Shy Children, Phobic Adults: Nature and Treatment of Social Anxiety Disorder


Buy It Now!

Book is welcome contribution to the field
(May 2007 Issue)

"Shy Children, Phobic Adults: Nature and Treatment of Social Anxiety Disorder"
By Deborah C. Beidel and Samuel M. Turner
American Psychological Association
Washington, D.C., 2007

By James K. Luiselli, Ed.D., ABPP, BCBA

Social anxiety disorder is a common problem among people referred to mental health professionals. In recent years, there has been increased research attention focusing on the epidemiology, etiology, and treatment of the disorder. "Shy Children, Phobic Adults" examines social anxiety disorder from multiple perspectives and with sophisticated clinical insight.

Defined broadly, social anxiety disorder is characterized by "a marked and persistent fear of one or more social performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others." Commonly feared situations include speaking, eating and drinking in public places, initiating and maintaining conversations, attending social events and having to perform in similar observable contexts. Beidel and Turner detail extensively the debilitating effects of the disorder as well as associated psychiatric comorbidity.

The book contains a lengthy chapter on the etiology of social anxiety disorder which looks at biological, genetic and conditioning influences. The authors conclude that there is "no one unified theory," favoring instead a "multiple pathways" explanation. The combination of a predisposed vulnerability to become anxious, exposure to traumatic events, observational learning and familial child-rearing appears to be a potent set of contributing factors.

True to its title, the book distinguished shyness and social anxiety disorder along a continuum, the former describing people who are socially reticent and behaviorally inhibited but able to interact functionally when necessary. Whether extreme shyness in children and adults predicts later social anxiety disorder is inconclusive. Accordingly, the authors offer many suggestions for expanded research that defines the shyness-social anxiety disorder relationship.

The chapter on assessment of social anxiety disorder explicates a multimethod approach geared to the practicing clinician. Beidel and Turner weight the pros and cons of structured and semi-structured diagnostic interviews, standardized rating scales, self-report inventories, self-monitoring protocols and behavioral assessment tests (BATs). I found this information highly instructive.

What treatment is the most effective for social anxiety disorder? Impressively, the book outlines the most recent evidence-based research as it applies to children and adults. Pharmacological studies point to antidepressant medication, particularly the SSRIs, as a first line treatment. The chapter on pharmacological treatment addresses other promising medication approaches, important considerations for patient care when medications are prescribed and new lines of inquiry.

The authors' extensive expertise as clinicians and researchers shines in their chapters concerning behavioral and cognitive-behavioral treatment of social anxiety disorder. Their contention is that with both children and adults, exposure to the feared stimuli and conditions, introduced gradually through imagery or in vivo practice, is the critical ingredient for success.

Other supplemental treatments such as cognitive restructuring and social skills training can be successful. All of the authors' claims of treatment effectiveness are supported by meta-analytic reviews and comprehensive descriptions of seminal studies.

Few books come along as impressive as this one. Beidel and Turner capture wonderfully the phenomenology of social anxiety disorder, guiding the reader through typical diagnostic, assessment and treatment challenges. Issues pertaining to children and adults are covered with precision, acumen and sensitivity to unique clinical presentation. The book has a decidedly scientist-practitioner orientation, grounded in evidence-based practice, with conclusions and recommendations that are thoroughly convincing. Beidel and Turner have produced a welcome contribution to the field and a book that should be digested by a wide audience of mental health professionals.

James K. Luiselli is senior vice president, applied research, clinical training and peer review at the May Institute in Norwood, Mass.