Anxiety is a common experience that can be a useful motivator or even life-saver in situations that are objectively dangerous. However, when the anxiety is out of proportion to the danger inherent in a given situation, is persistent and is markedly disabling, an anxiety disorder is likely to be diagnosed.

Social Anxiety Disorder is the most common anxiety disorder. It often starts in adolescence or earlier and affects around 1 in 10 individuals at some time during their life. Sufferers fear, and whenever possible, avoid social and performance situations (i.e. meeting strangers, talking to authority figures, working while being observed, public speaking). The fears often lead affected individuals to under-perform at school and work and can make forming close relationships difficult. Complications include markedly increased risks of alcohol or drug abuse, depression and suicide. Thankfully treatment trials have shown that several medications (e.g., selective serotonin reuptake inhibitors such as prozac and monoamine-oxidase inhibitors) and psychological treatments (exposure therapy and group cognitive-behaviour therapy) are effective but a substantial proportion of people continue to have significant social fears after a well-conducted course of either type of treatment.

In an attempt to further improve treatment effectiveness, we adopted a particular research strategy. First, a psychological model that attempted to explain why social fears persist was developed. Second, the maintaining factors specified in the model were tested in experimental studies. Third, specialized psychological treatment procedures that focused on the maintaining factors were developed and refined in clinical case series. Finally, the resulting treatment programme (a form of cognitive therapy) was evaluated in randomized controlled trials in our clinic and elsewhere.

The lecture covered the main features of social anxiety disorder, explained why it persists, described the cognitive therapy approach to treatment and summarized the evidence for the effectiveness of this approach. Future developments in the field are anticipated.

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