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New NICE guidance on the recognition, assessment and treatment of social anxiety disorder (1st post)

The National Institute for Health and Clinical Excellence (NICE) have just published their new evidence-based clinical guideline on "Social anxiety disorder: recognition, assessment and treatment".  They state: "This clinical guideline offers evidence-based advice on the recognition, assessment and treatment of social anxiety disorder in children and young people (from school age to 17 years) and adults (aged 18 years and older). It includes a recommendation on the treatment of specific phobias that updates and replaces the section of NICE technology appraisal guidance 97 that deals with phobia." 

The full guidance is available as a downloadable 292 page PDF with an additional 26 downloadable appendices.  For those who want something more succinct, there is a good 44 page guideline PDF.  The guidance is also available in web format and there are a series of implementation tools including an 8 minute personal experience podcast and a competence framework & list of CBT treatment manuals.  Additionally there is extensive material available for the general public.  This can be read on the web or downloaded.  It is also available as a Kindle ebook or an EPUB ebook.  If your computer, like mine, has difficulty with the EPUB format, one of many helpful advice websites is located here.  Gosh what riches!

As the guideline points out, there is a huge need for effective recognition & treatment: "Social anxiety disorder (previously known as 'social phobia') is one of the most common of the anxiety disorders. Estimates of lifetime prevalence vary but according to a US study, 12% of adults in the US will have social anxiety disorder at some point in their lives, compared with estimates of around 6% for generalised anxiety disorder (GAD), 5% for panic disorder, 7% for post-traumatic stress disorder (PTSD) and 2% for obsessive-compulsive disorder. There is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression (19%), substance-use disorder (17%), GAD (5%), panic disorder (6%), and PTSD (3%)."

A linked BMJ article - "Recognition, assessment and treatment of social anxiety disorder: summary of NICE guidance" - does a good job of overviewing the new guideline.  The authors highlight that social anxiety "can severely impair a person's daily functioning by impeding the formation of relationships, reducing quality of life, and negatively affecting performance at work or school. Despite this, and the fact that effective treatments exist, only about half of people with this condition seek treatment, many after waiting 10-15 years.  Although about 40% of those who develop the condition in childhood or adolescence recover before adulthood, for many the disorder persists into adulthood, with the chance of spontaneous recovery then limited compared with other mental health problems."

To identify adults with probable social anxiety disorder it is recommended that one "Ask the identification questions using the two-item generalised anxiety disorder scale (GAD-2) in line with NICE guidance (downloadable here as a Word doc or a PDF file), and if social anxiety disorder is suspected use the three-item mini-social phobia inventory (Mini-SPIN) or consider asking the following two questions: Do you find yourself avoiding social situations or activities? Are you fearful or embarrassed in social situations? If the person scores 6 or more on the Mini-SPIN or answers yes to either of the two questions above, refer for or conduct a comprehensive assessment for social anxiety disorder."  Note the Mini-SPIN, the full SPIN and several other relevant questionnaires and handouts are downloadable from this website's "Good knowledge" page on "Social anxiety information & assessment".

Some degree of concern about how we are evaluated by others is normal.  Humans are social animals and not to give a sh*t about what others think of us isn't adaptive.  However being over-concerned isn't adaptive either.  As usual "the middle way" is likely to be most helpful ... to pay some attention to how others are reacting to us, but not to be governed by their opinions.  Sadly a worryingly high percentage of us will have excessive levels of social anxiety.  Often this persists for many years.  As highlighted in today's post, identification of those who are suffering troublesome social concerns makes very good sense.  In tomorrow's post I'll talk about the social anxiety disorder guideline's recommendations for treatment. 

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