abnormal psych

Functional Fear: fear in response to objectively threatening events, this fear is of appropriate severity given the threat, the fear subsides when threat has passed, the fear leads to adaptive behaviors to confront or avoid the threat More Severe Functional Fear: fear may be somewhat unrealistic, this fear may be somewhat ore than is warranted given the severity of the threat, the fear persists after the threat has passed, the fear leads to behaviors that may be somewhat inappropriate Less Severe Dysfunctional Fear: (potentially meets diagnostic criteria for an anxiety disorder) fear is moderately unrealistic, the fear is definitely more than is warranted given the severity of the threat, the fear persists for quite a while after the threat has passed, the fear leads to behaviors that are potentially dangerous or impairing Dysfunctional Fear: (likely meets diagnostic criteria for an anxiety disorder) fears are completely unrealistic, the fear is excessive given the objective threat, the fear persists long after the threat has passed and chronic anticipatory anxiety exists, the fear leads to dangerous behavior or impairment Fear is adaptive when it is realistic, when it is in proportion to the threat, if it subsides when the threat has passed, and if it leads to appropriate behaviors to overcome the threat. Fear becomes maladaptive when it arises in situations that most people would not find threatening, or if it is greatly out of proportion to the threat. Fear becomes anxiety when it persists long after the threat has subsided. Fear can become an anxiety disorder when a person engages in maladaptive behaviors in response to a threat. Over time, humans have developed fight-or-flight response, which is a set of physical and psychological responses that help us fight a threat or flee from it. The physiological changes of the fight-or-flight response result from the activation of two systems controlled by the hypothalamus. Autonomic nervous system: sympathetic Adrenal-cortical system: hormone-releasing The hypothalamus first activates the sympathetic division of the autonomic nervous system which acts directly on the smooth muscles and internal organs in order to produce key bodily changes. The liver releases sugar to fuel muscles, heart rate, blood pressure, and breathing rates all increase, and the muscles tense. Saliva dries up which increases the size of the air passages to the lungs and the body secretes endorphins which are natural pain killers. Blood vessels are ready to reduce bleeding in case of injury. The spleen releases more red blood cells to help carry oxygen. Next, the hypothalamus activates the adrenal-cortical system by releasing corticotropin-realease factor (CRF) which signals the pituitary gland to secrete adrenocorticotropic hormone (ACTH) which is the bodys major stress hormone. The ACTH stimulates the outer layer of the adrenal cortex, releasing a group of hormones, especially cortisol. Corrtisol is used to measure stress. The ACTH also signals to adrenal glands to realease 30 other hormones which play a role in the bodys adjustment to emergency situations. After the threat has passed, the hippocampus turns off the physiological cascade. The hippocampus is the part of the brain that helps regulate emotions. The fight-or-flight system has its own feedback loop that normally regulates the level of physiological arousal we experience in response to a stressor. In many disorders, the fight-or-flight system becomes dysregulated. We can also experience terror and dread emotionally. In typical fear responses, these emotions subside when the threat subsides. In anxiety and related disorders, these emotions persist in the absence of the threat. Anxiety is part of many psychological disorders, common for those with serious depression. People with one anxiety disorder are likely to have another. Responses to threat Somatic: tense muscles, increased heart rate, changes in respiration, dilated pupils, increased perspiration, adrenaline secretion, inhibited stomach acid, decreased salivation, and bladder relaxation. Emotional: sense of dread, terror, restlessness, and irritability Cognitive: anticipation of harm, exaggeration of danger, problems in concentrating, hyper vigilance, worried and ruminative thinking, fear of losing control, fear of dying, and sense of unreality. Behavioral: escape, avoidance, aggression, and freezing Anxiety is a key feature in all of the following disorders: Two disorders in which an initial, potentially adaptive fear response develops into a maladaptive anxiety disorder: posttraumatic stress disorder (PTSD) and acute stress disorder. These two disorders are the consequences of experiencing extreme stressors known as traumas. The DSM-5 defines these traumas as events in which individuals are exposed to actual or threatened death, serious injury, or sexual violation. The DSM-5 requires that individuals either directly experience or witness the traumatic event, learn that the event happened to someone they are close to, or experienced repeated or extreme exposure to details of the traumatic event. (page 111 for specific details about the DSM-5 criteria). After 9/11, 20% of people living nearby had symptoms of PTSD, including re-experiencing the event, feeling numb and detached, or being hyper vigilant and chronically aroused. Nationwide, 44% of adults experienced PTSD from the event. A wide range of events can induce PTSD or acute stress disorder such as a terrorist attack