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Social Anxiety Disorder:

Western vs. Eastern Cultures

Hofstede's Five Cultural

Dimensions and Social Anxiety

Uncertainty Avoidance

An Eastern Perspective

Many people from Eastern countries feel threatened or uncertain about unknown situations, while those in Western cultures tend to not worry about the future as much. This uncertainty avoidance also connects to how these two different cultures view Social Anxiety.

Cultures with high UAI often desire strict rules, resist change, worry about future situations, and prefer a formalized and standardized environment. Cultures with low UAI are open for new things, embrace change, and are flexible towards rules and formalities.

Symptoms

Taijin kyofusho (TKS)

Orientation

Treatments

Masculinity vs. Femininity

http://www.tubechop.com/watch/1696881

TKS is very widespread in Asian cultures.

This phenomenon is most common among those who grew up according to the customs and social expectations of Japanese culture. Taijin Kyofusho is characterized by a crippling fear of social interactions and a vivid awareness of everything that could possibly go wrong. This includes things such as having an offensive body odor or doing something that will offend someone in any other way. It is unsurprising that this condition should arise in Japanese culture, since it is well known for placing importance on keeping up appearances and etiquette in social situations.

Medications

  • Although most people experience some types of feeling anxious, those with social anxiety fear more than one type of situation in intense ways.

  • Physical symptoms include blushing, sweating, nausea, abdominal distress, rapid heartbeat, shortness of breath, headaches, shaking and dizziness.

  • Other symptoms involve an avoidance of social situations, detachment from others, and a lack of expression of self.

Cultures with a low LTO cultivate virtues related to the past and present. They foster:

  • efforts should produce quick results
  • change is welcome and may happen rapidly
  • respect for traditions
  • social and status obligations are important
  • preservation of "face"

Cultures with high LTO cultivate virtues that are oriented toward sustainable future rewards. They foster:

  • perseverance
  • thrift
  • strong work ethic
  • willingness to subordinate oneself for a purpose
  • development is sometimes slow

High MAS cultures, like Japan, value performance and success. They also value:

  • Self-assertion/resolution
  • Career/ambition
  • Performance
  • Work life
  • Competition and conflict behavior
  • Analytical approach to problem-solving
  • Big and fast are beautiful

Lower MAS cultures, like the US, value quality of life and care for others. They also value:

  • Willingness to adapt
  • Quality of life
  • Sensitivity/empathy
  • Work is necessary to survive
  • Cooperation/compromising, strive for consensus
  • Intuitive approach to problem solving
  • Small and slow are beautiful

Triggers for Social Anxiety

The following situations are often stressful for people with social anxiety disorder:

 Meeting new people

 Being the center of attention

 Being watched while doing something

 Making small talk

 Public speaking

 Performing on stage

 Talking with “important” people or authority figures

 Being called on in class

 Being teased or criticized

 Going on a date

 Making phone calls

 Using public bathrooms

 Taking exams

 Eating or drinking in public

 Speaking up in a meeting

 Attending parties or other social gatherings

Transient: This type of TKS is short-lived and moderately severe. It most commonly appears in teens, but it can occur at any time.

Delusional: This is the most common type of TKS and is the most similar to social phobia. It is chronic, often begins before the age of 30, and varies in severity from moderate to severe.

Phobic with Schizophrenia: This is a more complicated disorder. TKS is a part of schizophrenic reactions, rather than a phobia.

Power Distance

Individualism vs. Collectivism

  • Also known as the Individuality Index (IDV)
  • How individual interests effect the interest of a group

What is SAD?

Cultures with low power distance, such as the United States, are used to sharing the power. In these cultures people are more likely to focus on themselves, and therefore would have an increased chance of social anxiety.

Most Eastern cultures have a high power distance where hierarchies are accepted. People are expected show respect to those superior and ranked above them. The emphasis of fear focuses more on making others feel uncomfortable, hence the higher the development of a disorder such as TKS.

  • Social Anxiety Disorder, also known as social phobia, is a disorder in which a person has an unreasonable fear of social situations and interactions.

  • This form of anxiety arises from a fear of being watched, judged, and criticized by others.

  • SAD is the 3rd most common mental disorder in the United States, after depression and alcohol dependence.

  • An estimated 17.2 million Americans are diagnosed with SAD.

  • Typical age of SAD development is 13.

  • 36% of people with SAD report symptoms for 10+ years before seeking help.

http://www.tubechop.com/watch/1704169

TKS vs. SAD

Causes

Conclusion

Treatments

  • Japanese culture stresses the good of the group over the desires of the individual. Those with this phobia have an intensive fear that their body, attitudes, views and actions may be offensive to others.

  • Although symptoms are similar, unlike social phobia, which is based on the sufferer's individual reactions, TKS is based on the perceived reactions of the group.

  • An estimated 10-20% of people in Japan are diagnosed with TKS.

  • Social anxiety is more common in women, while TKS is more prevalent in men.

  • Morita Therapy is the most used treatment, starting in 1910.

  • While SAD and TKS are influenced by their different cultures, the effects of the disorder are essentially the same.

http://www.tubechop.com/watch/1696828

SAD can be treated in three ways: Medication, Cognitive-Behavioral Therapy, and a combination of both.

  • Biological:
  • May be related to an imbalance of the neurotransmitter serotonin. Neurotransmitters- are special chemical messengers that help move information from nerve cell to nerve cell in the brain.
  • Problems if out of balance
  • This can alter the way the brain reacts to stressful situations, leading to anxiety.

  • SAD appears be genetic and can pass between generations in families.

  • Studies show an overactive amygdala often correlates with higher social anxiety and social phobia.
  • More active amygdala = increased fear, worry, uneasiness, or dread.
  • Strong emotional response to a stimulus can override logical thinking/reason.

  • Psychological: The development of social anxiety may stem from an embarrassing or humiliating experience in the past.
  • Environmental: People may develop anxiety from observing the behavior of others and those in their surroundings.

Medications

FACE YOUR FEARS!!!!

Selective Serotonin Reuptake Inhibitors (SSRI's):

  • Have been demonstrated as effective in several studies with relatively few major side effects.

  • Common SSRI's:
  • Citalopram (celexa)
  • Escitalopram (Lexapro, Cipralex)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)

  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Excessive Activity

Normal Brain

Cultures with low IDV

  • People are born into strong, cohesive groups or communities that are extremely loyal and protect them for life.
  • Emphasis on groups
  • People think in terms of "we"
  • Harmony and loyalty in groups is important; should be maintained
  • Avoid confrontation

Cultures with high IDV

  • Loose ties between individuals
  • Independent and look after family and others
  • Emphasis on individual goals exceeds the group goals
  • Distinctive from others
  • Emphasize their success and strive for even more
  • Personal freedom > equality

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs):

  • act on two brain chemicals (Serotonin and Norepinephrine)
  • common SNRI's: Duloxetine (Cymbalta)
  • Venlafaxine-XR (Effexor-XR)
  • only Venlafaxine has been studied as a treatment for SAD.

Monoamine Oxidase Inhibitors (MAOIs):

  • phenelzine (Nardil) has shown strong effectiveness in treating the disorder
  • have a number of significant side effects and require a strict diet that eliminates several common foods to avoid life-threatening reactions

Cognitive-Behavioral Therapy: The most effective treatment for SAD and is:

  • collaborative
  • brief and time-limited
  • focused on the present
  • structured
  • research-based

CBT draws on a number of theurapeutic strategies when addressing SAD that include the following components:

  • Pyschoeducation
  • Cognitive Restructuring
  • In Vivo exposure
  • Interoceptive exposure
  • Social skills training

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