lacked hope were more likely to experience somatic distress, loss of control, and social isolation. Based on their results they suggest that health professionals (they specify nurses in particular) should be more aware of family members' somatic concerns. They further suggest that a way of fostering hope, and ultimately health, is to address expressed feelings of anticipatory grief and facilitate coping. Once the grief responses are dealt with, the level of hope would be expected to increase, providing an incentive for constructive coping with loss.

Dsmivtr Diagnostic Criteria

Other anxiety disorders must be distinguished from separation anxiety disorder. In contrast to SAD, where the anxiety is focused on separation issues, in generalized anxiety disorder (GAD) the anxiety is more free floating, less situation specific, and occurs independent of separation from the primary attachment figure. Children with social phobia will display a fear of social situations in which they may be the object of public scrutiny. This anxiety may be ameliorated by the presence of a familiar person but will not occur exclusively when the attachment figure is absent, as with separation anxiety. School refusal has long been associated with separation anxiety disorder, though this relationship holds mainly for younger children when school nonattendance is most closely linked to fear of separation, whereas in adolescents fear of school and social-evaluative situations is more typical. It is important in the assessment of school nonattendance, a frequent impairment associated with...

Selective Mutism Diagnosis

The essential feature of selective mutism is the persistent failure to speak in specific social situations (e.g., school, or with peers) where speaking is expected, despite speaking in other situations (e.g., home). Previously referred to as Elective Mutism, in DSM-III the condition was renamed Selective Mutism, so as to be less judgmental (doesn't speak rather than chooses not to speak).

Treatment Of Distress Occurring In The Context Of Hiv Infection

Use of HAART has dramatically improved the lives of millions of patients living with HIV AIDS and has transformed HIV into a chronic illness. Few studies have investigated adequately the impact of HAART on the psychological well-being of infected individuals, but currently available evidence does suggest the beneficial role of HAART on psychological well-being (Rabkin et al., 2000). The effect of HAART on reducing distress has been shown in other studies as well (BeLow-Beer et al., 2000). Other interventions can begin by identifying distress through routine use of screening instruments. Prompt identification and treatment of comorbid psychiatric disease can allow initiation of effective interventions and minimize suffering. Attention to psychological coping mechanisms and bolstering of social and spiritual supports can limit the impact of loneliness and social isolation, thus enabling a higher quality of life in this vulnerable population.

The Self Medication Hypothesis

Two fundamental assumptions underlie this hypothesis first, that substances are abused to relieve psychological pain, not just to create euphoria and second, that there is specificity between patients' drug of choice preference and the specific intolerable emotions or symptoms that they are attempting to alleviate. For example, patients with social anxiety may be drawn to alcohol to decrease their symptoms, while patients who are prone to violence and anger outbursts may prefer the calming effects of opioids to the potentially disinhibit-ing effects of alcohol.

Other Psychiatric Populations

In non-SPMI populations, integrated treatment models have also been developed for other patient subpopulations with psychiatric disorders and SUDs such as bipolar disorder (Weiss et al., 2000), personality disorders (Ball, 1998 Linehan et al., 2002), and anxiety disorders such as PTSD (Brady, Dansky, Back, Foa, & Carroll, 2001 Najavits, Weiss, Shaw, & Muenz, 1998), obsessive-compulsive disorder (Fals-Stewart &Schafer, 1992), and social phobia (Randall, Thomas, & Thevos, 2001). With the exception of social phobia, for which integrated CBT for social phobia and alcohol use disorders has yielded worse anxiety and drinking outcomes compared to group CBT geared toward alcohol relapse prevention alone (Randall et al., 2001), preliminary evidence suggests that these new treatments are generating some positive results.