or traffic accident. DSM-5 considers the event a trauma as long as they expose the individual to actual or threatened death, serious injury, or sexual violation. Studies show that 7% of adults will be exposed to a traumatic event and develop PTSD at some point in their lives, women are at greater risk then men are. Symptoms can range from being mild and moderate to immobilizing and causing deterioration in their work, family, and social lives. A diagnosis of PTSD requires the presence of four types of symptoms: Repeated re-experiencing of the traumatic event: intrusive images or thoughts, recurring nightmares, or flashbacks in which they relive the event Persistent avoidance of situations, thoughts, or memories associated with the trauma. Negative changes in thought and mood associated with the event Hyper vigilance and chronic arousal, sounds or images may create panic and flight Many people with PTSD experience some symptoms of dissociation: a process in which different facets of their sense of self, memories, or consciousness become disconnected from one another. People experiencing dissociation could be diagnosed with the subtype PTSD with prominent dissociative (depersonalization/derealization) symptoms. Acute stress disorder occurs in response to traumas similar to those involved with PTSD, but is diagnosed when symptoms arise within 1 month of exposure to the stressor and last no longer than 4 weeks. The individual with acute stress disorder persistently re-experiences the trauma through flashbacks, nightmares, and intrusive thoughts. The individual avoids reminders of the trauma and is constantly aroused. Dissociative symptoms are common, including detachment, reduced awareness of surroundings, derealization, depersonalization, and inability to recall important aspects of the trauma. People who experience acute stress disorder are at high risk of continuing to experience PTSD for many months. Adjustment disorder, which consists of emotional and behavioral symptoms, anxiety symptoms, and antisocial behaviors, that arises within 3 months of the experience of a stressor. The stressors can be any severity, not just extreme like in PTSD and acute stress disorder. Adjustment disorder is a diagnosis for people experiencing emotional and behavioral symptoms following a stressor who do not meet the criteria for a diagnoses of PTSD, acute stress disorder, or an anxiety or mood disorder resulting from stressful experience. Traumas leading to PTSD: traumas leading to PTSD are common. Examples are natural disasters (those who experience the natural disasters, including the search and rescue personnel, are at significant risk). Ambulance workers had the highest rate of PTSD. Wars, terrorist attacks, and torture are even more likely to lead to PTSD. PTSD can also be known as “combat fatigue syndrome” or “war zone stress” and “shell shock.” Citizens of countries in war are also at high risk of PTSD. Sexual assault is the trauma most commonly associated with PTSD. 46% of sexual assault survivors experience PTSD at some time in their lives. Theories of PTSD: Environmental and Social Factors: Peoples reactions to the trauma include its severity, duration, and the individuals proximity to the trauma. People who experience more severe and long-lasting traumas who are directly affected by it are more prone to developing PTSD. Rape survivors who were violently and repeatedly raped over an extended period are highly likely to experience PTSD. Victims of natural disasters who are injured r who lost their homes or loved ones during the event are more likely to experience PTSD than those less severely affected. Social support also determines PTSD. People who have emotional support recover more quickly than those who do not. Psychological Factors: People who already experience anxiety or depression are before the trauma are more likely to develop PTSD following a trauma. After the trauma occurs, peoples styles of coping may also influence their vulnerability. People who use drinking and self-isolation after the trauma are more likely to experience PTSD. Dissociation or psychological detachment from the trauma and ongoing traumatic events also increases the likelihood of PTSD. People who dissociate directly after the trauma are at even more of a risk. Gender and Cross-cultural Differences: Women are more likely than men to be diagnosed with PTSD, as well as other anxiety disorders. Women experience some of the triggers for anxiety disorders more of then than men, such as sexual abuse. Women also may be more likely to develop PTSD because of the types of traumas they experience such as sexual abuse, which is stigmatized; decreasing the amount of social support they receive. Men are more likely to suffer traumas that carry less stigma, such as war. Nationwide, studies show that African Americans have higher rates of PTSD compared to all other races. African Americans witness more domestic violence and being victims of violent assault. All minorities were less likely than whites to seek treatment for traumatic related symptoms. Culture also appears to strongly influence the manifestation of anxiety. Latinos report a syndrome known as “attack of the nerves” such as trembling, heart palpitations, a sense of heat in the chest rising to the head, difficulty moving limbs, loss of consciousness, memory loss, needles in body chest tightness, and difficulty breathing. “Attack of the nerves” is more common in recent trauma victims. Moe chronic anxiety-like