Based on the World Health Organization (2017), depression is ranked as the greatest source of disability worldwide (with 7.5% of individuals in 2015 having depression) and anxiety disorder globally ranked as the sixth causing significant impairment (among 3.4% of individuals in 2015). The National Comorbidity Survey (Kessler et al., 2005) found that social anxiety is presented as the third communal disorder among individuals followed by depression and alcohol dependence.
What are the etiologies of social anxiety disorder?
Several twin studies disclosed that there is a significant genetic influence of 30-40% on the emergence of social anxiety disorder (Beatty et al., 2002). Anxiety disorders are known to be transgenerational and passed on to individual’s offspring (Allain et al., 2022).
Biological and environmental factors
Studies show that social anxiety disorder likely results from a compound interaction of biological and environmental influences, like many other mental health illnesses (Allain et al., 2022).
People who were socially anxious consistently underperformed, had more negative self-evaluative views, and consistently underestimated their abilities (Stopa & Clark, 1993). There is a component in the brain responsible for eliciting fear when in danger called the amygdala. When an individual with social anxiety feels unsafe or threatened in a social event, their brain tends to trigger the fear response and increase cortisol levels, which results in them feeling anxious.
Research studies indicated that the "extended amygdala" plays a crucial role in anxiety disorders (Rose & Tadi, 2022). When exposed to unfavorable or frightening facial expressions, those with social anxiety disorder have higher amygdala activity and frontal-striatal cortex. The white matter connection between the amygdala and orbitofrontal cortex was found to be lower than that of the medial prefrontal cortex. However, in several investigations of brain structure and functional connectivity in people with social anxiety disorder, the medial prefrontal cortex was found to be higher (Nagata et al., 2015).
Children with social anxiety disorder are often found to have parents that are more likely to have a social anxiety condition (Rose & Tadi, 2022). Authoritarian parents may induce invasive and controlling parenting skills that have shown to result in withdrawn temperament in children leading to increased risk of social anxiety disorder (Rose & Tadi, 2022). The behavior is stated to be learned by classical conditioning (social stimulus is associated with a negative outcome) and through expectancies.
What theories say about intervention and treatment?
CBT compared to psychodynamic psychotherapy is regarded as an effective ascribed treatment and the best intervention for the initial treatment of social anxiety disorder (Rose & Tadi, 2022). However, SSRIs show the most consistent evidence of benefit for individuals who show a decline in psychological intervention (Hjorth et al., 2022). Medication can help in regulating neurotransmitter imbalance. CBT alone may not be sufficient in treating individuals with social phobia (Pearcey et al., 2021). Therefore, the combination of medication and CBT have complementary benefits (Nagata et al., 2015).
The article discusses three theories of psychopathology explaining social anxiety disorder. The first theory suggests that genetics factors play a significant role in the emergence of social anxiety disorder. Twin studies reveal a 30-40% genetic influence on social anxiety disorder. The second theory suggests that social anxiety disorder is likely the result of a compound interaction of biological and environmental influences. Individuals with social anxiety disorder consistently have negative self-evaluative views and trigger the fear response in their amygdala when feeling unsafe in a social situation. The third theory suggests that social anxiety disorder has developmental aspects, and children with social anxiety disorder often have parents with a social anxiety condition. Invasive and controlling parenting skills may lead to withdrawn temperament in children, increasing their risk of social anxiety disorder. Regarding intervention and treatment, cognitive-behavioral therapy (CBT) is regarded as an effective treatment for social anxiety disorder. However, selective serotonin reuptake inhibitors (SSRIs) show the most consistent evidence of benefit for individuals who show a decline in psychological intervention. Medication can help regulate neurotransmitter imbalance. While CBT alone may not be sufficient in treating individuals with social phobia, the combination of medication and CBT have complementary benefits. In summary, the article provides insight into the etiologies of social anxiety disorder, including genetic factors, biological and environmental influences, and developmental aspects. The article also suggests that a combination of medication and CBT may be an effective treatment for individuals with social anxiety disorder. The article also has clinical utility in providing healthcare professionals with a better understanding of the underlying causes of social anxiety disorder and effective treatment options.
