A Study to Assess the Knowledge and Attitude of Social Phobia Among the Adolescent In

“A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF SOCIAL PHOBIA AMONG THE ADOLESCENT IN SELECTED COLLEGE AT TUMKUR WITH A VIEW TO DEVELOP A HEALTH EDUCATION MODULE .”

PERFORMA FOR REGISTRATION OF SUBJECT FOR

DESERTATION

MR.PRAVIN RAMESH GHOLAP.

PSYCHIARIC NURSING

ARUNA COLLEGE OF NURSING

RING ROAD, TUMKUR

2009-2010

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1.NAME OF THE CANDIDATE:MR. PRAVIN RAMESH GHOLAP.

AND ADDRESS ARUNA COLLEGE OF NURSING

RING ROAD, MARALUR

TUMKUR-572105

2.NAME OF THE INSTITUTION: ARUNA COLLEGE OF NURSING

RING ROAD, MARALUR

TUMKUR-572105

KARNATAKA

3. COURSE OF STUDY : 1 YEAR M.Sc. NURSING

AND SUBJECT PSYCHIATRIC NURSING

4. DATE OF ADMISSION : 10.06.2009.

TO COURSE

5. TITLE OF THE TOPIC :“A STUDY TO ASSESS THE

KNOWLEDGE AND ATTITUDE OF

SOCIAL PHOBIA AMONG THE

ADOLESCENT IN SELECTED

COLLEGE AT TUMKUR WITH A

VIEW TO DEVELOP A HEALTH

EDUCATION MODULE.”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

The term social phobia (phobic- des- situation socials) was first coined by Janet (1903) to describe the patient who feared being observed while specking, playing, the piano or writing, symptoms of shyness, social anxiety and social avoidance had been described as early as the time of Hippocrates (1969). Person with social phobia experience fear of being humiliated or judged negatively in social or performance situation. In feared situation they tend to be self conscious and self critical and they often experience physical symptoms of anxiety. The person with social phobia is also generally aware from the start of an anxiety reaction that it is related to social or performance fear and rarely fears dying during episode unlike person with panic disorder.1

At least 1 out of 50 American experiences a degree of trait social anxiety sufficient to quality for the diagnosis of social phobia. Those clients who seek professional help for excessive anxiety approximately 10% are diagnosed as social phobia. Despite the obvious similarity between the trait social anxiety and social phobia the question exists of whether social phobia is nothing but excessive anxiousness. On the other hand most evidence of normal social anxiety and that the differences between trait social anxiety and social phobia are primarily a matter of degree on the other hand some have argued that social phobia is qualitatively distinct from social anxiousness just a clinical depression is something other than extreme sadness. 2

If you are shy so you have something in common with 20% to 50% of college students depending on survey. A much smaller number of people who suffer severely around others have social phobia. As many as 12.1% of the general population suffer from social phobia at same point in their lives. Many more people are shy but not severely enough to meet criteria for social phobia. The sex ratio favours female only somewhat (1.4 to 1.0) unlike other anxiety disorder for which females predominate social phobia usually being during adolescence with a peak age of onset around 13 years later than specific phobia. Social phobia also tends to be more prevalence in people who are young (18-29 years) undereducated, single and of low socioeconomic class. Japanese people with this form of social phobia strongly fear looking people in the eyes and are afraid that some aspect of their personal presentation.3

In some instance the fear may be much defined, such as the fear of using a public rest room, or fear of writing in presence of others, fear of eating or speaking in a public spaces. In the other case social phobia may involve general social situation, such as saying thing or answering questions in a manner that would provoke language as part of others. Exposure to phobic situation usually result in feeling of panic anxiety, with sweating and dyspnoea.4

6.1. NEED FOR THE STUDY

Social phobia is the fear of situation in which a person might to do something embarrassing or be evaluated by others. The individual concerns about being exposed a possible scrutiny by others and fears social or performance situation in which embarrassment may occur. In India the extrapolated prevalence is 20,753,213 in population of 1,065,070,607. Approximately 5.3 million adolescents or 3.7% of people in this age in a given year has social phobia, the prevalence rate is 1.95% in USA, by national institute of mental health 5