symptoms “nervious” are common in Latino communities, especially those poor and uneducated. Biological Factors: biological responses to threat appear to be different in people with PTSD than in people without the disorder. Genetic factors may predispose victims of threat to these different biological responses. Neuroimaging Findings: uses PET and MRI to show differences in brain activity between people with PTSD and those without it in response to threatening or emotional stimuli. These differences occur in brain areas the regulate emotion, fight-or-flight response, and memory, including the amygdala, hippocampus, and prefrontal cortex. The amygdala appears to respond more actively to emotional stimuli in those with PTSD. The medial prefrontal cortex modulates the reactivity of the amygdala to emotional stimuli and is less active in people with more severe symptoms of PTSD than in people with less severe symptoms of PTSD than in people with less severe symptoms. The brains of people with severe PTSD may be both more reactive to emotional stimuli and less able to dampen that reactivity when it occurs. Shrinkage in the hippocampus is also shown among PTSD patients, due to overexposure to neurotransmitters and hormones released in the stress response. Damage to the hippocampus shows memory problems and may interfere with returning the fear response to a normal level after the threat has passed. Biochemical findings: cortisol is the major hormone released during the fight-or-flight response; high levels of cortisol indicate an elevated stress response. Resting levels of cortisol among people with PTSD are lower than those without. Cortisol acts to reduce sympathetic nervous system activity after stress, so lower levels result in prolonged activity of the sympathetic nervous system following stress. This is why some people develop PTSD more easily. Physiological responses such as elevated heart rate and increased secretion of the neurotransmitters epinephrine and norepinephrine are exaggerated in PTSD sufferers. In people vulnerable to PTSD, different components of the stress response may not be working in sync with one another. The hypothalamic-pituitary-adrenal (HPA) axis may be unable to shut down the response of the sympathetic nervous system by secreting necessary levels of cortisol, which results in overexposure of the brain to epinephrine, norepinephrine, and other neurochemicals. This overexposure can cause memories of the trauma to be “over consolidated” or planted more firmly in memory. Exposure to extreme stress during childhood may permanently alter children’s biological stress response, making them more vulnerable to PTSD and other anxiety disorders/depression throughout their lives. Physically, emotionally, or sexually abused children show abnormal cortisol responses to stressors and a diminished startle response. Adults abused as children continue to have these abnormal cortisol responses and elevated startle and anxiety responses to laboratory stresses, even without symptoms of PTSD. Depressed women who were abused as children show lower volume of the hippocampus than depressed women who were not abused as children. Early childhood trauma may leave permanent physical and emotional scars that predispose individuals to later psychological problems, such as PTSD. Genetics: vulnerability to PTSD can be inherited. Twins are more likely to both develop PTSD if one twin has it. Children of holocaust survivors are more likely to develop PTSD. These children develop abnormally low levels of cortisol, whether or not they have ever been exposed to a traumatic event or developed PTSD. These findings suggest that abnormally low cortisol levels may be one heritable risk factor for PTSD. Abnormalities in brain responses to emotional stimuli also appear to have a genetic basis. Treatments for PTSD Psychotherapies for PTSD have three goals: Exposing clients to what they fear in order to extinguish that fear Challenging distorted cognitions that contribute to symptoms Helping clients reduce stress in their lives These goals are addressed in cognitive-behavioral therapy for PTSD and in stress-management therapies. Some clients also benefit from antianxiety and antidepressant medications. Cognitive-behavioral Therapy and Stress Management: cognitive-behavioral therapy has proven effective in the treatment of PTSD. A major element is systematic desensitization. The client identifies thoughts and situations that create anxiety, ranking them from most anxiety provoking to least. The therapist then takes the client through their hierarchy and uses relaxation techniques to quell the anxiety. Imagining the traumatic event vividly replaces the actual event. The therapist also pays attention to unhelpful thinking patterns and helps the client challenge these thoughts. Repeatedly and vividly imagining and describing the feared events in the safety of the therapists office allows the client to habituate to his or her anxiety and distinguish memory from present reality. It may also allow the client to integrate the events into his or her concepts of self and of the world. This kind of repeated exposure therapy decreases PTSD symptoms and helps prevent relapse with rape survivors, combat veterans, refugees, and survivors of traffic collisions. On the other hand, some clients cannot handle exposure to their traumatic memories, so stress-inoculation therapy is used. The therapist teaches clients skills for overcoming problems in their