Cite This Article
Kaidbay, R., & Callahan D. (2023, April). Explanation of Social Anxiety Disorder: Neurobiological -Environmental- Developmental- Treatment Factors. [Web article]. Retrieved from http://www.societyforpsychotherapy.org/explanation-of-social-anxiety-disorder-neurobiological-environmental-developmental-treatment-factors
Allain, J., Griffey, S., & Cook-Perry, C. (2022). Anxiety and depression mushroomed in US at start of pandemic. The Clinical Advisor, 25(4), 12-16. https://www.clinicaladvisor.com/home/topics/psychiatry-information-center/covid-19-anxiety-mental-health-series-part-1/
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
Arad, G., Shamai-Leshem, D., & Bar-Haim, Y. (2021). Social distancing during a COVID-19 lockdown contributes to the maintenance of social anxiety: A natural experiment. Cognitive Therapy and Research, 45(4), 708-714. https://doi.org/10.1007/s10608-021-10231-7
Bruch, M. A., & Heimberg, R. G. (1994). Differences in perceptions of parental and personal characteristics between generalized and nongeneralized social phobics. Journal of Anxiety Disorders, 8(2), 155-168.https://doi.org/10.1016/0887-6185(94)90013-2
Canton, J., Scott, K. M., & Glue, P. (2012). Optimal treatment of social phobia: systematic review and meta-analysis. Neuropsychiatric Disease and Treatment, 8, 203-215. https://doi.org/10.2147/NDT.S23317
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds III, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. Focus, 12(3), 347-358. https://doi.org/10.1176/appi.focus.12.3.347
Hirsch, C. R., & Clark, D. M. (2004). Information-processing bias in social phobia. Clinical Psychology Review, 24(7), 799-825. https://doi.org/10.1016/j.cpr.2004.07.005
Hjorth, O., Frick, A., Gingnell, M., Engman, J., Björkstrand, K., Faria, V., Alaie, I., Carlbring, P., Andersson, G., Jonasson, M., Lubberink, M., Antoni, G., Reis, M., Wahlstedt, K., Fredrikson, M., & Furmark, T. Serotonin and dopamine transporter availability in social anxiety disorder after combined treatment with escitalopram and cognitive-behavioral therapy. Transl Psychiatry 12, 436 (2022). https://doi.org/10.1038/s41398-022-02187-3
Hoffman, T. (2019). The psychodynamics of performance anxiety: Psychoanalytic psychotherapy in the treatment of social phobia/social anxiety disorder. Journal of Contemporary Psychotherapy, 49(3), 153-160. https://doi.org/10.1007/s10879-018-9411-1
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593-602. doi:10.1001/archpsyc.62.6.593
Laban, T. S., & Saadabadi, A. (2022). Monoamine oxidase inhibitors (MAOI). StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK539848/
Leichsenring, F., Beutel, M., & Leibing, E. (2007). Psychodynamic psychotherapy for social phobia: A treatment manual based on supportive-expressive therapy. Bulletin of the Menninger Clinic, 71(1), 56. https://doi.org/10.1521/bumc.2007.71.1.56
Mayo Clinic. (2020)., Social anxiety disorder (social phobia). https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376. https://doi.org/10.1016/S2215-0366(14)70329-3
Nagata, T., Suzuki, F., & Teo, A. R. (2015). Generalized social anxiety disorder: A still‐neglected anxiety disorder 3 decades since Liebowitz’s review. Psychiatry and Clinical Neurosciences, 69(12), 724-740. https://doi.org/10.1111/pcn.12327
National Collaborating Centre for Mental Health. (2013). Social anxiety disorder: recognition, assessment and treatment. British Psychological Society. https://www.ncbi.nlm.nih.gov/books/NBK266258/
Norton, A. R., & Abbott, M. J. (2016). The efficacy of imagery rescripting compared to cognitive restructuring for social anxiety disorder. Journal of Anxiety Disorders, 40, 18-28. https://doi.org/10.1016/j.janxdis.2016.03.009
Olivares-Olivares, P. J., Ortiz-González, P. F., & Olivares, J. (2019). Role of social skills training in adolescents with social anxiety disorder. International Journal of Clinical and Health Psychology, 19(1), 41-48. https://doi.org/10.1016/j.ijchp.2018.11.002
Pearcey, S., Gordon, K., Chakrabarti, B., Dodd, H., Halldorsson, B., & Creswell, C. (2021). Research Review: The relationship between social anxiety and social cognition in children and adolescents: A systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry, 62(7), 805-821.
Rose, G. M., & Tadi, P. (2021). Social anxiety disorder. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555890/
Sawyers, C., Ollendick, T., Brotman, M. A., Pine, D. S., Leibenluft, E., Carney, D. M., Roberson-Nay, R., & Hettema, J. M. (2019). The genetic and environmental structure of fear and anxiety in juvenile twins. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 180(3), 204-212. https://doi.org/10.1002/ajmg.b.32714
Tanner, R. J., Stopa, L., & De Houwer, J. (2006). Implicit views of the self in social anxiety. Behaviour Research and Therapy, 44(10), 1397-1409. https://doi.org/10.1016/j.brat.2005.10.007
World Health Organization. (2017). Depression and other common mental disorders: Global health estimates (No. WHO/MSD/MER/2017.2). https://apps.who.int/iris/handle/10665/254610