The concept of social phobia as distinct from other phobic disorder. It was first reported by first proposed by marks. The central feature of social phobia as marked persistence situation in which humiliation or embracement may occur this is generalised in earlier age of onset, lower socio-economic status, and unmarried and poor job record. The diagnosis is found a life time prevalence of 11.9% in males and 15.5% in females. The age of onset was 16.3 years females and 14.8 years for males.6

Predicting depression, social phobia, and violence in early adulthood from childhood behaviour problems in March 2004. This study examined childhood behaviour problems at ages 15 and 18 years as predictors of young adult depression, social phobia, and violence at age 21 years. Data were collected as part of the Seattle Social Development Project, a longitudinal study of 808 elementary school students from high-crime neighbourhoods of Seattle. Reports of childhood behaviour problems were obtained from parents and children in fall 1985 and from teachers in spring 1986. Follow-up reports of violence and DSM-III-R depression and social phobia were collected from 765 respondents using standard survey items and the Diagnostic Interview Schedule in 1996 this result shows past-year prevalence of depressive episode and social phobia were 20% and 17%, respectively. Twenty-one percent of the respondents reported two or more violent acts in the past year at age 21 years. Results showed that children who reported higher, relative to lower, levels of conduct problems were nearly four times more likely to experience a depressive episode in early adulthood. Findings suggest the potential value of intervening to reduce childhood conduct problems as a prevention strategy for not only violence but also depression.7

The study was to compare the effectiveness of the Social phobia scale (SPS), Social interaction anxiety scale (SIAS), ASI-physical scale and STAI-T (State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press (1970)) as predictors of anxious response to a social challenge (asking an aloof confederate out on a date). Consistent with the hierarchical model of anxiety, the measures of trait anxiety were moderately correlated with each other and each was a significant predictor of anxious response. The specific measures of trait social anxiety were slightly better predictors of anxious response to the social challenge than was either the ASI-physical scale or the STAI-T. The results provide evidence of the predictive validity of these social trait measures and some support for their specificity in the prediction of anxious response to a social challenge.8

This study shows that social phobia in children and adolescents. Current assessment of childhood social anxiety includes psychometrically sound self report and clinician administered measures either specifically targeting SP disorder or including the construct as a subscale of a broader measure. The type of measure that is used most often depends on the purpose of the assessment, the setting, time constraints, and required training. Extant data support the efficacy of both psychosocial and pharmacological interventions, with response rates ranging from 50-80%. Further research is needed to clarify the developmental stages of SP, the psychometric properties of brief measures, as well as the efficacy of combined interventions.9

Adolescents especially in the college student mainly have social phobia characteristics in the way they treated by classmates. The study was conducted on class behaviour during oral presentation and the social anxiety of the speakers was investigated. For this study a group of 55 students from grade 8 to 9 were selected to participated class behaviour during their prosecutions was rated by students themselves, their and independent observer. Result show that negative class behaviour was noted that it was related to social phobia. The negative social outcome is related to long lasting social interaction in the class room; and not to specific anxiety characteristics.10

In the light of the above facts the investigator evidence the characteristics of social phobia in adolescents mainly affect in their educational practices and occupational function mainly, as it appears to be equal common among male and female. These impairments mainly lead to distress. Despite intense research in this area, this is still must be learned about knowledge on social phobia. Hence the investigator felt need and importance of trying some education which will helpful in education practice and also in occupational function in future.