As Sources Of Distress

Other factors causing distress are the multiple complications resulting from immunological suppression, including visual loss, neurological illness, and fears of progressive health decline and changes in one's ability to care for one's self independently. Cytomegalovirus (CMV) retinopathy is one of the most distressing complications of HIV disease, as it results in vision loss with accompanying social isolation, loss of independence, and loss of function. Fatigue also plays an important role in HCV infection, as fatigue is a common complaint among sufferers of HCV both prior to and during treatment with biological agents such as interferon-based therapies. Four hundred and eighty-four HIV-seropositive subjects participated in a self-report trial which confirmed that HCV-coinfected patients demonstrated significantly more elements of distress compared to the HIV-only group in social, psychological, and biological arenas. The patients were also more likely to be in unstable social...

The Developmental Basis of Psychotherapeutic Processes

The DIR model is based on relatively recent insights about three interrelated processes that contribute to a child's development. The first process involves early stages in a child's presym-bolic functional emotional development (the building blocks of ego functioning and intelligence). These capacities include regulation and shared attention relating with intimacy gestural, affective reciprocal and social interactions and creating and connecting symbols. The second process involves each child's individually different underlying processing capacities, such as sensory modulation, auditory and visual-spatial processing, and motor planning. Infants and young children differ significantly in their sensory reactivity, auditory and visual-spatial processing, and motor planning and sequencing, and these differences are important contributors to ego structure, character, and symptom formation. The third process involves the role of relationships and affective interactions in facilitating a...

Differential Diagnosis

Perhaps the most difficult differentiation is in a child with severe obsessive-compulsive disorder (OCD) who also has unusual interests and is somewhat rigid in terms of being inflexible to changes in routines or transitions to a new activity. It is even further complicated if attentional problems coexist. In these cases, it is important to emphasize the social difficulties of children with ASD even if the child with OCD is difficult inter-personally, his or her ability to maintain eye contact, interpret social situations and emotions, and otherwise interact socially is relatively preserved.

In Search and Discovery of Potential New Therapeutic Indications

Based on the low potential of addiction and dependence, a preliminary study provided evidence that modafinil improved clinical outcome when combined with psychosocial treatment for cocaine dependence.101 An anecdotal story in a woman outpatient with social phobia and comorbid amphetamine dependence reported that her craving for amphetamines diminished and her anxiety and depression improved without the same 'high' with modafinil that she experienced with amphetamines.102

Obsessive Compulsive Disorder

OCD is a chronic and often disabling disorder that affects 2-3 of the US population. OCD has been labeled a 'hidden epidemic' and is ranked 20th in the Global Burden of Disease studies among all diseases as a cause of disability-adjusted life years lost in developed countries. OCD is often associated with substantial quality of life impairment especially in individuals with more severe symptoms. The disease usually begins in adolescence or early adulthood with 31 of first episodes occurring at 10-15 years of age and 75 by the age of 30. The essential features of OCD are recurrent obsessions or compulsions that are severe enough to be time consuming (i.e., take more than 1 h per day) and or cause significant levels of distress or interference with normal daily activities. OCD can have comorbidity with major depression and social phobia, as well as other mental disorders such as eating disorders and schizophrenia.9

Psychotherapeutic Interventions

The enhancement of social-cognitive skills typically involves three kinds of skill development (1) accurate interpretation of social situations (2) effective use of social behaviors in interactions with others and (3) the evaluation of one's own performance and the ability to make adjustments, depending on the environmental context.

Club Drugs and the Circuit Scene

Amine and alcohol are the most frequently used substances. Recent studies by Mansergh and colleagues (2001), Mattison, Ross, Wolfson, Franklin, and San Diego HIV Neurobehavioral Research Center Group (2001), and Lee, Galanter, Dermatis, and McDowell (2003) indicate high rates of simultaneous drug use at circuit parties the average number of substances ingested by responders on the day of the circuit party studied by Lee and colleagues was 2.4, with a range of 0 to 7. Most people report that using drugs during a circuit party enhances the dancing experience, relieves inhibitions, and improves sex. Others describe multiple substance use as self-medication for depressed mood, anxiety, social isolation, or stress associated with living with HIV disease or AIDS. Some participants report a synergistic effect between drugs, as in the case of the MDMA and ketamine combination some users believe that it results in a more intense high, while others feel that ketamine prolongs the effect of MDMA.

