Environmental And Biological Factors Of Social Anxiety Disorder

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The propensity of people to experience fear and avoid the condemnation of others is labelled as shyness and self-consciousness. These constructs bring benefits to people, as it helps them stick to the norm. Fitting in brings benefits as people have their lives run easier while they seek to be normal and like everyone else. However, as pointed out by Murray (2001), this may bring negative implications. Certain individuals experience these feelings intensely, often causing them to withdraw or endure them with varying degrees of discomfort. People in such situations are suffering from what is known as social anxiety disorder (SAD), and it is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a recurring fear and anxious response to one or more social or performance situations in which the person is exposed to unfamiliar people or possible judgment by others. SAD often manifests during the early decades of lifespan, specifically during childhood and adolescence (Beesdo et al. 2007). Determining a particular cause is challenging, let alone investigating the extent to which it affects the development and severity of social anxiety. A diathesis-stress represents the aetiology of SAD, as it highlights the interaction between a tendency to develop a disorder and environmental disturbances. The higher the genetic vulnerability toward a particular disorder, the less stress is required to trigger the associated problem behaviours.

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Parenting styles that involve overcontrolling, such as helicopter parenting, tends to have a direct impact on child anxiety, research by Borelli et al. (2015) suggests. Overcontrol leads to a decrease in child autonomy and possibly rejection or a lack of warmth, resulting in insecure attachments. These are significant elements that contribute to the development of social anxiety disorder. It was previously assumed that the domain of parenting is exclusive to mothers, yet a study conducted by Greco et al (2002) alluded that the inclusion of fathers as well as other members of the family in future investigations into SAD is vital to further the understanding of the topic. Attachment styles as a result of a particular brand of parenting also contribute to the development of SAD. Research by Green and Goldwyn (2002) suggests a connection between insecure attachment and later disorders. Insecurely attached children display struggles in controlling emotions and in their interaction with their peers, contributing further to the development of anxiety. Renken et al (1989) presented an association between ambivalent attachment, resulting from a mother who is inconsistent in her availability, unaware of her child’s emotional needs, and discourages autonomy, to social withdrawal in middle school. Despite it being unclear how exactly these factors contribute to SAD, it is undoubtedly a risk factor. Thus, parenting plays a significant role in the development of SAD and is vital in understanding how SAD develops in the early stages of childhood. This comes as no surprise, considering how most children spend most of their time around or with their parents. It can be convincingly argued that parenting falls under the environmental category, but for the nature of the further discussion which involves interventions at an early stage of the lifespan, it is worth studying parenting as a factor.

An individual is, to a certain extent, influenced by the environment they are raised in. Specific elements in an environment can influence the development of SAD, such as adverse life events and societal and cultural factors. Adverse life events include traumatic events, resulting in an individual experiencing fear and anxiousness as a result of physical, emotional, psychological or spiritual harm. Some events are ‘normal’ events such as death, illness natural disasters, academic failure, and moving schools while others are mistaken as such, e.g. sexual and physical abuse, bullying and familial violence. Events such as the arrival of a new stepparent and changing schools, negative family environment, death and academic failure, parental marital discord, sexual abuse (Magee, 1999), teasing in childhood, and poor peer acceptance have influenced the development of SAD, yet it can be questioned why only certain children develop anxiety since life naturally aversive, a question better understood by the aforementioned diathesis-stress model. Cultural norms define the standards by which people live by; an individual is expected to live up to it and when this is not the case, they are condemned, resulting in either conformity or withdrawal. Cross-cultural studies noted two distinct groups of population; individualistic and collectivistic. Heinrichs et al (2006) investigated social norms’ impact on the level of anxiety in these cultures. A correlation was noted between the acceptance of social withdrawal in collectivistic nations and the higher levels of SAD, and that the development of SAD is concluded to be associated with cultural norms. This indicates that despite similarities, each culture has a unique anxiety characteristic and further research will lead to culture-specific SAD treatments.

Genetics contributes to the development of SAD as well. Watson et al (1994) state 5 distinct personality traits, among which both neuroticism and extraversion have been linked to SAD (Watson et al 2005). Neuroticism is a sensitivity towards negative stimuli and the consequent tendency to experience negative emotions, whilst extraversion is the tendency to experience positive emotions and to be outgoing. By their definitions alone, it is expected that any individual who is neurotic or suffering from low levels of extraversion could potentially develop SAD. Biedel et al (1999) suggest a positive relation between neuroticism and the development of social phobia in youth. They also discovered that there is an association between social anxiety and lower levels of extraversion in clinical samples. Another study by Svihra et al (2004) suggested behavioural inhibition as a viable predictor for anxiety as there is an existence of an association. Behavioural inhibition is the propensity of an individual to display a restrained response (shyness) to an unfamiliar setting and is preserved throughout middle childhood and early adolescence. Genetics plays a significant role in the long-term development of SAD, according to Torvik et al (2016). Genetic risks contribute to stability whilst the environment largely contributed to the change; the impact of environmental factors (adverse life events) is short term in comparison to genetic risks. Torvik et al (2016) stated that when it comes to genetic risks, people who have had a good upbringing may still develop SAD. In conclusion, biological factors such as temperament and genetics play a unique role in the development of SAD as opposed to environmental factors.

Several interventions are proven effective in treating children with SAD. Among the interventions that will be discussed are cognitive-behavioural therapy (CBT) and mindfulness-based cognitive therapy (MBCT). CBT is based on the principle that cognitive factors are a stability factor for mental disorders and psychological distress. According to Beck (1970), examples of cognitive factors are maladaptive schemas. CBT focuses on changing thinking and behaviour patterns; raising awareness of their mentality and replacing it with constructive thinking. Concerning SAD, CBT has a significant and immediate post-treatment effect size (Gil, Carrillo, & Meca, 2001). Compton et al (2004) reviewed and reported substantial evidence supporting the efficiency of CBT interventions for various childhood anxiety disorders, proving that CBT is an effective intervention option for treating anxiety in children. Despite such impressive results, it has also been debated that there exists a sizeable number of people, suffering from SAD, who display little or no improvement following CBT treatments (Hofmann et al, 2006). This has been the main principle to the rise of mindfulness-based cognitive therapy (MBCT), a brand of psychotherapy which integrates meditation, cognitive therapy, and a non-biased state of awareness (mindfulness). The contrast between these two treatments is that MBCT focuses on helping isolate the individual from his/her thoughts, examine them from the outside in and then make the proper adjustments. Nonetheless, MBCT provides an alternative and caters to the remaining individuals who have yet to experience beneficial outcomes from CBT. Bockstaele et al (2014) reported that MBCT is proving to be an on-hand, cost-effective substitute or supplement to CBT while Lee et al (2008) confirms MBCT’s productivity in treating children with SAD. Both CBT and MBCT have proven to be efficacious intervention methods for treating SAD, particularly in children.

SAD is generally caused by two major factors; environmental and biological. Parenting was isolated as a third factor due to the nature of discussion involving interventions treating SAD in children. As previously mentioned, barring any genetic factors or other unforeseen circumstances, SAD can be successfully treated and is not a long-term disorder. Interventions and treatments including (but not limited to) cognitive behavioural therapy (CBT) and its innovative counterpart, mindfulness-based cognitive therapy (MBCT) will help many individuals get the treatment they need and help reintegrate them back into society. However, this will only be made possible if society is made aware of this matter, both the individuals afflicted with SAD as well as the people in the surrounding. 

16 August 2021

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