6.2. REVIEW OF LITERATURE:

A study was conducted on Social Phobia in College Students in December 2007. We used the Social Phobia Inventory (SPIN) to identify self-reported social phobia symptoms in 59 students presenting for intake at our counsellingcentre and 119 students meeting a course requirement for research participation. We expected that students presenting for clinical service would have higher scores than the students not seeking such service. Interestingly, students in both samples scored in the clinical range on the SPIN, suggesting there was no difference in mean levels of self-reported social phobia symptoms between the two groups. We interpreted this finding from a developmental perspective that “de-pathologizes” the symptoms of social anxiety and reframes them within an emerging identity context. Implications for intervention and programming for social phobia on campus are discussed, including recommendations to increase the utility of the SPIN with a college population.11

A study to determine the effectiveness of group therapy for social phobia in adolescents with learning disability. This study conducted for duration of three months consisted of sample size of 20 adolescents with learning disability selected randomly. They were also found to have various levels of social phobia as measured by the LSAS. The separate groups were conducted for 10 students for two separate settings. Each group received six separate group therapy sessions, once a week. The data analysis that observed value is greater than critical value thus there is mean difference of between the pre test and post test scores. It conclude that group therapy is effective in treating with learning disability by reducing their social phobia.12

A study was conducted on prevalence of social phobia in school- going adolescents in an urban area. To assess the incidence of social phobia disorder in the age group of 14-17 years attending school. The incidence of this sample of population was found out to be 10.3%, in which 5% belonged to the moderate category, 4.3% to be marked 0.7% to the severe phobia in adults include a range of physical sign. Female showed a higher incidence of social phobia when compared to males and in the age group of 14-15 years had a higher incidence of social phobia than those of the age group 16-17 years.13

A study was conductedon social phobia in Nigerian university students: prevalence, correlates and co-morbidity in June 2009. A cross-sectional survey of students at the University of Ibadan was carried out. Instruments used were the Composite International Diagnostic Interview (CIDI), the Alcohol Use Identification Test, the General Health Questionnaire and the WHO-Disability Assessment Schedule. The result show that the lifetime and 12-month prevalence of social phobia were 9.4 and 8.5% respectively. On bivariate analysis, social phobia was significantly associated with lifetime and 12-month depression, psychological distress and reporting poor overall health (P < 0.05). Lifetime depression, psychological distress and perceived poor overall health remained strongly and independently associated with social phobia after regression analysis. The prevalence of social phobia among Nigerian university students is similar to what has been found in other parts of the world. There is a need for increased awareness of this disorder and its association with depression so that sufferers can receive early treatment to prevent long-term disability.14

A study was conducted on social anxiety in college students. The purpose of this study was to: (a) provide normative data on the frequency with which individuals in a nonclinical sample experience particular symptoms of social anxiety (e.g., sweating, shaking, etc.); (b) to examine how the perception of anxiety in others influences participants' immediate impressions of various personal characteristics (e.g., intelligence, attractiveness, etc); and, (c) investigate the relationship between social anxiety and perceptions regarding others who appear to be anxious. Eighty-one undergraduate students completed self-report measures of social anxiety and social desirability, and then rated the degree to which their impressions of various personal characteristics were influenced when another individual was perceived to be anxious. Results suggested that the vast majority of individuals experience symptoms of anxiety in social situations from time to time. In addition, individuals who themselves reported elevated social anxiety were more likely than individuals less socially anxious to judge others who appear anxious to have less strength of character and to be less attractive and more compassionate compared to others who do not appear anxious.15

The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior college at the risk-period for developing social phobia of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Students from seventeen colleges in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5-5.2) and a significant gender difference (6.6% girls vs. 1.8% boys, P < 0.001). No significant differences in prevalence of probable cases emerged across the ages. At sub-threshold level, marked social fear of at least one social situation was reported by 13.8% of the total group. "Speaking in front of class" and "calling someone Sun familiar on the phone" were the most feared social situations. In the social phobia group, 91.4% reported impairment in the school-domain due to their social fear. As impairment in the school-domain is reported to a high degree, professionals and teachers need to recognize social phobia in adolescents so that help in overcoming the difficulties can be offered.16