Personality Disorders

This diagnostic class is for personality patterns that significantly deviate from the expectations of the person's culture, are pervasive, and lead to significant impairment or distress. Ten specific personality disorders are included in DSM-IV-TR paranoid personality disorder (pervasive distrust and suspiciousness of others), schizoid personality disorder (detachment from social relationships and a restricted expression of emotions), schizotypal personality disorder (acute discomfort with close relationships, perceptual distortions, and eccentricities of behavior), antisocial personality disorder (disregard for the rights of others), borderline personality disorder (instability of personal relationships, instability of self-image, and marked impulsivity), histrionic personality disorder (extensive emotionality and attention seeking), narcissistic personality disorder (grandiosity, need for admiration, and lack of empathy), avoidant personality disorder (social inhibition, feelings of...

Why the Andrews Reiter Treatment Was Developed

Seizures cause strong emotional effects. Furthermore, the strong emotions generated by external events can precipitate seizures, often serving to reduce social interactions (14). AEDs may further impair cognitive and behavioral functioning (12,13,15). Therefore, a treatment method that both reduces seizures and the need for AEDs could significantly improve the quality of life for people with epilepsy.

Palliative Nutritional Endpoints and Decision Making

About the goals of an intervention is important to avoid both extremes neglect and overactivity. The focus on amount of intake, optimisation of nutrients or weight is curative in nature, since it does not aim to relieve primarily suffering. Treatment of the sensation of loss of appetite, decreasing the distress related to social interactions associated with meals, is palliative in nature. However, the optimal management of constipation leading to (almost) complete reversal of anorexia, or stenting the colon to improve bowel obstruction, aim to relieve suffering but are curative in nature. In both cases a pure palliative approach to relieve anorexia, visceral pain, and nausea in constipation and bowel obstruction would probably be of minor quality in many patients.

Psychiatric Comorbidity And Sequelae

More than one-half of all cocaine abusers meet criteria for a current psychiatric diagnosis and nearly three-fourths for a lifetime psychiatric diagnosis (Ziedonis, Rayford, Bryant, Kendall, & Rounsaville, 1994). The most common comor-bid psychiatric diagnoses among cocaine abusers include alcohol dependence, affective disorders, anxiety disorders, and antisocial personality disorder (Kleinman et al., 1990 Marlowe, Husband, Lamb, & Kirby, 1995 Mirin, Weiss, Griffin, & Michael, 1991 Rounsaville et al., 1991 Weiss, Mirin, Griffin, Gunderson, & Hufford, 1993). For most cocaine users, co-occurring psychiatric disorders (including agoraphobia, alcohol abuse, alcohol dependence, depression, posttraumatic stress disorder (PTSD), simple phobia, and social phobia) precede cocaine use (Abraham & Fava, 1999 Shaffer &Eber, 2002).

Psychiatric Disorders 601411 Schizophrenia

Panic disorder without agoraphobia Panic disorder with agoraphobia Social phobia Anxiety disorders (see 6.04 Anxiety) are characterized by an abnormal or inappropriate wariness. There are several disorders that fall under the heading of anxiety including panic disorders, phobias, generalized anxiety disorder (GAD), acute stress disorder, and posttraumatic stress disorder (PTSD). Panic disorder is characterized by rapid and unpredictable attacks of intense anxiety that are often without an obvious trigger. Phobias are examples of life-disrupting anxiety or fear associated with an object or situation, including social phobias. GAD develops over time and involves the generalization of fears and anxieties to other, usually inappropriate situations until they ultimately result in an overwhelming anxiety regarding life in general. Acute stress disorder involves the response to a threatened or actual injury or death and is characterized by dissociation, detachment, and depersonalization....