lives that increase their stress and problems that may result from PTSD. Meta-analyses find stress-inoculation therapy to be an efficacious form of treatment for PTSD. Biological Therapies: the selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are used to treat symptoms of PTSD, such as sleep problems, nightmares, and irritability. Although some people with PTSD benefit from these medications, the evidence for their effectiveness in treating PTSD is mixed. Specific Phobias and Agoraphobia People can develop irrational fears of many objects and situations. The DSM-5 divides phobias into specific (focus on particular objects or animals or places) and agoraphobia (a generalized fear of situations in which the person might not be able to escape or get help if needed) Specific Phobias: These are unreasonable or irrational fears of specific objects or situations. The DSM-5 groups these phobias into five categories Animal type: focuses on specific animals or insects. Snakes and spiders are most common because it has been adaptive over evolutionary history to fear these objects. When people come across the feared animal, they get startled and move away quickly. Natural environment type: these are extremely common and focus on events or situations in the natural environment such as storms, heights, or water. Mild to moderate fears of these natural events or situations are extremely common and are adaptive in that they help us avoid danger. Diagnosis of this phobia is warranted when people reorganize their lives to avoid the feared situations or have severe anxiety attacks when confronted with them. Situational type: this usually involves fear of public transportation, tunnels, bridges, elevators, flying, or driving. Claustrophobia is a common situational phobia. One prominent person with a situational phobia is John Madden, former coach and sports announcer. He is afraid of flying so he needs to have a personal bus that takes him to sports events around the United States. Blood-injection-injury type: diagnosed in people who fear seeing blood or any injury. People with this phobia experience significant drops in heart rate and blood pressure, causing them to be more likely to faint. This type of phobia runs more strongly in families. Other When people with these phobias encounter their feared object or situation, their anxiety is immediate and intense (sometimes leading to a panic attack). They also become anxious over the possibility of encountering the object or situation and will go to great lengths to avoid it. Most of these phobias develop during childhood, and as an adult they realize these phobias are unreasonable. 13% of people develop a specific phobia at some point in their lives. Phobias are one of the most common mental disorders. Almost 90% of people with phobias never seek treatment. Agoraphobia: (“fear of the marketplace”) people with this phobia fear places where they might have trouble escaping or getting help if they become anxious. This includes public transportation, open spaces, shops or theaters, crowded places, or being alone anywhere outside their home. People with this phobia also often fear that they will embarrass themselves if others notice their symptoms of their efforts to escape during an attack, when in reality people can rarely tell when a person is anxious. 50% of people with agoraphobia have a history of panic attacks. The remaining people have history of other anxiety disorders, somatic symptoms disorder, or depression. This phobia most often begins when people are in their early 20s and is more common in women than in men. People often reach the point where they will not leave their homes alone. Some people turn to alcohol or another substance to dampen their anxiety symptoms. Theories of Phobias Phobias have been a battleground among various psychological approaches to abnormality. Freud argued that phobias result when unconscious anxiety is displaced onto neutral or symbolic objects. Basically, people become phobias of objects or situations not because they have any real fear of them, but because they have displaced their anxiety over other issues onto them. This theory is detailed in the case story of Hand who had a phobia of horses after seeing a horse fall on the ground and writhe violently. According to Freud, young boys have a sexual desire for their mothers and hate their fathers of jealousy. After Hans gained insight to his anxiety, his fear of horses lessened. Little evidence is given to accept Freud’s theory of phobias. Psychodynamic therapy is not highly effective for treating phobias, suggesting that insight into unconscious anxieties is not what is needed to treat phobias. Behavioral Theories: contrasts the psychodynamic theories of Freud, and have been very successful in explaining phobias. Mowrer’s two-factor theory of classical and operant conditioning explains the behavioral theories. Classical conditioning leads to the fear of the phobic object and operant conditioning helps maintain it. In classical conditioning, a previously neutral object (conditioned stimulus) is paired with an object that naturally elicits a reaction (unconditioned stimulus that elicits an unconditioned response) until the previously neutral object elicits the same reaction (now the conditioned response). These theories appeared 90 years ago when John Watson and Rosalie Raynor placed a white rat in front of a little boy (Little Albert). As the little boy reached for the rat, they rang a metal bar loudly