Several anxiety disorders, including social phobia, are genetically influenced. Genetic linkage analysis can provide the means to identify genomic locations harboring susceptibility loci for genetically influenced disorders. Identifying loci for social phobia was the goal of this study. The authors conducted a genome-wide linkage scan, i.e., tested enough genetic markers to query the entire genome, in 17 American pedigrees (163 subjects) ascertained through probands with panic disorder. Several anxiety disorders segregate in these families; diagnoses were based on structured interviews. A total of 422 markers (404 autosomal, 18 on the X chromosome) with an average spacing of less than 10 centimorgans were genotyped. Multipointlod score and nonparametric (Zlr score) linkage analyses for social phobia were completed with Allegro and Genehunter X software. The result shows that evidence for linkage to social phobia for chromosome 16 markers was identified. A Zlr score of 3.41 was observed for chromosome 16 near marker D16S415. The maximum observed lod score was 2.22, also for chromosome 16, between D16S415 and D16S503 (under a model of recessive inheritance). Additional areas of interest were identified on chromosomes 9, 14, and 18.17

Psychological group treatments, such as behavioral or cognitive-behavioral therapy, are generally effective interventions for social phobia. However, a substantial number of individuals discontinue these treatments prematurely. Participant attrition can threaten the validity of treatment outcome studies if attrition during therapy does not occur randomly. In order to examine this issue, we studied 133 individuals with a principal diagnosis of social phobia who initiated a 12-week behavioral or cognitive-behavioral group treatment for social phobia. Thirty-four participants discontinued therapy prematurely. These dropouts were compared to treatment completers in demographic characteristics, Axis I and II psychopathology, and their attitude toward treatment. The results only showed a small difference between treatment completers and dropouts in their attitude toward treatment: dropouts rated the treatment rationale as less logical than completers at the beginning of treatment. No other differences between dropouts and completers were observed. Therefore, dropouts are unlikely to present a serious threat to the external validity of treatment outcome studies for social phobia.18

This study seeks to examine the incidence of social phobia in the general population and to establish a number of risk indicators. Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) which is a population based prospective study (n=7076). A sample of adults aged 18-64 years (n=5618) were re-interviewed 1 year later using Composite International Diagnostic Interview (CIDI). The 12-month incidence of DSM-III-R social phobia was 1.0%. Low education, low mastery, low self-esteem, emotional neglect in childhood and ongoing difficulties were found to be risk indicators. After including other mental disorders as risk indicators in the model, the incidence was found to be more common among those with low mastery, major depression, sub threshold social phobia, emotional neglect, negative life events, and low education. The incidence of social phobia can be predicted relatively well with psychosocial variables and co morbidity.19

This study seeks to Linking self-reported childhood behavioral inhibition to adolescent social phobia. Behavioral inhibition in children has been hypothesized to be a risk factor for the later development of social phobia. However, this hypothesis has yet to be demonstrated in a prospective study. The purpose of the study presented here is to test whether behavioral inhibition in childhood constitutes a risk factor for social phobia during adolescence. The sample consisted of 2,242 high school students assessed over a 4-year period. Assessments included self-report questionnaires, structured clinical interviews, and measurements of heart rate. Cox proportional hazards models were used to evaluate risk. The result shows that social avoidance, a component of behavioral inhibition, predicted onset of social phobia during high school. However, social avoidance was not related to depression in adolescence. Another component of behavioral inhibition, fearfulness, increased the risk for both social phobia and depression. Among subjects who were both socially avoidant and fearful, 22.3% developed social phobia--a risk more than four times greater than that for subjects with neither feature of behavioral inhibition. This prospective study demonstrates that behavioral inhibition in childhood increases the risk of social phobia in adolescence.20

The study was conductedonwhy is the self important in understanding and treating social phobia? Current cognitive models of social phobia all agree that the self plays a key maintaining role in the disorder. However, all of these models use a relatively limited conceptualization of the self. The author proposes a tripartite approach in which theories of the self are grouped into three broad categories: content, structure, and process. Content refers to knowledge and information about the self, structure to the way that information is organized, and process to the ways in which individuals attend to and regulate the self. Structure has been largely neglected to date, and the author outlines ways in which the structural organization of self-knowledge could contribute to social anxiety. High social anxiety is associated with low clarity about the self and with more uncertainty about self-judgments. Structure interacts with content, and in the final part of the article potential interactions among imagery, self-concept, and self-structure are discussed.21