The Meaning of Eating in Terminally Ill Patients Importance of Carers

Meares et al. conducted semi-structured interviews with women primary caregivers of adult inhome hospice patients with terminal cancer 15 . This systematic qualitative study summarises as follows 'Shift in thinking eating is best to not eating is best .' It reports seven elements related to gradual cessation of oral intake (1) the meaning of food (cultural aspects, love, socialised role of food, social situations, dinner hour) (2) the caregiver as sustainer (knowledge of care-giving, difference of emotion and intellect, vigilance, balance of respect and concern in choice of action) (3) concurrent losses (lived experience enmeshed, carer's personal pain) (4) personal responses (patient eats to please family) (5) ceasing to be-starved to death (6) being bereaved - the meaning now (meaning of cooking changed, patient remembered by using

Table of Contents

Personality Disorder 439 Diagnosis 439 Treatment 440 Paranoid Personality Disorder 441 Diagnosis 441 Treatment 442 Schizoid Personality Disorder 443 Diagnosis 443 Treatment 444 Schizotypal Personality Disorder 444 Diagnosis 444 Treatment 445 Antisocial Personality Disorder 446 Diagnosis 446 Treatment 447 Borderline Personality Disorder 448 Diagnosis 448 Treatment 448 Histrionic Personality Disorder 450 Diagnosis 450 Treatment 451 Narcissistic Personality Disorder 452 Diagnosis 452 Treatment 453 Avoidant Personality Disorder 453 Diagnosis 453 Treatment 454

Negative Mood

Lending support to the clinical relevance of decrements in immune status are findings highlighting the association between depressive symptoms and disease end points. Specifically, depressive symptoms have been related to faster progression to AIDS (PageShafer et al., 1996 Leserman et al., 1999) and development of an AIDS-related clinical condition (Leserman et al., 2002). Other investigations have determined that chronically elevated depressive symptoms are associated with hastened mortality among HIV-positive men (Mayne et al., 1996) and women (Ickovics et al., 2001). Again, the majority of studies reporting no effect of depressive symptoms on hastened mortality used only baseline measures (Burack et al., 1993 Lyketsos et al., 1993 Page-Shafer et al., 1996). Interestingly, in a follow-up to one study in which no effects of baseline depressive symptoms were observed on HIV disease progression, participants reported a dramatic increase in depressive symptoms 6 to 18 months before an...

Social Adjustment

Because the social environment is a major source of reinforcement, it is essential to identify the reward contingencies, role models, and contextual factors associated with alcohol or drug use. It should be recognized that the individual not only responds to the particular social environment but also seeks out an environment that has reinforcing value. Hence, during the course of the psychological assessment, an attempt should be made to learn why the substance abusing client seeks out social interactions that have maladaptive consequences.

Anxiety Disorders

Compared to depressive disorder, it is usually easier to determine whether or not an anxiety disorder is independent of alcohol use. For example, posttrau-matic stress disorder (PTSD) does require a specific traumatic event. Panic attacks are typically clearly recalled by individuals and are therefore easier to separate from possible anxiety symptoms that have resulted from alcohol use, intoxication, or withdrawal. There is a strong comorbidity between alcohol use disorders and anxiety disorders nearly 37 of individuals with alcohol dependence have met criteria for an anxiety disorder during the previous year. Generalized anxiety disorder accounts for 11.6 , panic disorder for 3.9 , and PTSD for 7.7 . Another way to appreciate these comorbidities is that the alcohol-dependent person is 4.6 times more likely to have generalized anxiety disorder, 2.2 times more likely to have PTSD, and 1.7 times more likely to have panic disorder than the non-alcoholic-dependent individual. The...

Treatment Structure

Treating the young people in groups provides useful developmental information. In the group setting, opportunities to observe the adolescents and their parents in normal social situations rather than in the shorter intense therapeutic relationship occur. This allows the team to identify other developmental issues that may make change more difficult for certain children. An example is the observation of poor social skills or awkward peer interactions. If this is occurring in the therapeutic group, then it will also be happening at school and will need to be addressed if the young person is to return successfully to education. Specific learning difficulties that may interfere with the management of pain can also be observed during the therapeutic tasks, for example, poor sequencing and problem


Persons with HIV experience loss in many different ways over the course of their illness, including loss of friends, primary support networks, and physical integrity, and the continuing social stigmata of HIV and AIDS. Unfortunately for many, the loss of family and friends may occur at a time when they are most needed, which may further compound the loss of occupational and recreational capabilities across the course of the disease through both social isolation and physical impairment. Importantly, though, studies have demonstrated that group interventions designed to target maladaptive bereavement processes not only counter psychological distress and improve health-related quality of life but also may have a direct impact on HIV illness progression.

