Social Anxiety and Self-soothing
Dec 20, 2012
Recent research by Bruce and likely "senior author' Richard Heimberg, and fellow colleagues [LINK] from Temple University, has replicated previous research showing high levels of childhood maltreatment amongst those adults suffering from Social Anxiety Disorder (SAD) and explored the impact of this history on response to pharmacotherapy. In this study it was found that all types of maltreatment except for sexual abuse and physical abuse were related to greater symptom severity. Emotional abuse and neglect were related to greater disability, and emotional abuse, emotional neglect, and physical abuse were related to decreased quality of life. Emotional abuse significantly predicted dropout from treatment. A time by emotional abuse statistical interaction suggests that for those who stayed the course, the impact of emotional abuse on severity of social anxiety weakened significantly over time. Emotional maltreatment was most strongly linked to dysfunction in SAD, despite a tendency in the anxiety literature to focus on the effects of sexual and physical abuse. Additionally, individuals reporting emotional abuse were more likely to dropout from pharmacotherapy, but those who stayed the course displayed similar outcomes to those without such a history. This is a valuable finding given the difficulty people with SAD have in taking part, initially, and early in life, in treatment, at times choosing to rely on "self-treatment".
In another study by Richard Heimberg, this time with colleagues from Louisiana State University, [LINK] has examined sufferers' "self-treatment" through substance use,a commonly occurring problem in this group. Most previous research has utilized existing theories of substance use (e.g. tension reduction-based theories) to understand SAD–SUD relations. However, these theories do not address why individuals with social anxiety, in particular, experience such high rates of substance-related problems. A possible explanation may lie in the nature of social anxiety itself, which is characterized not only by chronically elevated negative affective states, but by low positive affect, fear of scrutiny, and social avoidance. These aspects of social anxiety may work in concert to place these especially vulnerable individuals at risk for SUD. Buckner's paper presents a biopsychosocial model of SAD-SUD comorbidity that focuses on several specific facets of social anxiety that may be especially related to SUD risk. The utility of this model is evaluated via a review of the literature on the relations between SAD and substance-related behaviors. Unfortunately, this paper neglects to consider the integration of processes relating to childhood maltreatment into their model, although the processes examined: chronically elevated negative affective states,low positive affect, fear of scrutiny (perhaps allied to feelings of shame, common in survivors of childhood abuse), and social avoidance (note my previous allusions to Martin Dorahy's research on social disconnectedness in those with histories of childhood interpersonal trauma). Of course, one could always hypothesise the additive / interactive effects of these variables,but I would argue for the need to include childhood experiences, and temperament, factors into any "bio-psycho-social" model.