above his head. The little boy would be startled and begin to cry. Eventually, when shown the rat, little Albert would show distress. After he formed his fear of white rats, he would not approach white rabbits either. This showed the creation of classical conditioning. Most people who develop phobias try to avoid being exposed to their feared object. When being exposed to the feared object, they get extreme anxiety and run away. Running away reduces the anxiety, thus avoiding the feared object reduces anxiety. This process of operant conditioning is known as negative reinforcement. Some theories argue that phobias can develop through observational learning as well as through direct classical conditioning. Human evolved over time to be afraid of specific objects, such as snakes, spiders, and strangers. Avoidance of these feared objects have benefited humans over years. Those who avoided feared objects were more likely to survive and bear offspring, thus those offspring would fear the same objects. This theory is known as prepared classical conditioning. Objects such as guns and knives have not been around long enough for phobias to be created from them yet. To prove this theory, researches showed patients pictures of snakes, spiders, houses, and flowers along with small electric shocks. It took only two shocks for the patients to react to the picture of snakes and spiders, but 6 shocks for them to react to the pictures of houses and flowers. After getting rid of the shock, the same reaction was shown for spiders and snakes, but there was no reaction towards the houses and flowers. The behavioral theory provides a compelling explanation for phobias, particularly when we add the principles of observational learning and prepared classical conditioning. It has also led to effective therapies. The most significant problem with the behavioral theory is that many people with phobias can identify no traumatic event in their own lives or the lives of people they are close to that triggered their phobia. Without conditioned stimuli, it is hard to argue that they developed their phobias through classical conditioning or observational learning. Some people may just develop their phobias due to chronic low-level anxiety or reactivity, which makes them more susceptible to the development of phobias given even mildly aversive experiences. Biological Theories: the first-degree relatives (parents, children, siblings) of people with phobias are three to four times more likely to have a phobia than the first-degree relatives of people without phobias. Twin studies show that this is due to genetics. Studies suggest that situational and animal phobias are associated with similar genes, while other studies show a general tendency toward phobias that is not isolate to one type of phobia. Treatments for Phobias A number of behavioral techniques can treat phobias. Some therapists include cognitive techniques and medications. Behavioral treatments: behavioral therapies for phobias use exposure to extinguish the persons fear of the object or situation. These therapies cute the majority of phobias and studies suggest that just one sessions of behavior therapy can lead to major reductions in phobic behaviors and anxiety. Three basic components of behavior therapy for phobias are Systematic desensitization: In systematic desensitization, clients formulate lists of situated or objects they fear ranking from most to least feared. They learn relaxation techniques and begin to expose themselves to the items on their list of fears, beginning with least feared. Blood-injection-injury phobia requires a different approach because people with this phobia experience severe decreases in heart rate and blood pressure. Therapists teach them to tense the muscles in their arms, legs, and chest until they feel the warmth of their blood rising in their faces. This applied tension technique increases blood pressure and heart rate and can keep the person from fainting when confronted with their feared object. Then systemic desensitization with can help extinguish the fear of blood, injury, or injections. Modeling: these techniques are often adopted in conjunction with systematic desensitization. The fear is modeled, and then the client performs it. The therapist will stand in the room with the client and through observational learning; the client associates the calm response of the therapist with their own behaviors. This reduces anxiety about engaging in the behaviors. Modeling is as effective as systematic desensitization in reducing phobias. Flooding: this intensively exposes a client to his or her feared object until anxiety is extinguished. In flooding treatment, a person with claustrophobia may be locked in a closet for hours. The therapist typically will prepare clients with relaxation techniques they can use to reduce their fear. Flooding is as effective as systematic desensitization or modeling and often works more quickly. It is more difficult to get clients to agree to this type of therapy because it is frightening to contemplate. Biological Treatments: some people use benzodiazepines to reduce their anxiety when forced to confront their phobic objects (drugs such as Valium). These drugs produce temporary relief, but the phobia remains. On the other hand, behavioral techniques can cure most phobias in a few hours. Confronting your fears through behavior therapy seems to be the best strategy so far. Social Anxiety Disorder One of the most common social fears