Social Factors

Retirement can lead to reduced household income and thus to insecurity about buying food and then to weight loss 29 . Moreover, retirement can also lead to social isolation, changes in life style, and loss of contacts. All of these add up to the risk of weight loss and cachexia following retirement. Simple changes, such as the expansion of commercial shopping areas, the erection of high-rise apartments, or the increasing diversity of the neighbourhood, may elicit a strong sense of insecurity within an environment the older adult previously perceived as safe 29 .

Psychosocial issues

Young women frequently have concerns about the impact of the diagnosis on their partner and may have practical issues related to the care of young children during their treatment. Research suggests that peer support and self-help groups decrease feelings of social isolation, depression, and anxiety 112, 113 . Young age of onset of disease has been identified as a risk factor predicting adverse psychological outcomes, and very young women are especially vulnerable to psychological distress related to body image and sexuality. Loss of fertility may also be the source of psychological distress in young patients, with between 10 and 50 of women experiencing sexual problems following the diagnosis and treatment of breast cancer 114, 115 . Adjuvant chemotherapy and endocrine therapy may

Sources of Knowledge

Several studies reporting sources of practice knowledge used by nurses are published all used survey methods (140-142). We located no studies that asked clinicians themselves to describe and categorize the kinds of knowledge needed to practice or any that attempted to understand how clinicians privilege various knowledge sources. Drawing on individual and card sort interviews, as well as participant observations, in the research utilization studies described above, we identified nurses' sources of practice knowledge. Our findings suggested that nurses categorize their sources of practice knowledge into four broad groupings social interactions, experiential knowledge, documents, and a priori knowledge (143). Experiential knowledge and knowledge produced in and shared via interactions were the most commonly identified sources. In addition, the choice of knowledge source is influenced by factors such as trust, hierarchy, question specificity, time, and knowledge presentation style (144)....

Group Interventions

In many posttrauma environments, group-administered early intervention activities are a staple element of care. This is especially true when (1) large numbers of persons are exposed to the same traumatic event (e.g., terrorist attacks, industrial accidents, mass violence, community disasters), (2) preexisting groups are exposed to trauma (e.g., a workplace exposed to a violent assault), and (3) workgroups are exposed to trauma as part of their job duties (e.g., military personnel, emergency response workers, police, forensic investigators). Groups would appear to be well-suited to challenging common distressing perceptions of survivors (e.g., feeling alone, different, misunderstood by those around them), reducing social isolation, and providing social support and may also be useful in helping survivors address the worries associated with traumas that are particularly difficult to talk about with family and friends (e.g., sexual assault), due to perceived social stigma, embarrassment...

Dog Assisted Therapy

The use of assistance dogs for people with visual impairment is well known and has a long history, and is not further described here. The therapeutic use of dogs in reacting to human situations falls into two main categories response and alert. Response dogs assist humans by behaving in a specific, useful way when a particular event occurs, such as drawing the hearing-impaired human's attention to the presence of a visitor at the door. Alert dogs are said to anticipate certain kinds of impending events and provide a useful warning to humans. In psychiatry, dog therapy has been advocated for the anticipation of panic attacks (alert type), for desensitizing people to phobias, and for reducing social anxiety (mainly response type). Little research data support such claims, and these topics require further investigation.

Seizure Generation

What evidence do we have to support this model Some evidence is gleaned from animal studies. Martinek and Horak (1) have shown that seizures can be triggered by emotional excitement in genetically susceptible dogs Lockard (2) has shown that in a monkey hierarchy, seizures can be caused by exposing a subservient monkey to a dominant one. Thus, social stress is clearly a precipitating cause. Lockard went on to show that pleasant social situations (e.g., a monkey in a nonthreatening social group) produced a reduction in seizure frequency as well as a reduction in the abnormal spike discharges that often precede a seizure.

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