is public speaking, most common among college students. People with this disorder become so anxious in social situations and are so afraid of being rejected, judges, or humiliated in public that they are preoccupied with worries about such events to the point that their lives may become focused on avoiding social encounters. Social anxiety disorder is more likely than a specific phobia to create severe disruption in a person’s daily life. In most cultures it is harder to avoid social situations than spiders or snakes. In social situations, people with social anxiety disorder may tremble, perspire, feel confused and dizzy, have heart palpitations, and eventually have a full on panic attack. People with social anxiety disorder may avoid eating or drinking in public for fear that they will make noises, drop food, or embarrass themselves. They may avoid writing in public in fear that their hands will tremble. Men with social anxiety disorder often avoid peeing in public bathrooms. Social anxiety disorder is relatively common with a lifetime prevalence of about 12% in the U.S. and 7% worldwide. Women are more likely to develop this disorder than men, and their social fears are more severe (particularly with regard to performance situations). This disorder tends to develop in either the early preschool years or adolescence, when people become self-conscious and concerned about others’ opinions of them. This disorder often co-occurs with mood disorders and other anxiety disorders. Once it develops, it tends to be chronic if left untreated and most people do not seek treatment. In Japan, the term “taijinkyofu-sho” describes an intense fear of interpersonal relations. This word is characterized by shame about and persistent fear of causing other offense, embarrassment, or even harm through ones person inadequacies. It is most commonly encountered among young men. People with this disorder may fear blushing, emitting body odor, displaying unsightly body parts, speaking their thoughts out loud, or irritating others. This concern is in line with the emphasis in Japan on deference to others. Theories of Social Anxiety Disorder Social anxiety (shyness) runs in families and twins studies suggest it has a genetic basis. Genetic factors do not appear to lead specifically to anxiety about social situations, however, but rather to a more general tendency toward the anxiety disorders. Cognitive perspectives on social anxiety disorder have dominated psychological theories. Cognitive perspectives show that people with this disorder have excessively high standards for their social performance. They also focus on negative aspects of social interactions and evaluate their own behavior harshly. They tend to notice potentially threatening social cues and to misinterpret them in self- defeating ways. They are exquisitely attuned to their self-presentation and their internal feelings and ten to assume that if they feel anxious, it is because the social interaction is not going well. They engage in a number of safety behaviors to reduce their anxiety. They may avoid eye contact, or social interactions all together; excessively rehearse what they will say in an interaction and fail to self-disclose, thereby reducing the quality of the social interaction and the impression they actually leave with others. After a social interaction, they ruminate excessively about their performance and the other person’s reactions. Treatments for Social Anxiety Disorder Social anxiety is reduced by the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). When these medications are no longer taken, the symptoms of social anxiety tend to return. Cognitive-behavioral therapy (CBT) tends to be useful in treating social anxiety. The behavioral component of this therapy involves exposing clients to social situations that make them anxious, starting with the least anxiety producing situations and working up to higher ones. Therapists sometimes role-play situations with clients, accompany clients in social situations to coach them as they engage in social encounters, and assign clients homework to carry out experiments in which they attempt a social interaction they believe they cant tolerate. The therapists may teach them relaxation techniques to quell their anxiety in these situations or skills that can help them interact more effectively with others. They also help them recognize and eliminate their safety behaviors. The cognitive component comes in which involves identifying negative cognitions clients have about themselves and about social situations and teaching them how to dispute these cognitions. CBT for social anxiety can be administered in a group setting in which group members form an audience for one another, providing exposure to the very situation each member fears. Individuals can practice their feared behaviors in front of the others while the therapist coaches them in the use of relaxation techniques to calm their anxiety. The group can also help with individual challenges against negative and catastrophizing thoughts about their behaviors. A number of meta-analyses have found that CBT is an effective treatment for social anxiety disorder, just as effective as antidepressants in reducing symptoms over the course of therapy. It is much more effective in preventing relapse following therapy. It is equally effective whether administered individually or in a group. Mindfulness based interventions also can prove helpful for people with social anxiety disorder.