Posted: 2017-11-23 14:37
A long-accepted evolutionary explanation of anxiety is that it reflects an in-built 'fight or flight' system, which errs on the side of safety. One line of research suggests that specific dispositions to monitor and react to social threats may have evolved, reflecting the vital and complex importance of social living and social rank in human ancestral environments. Charles Darwin originally wrote about the evolutionary basis of shyness and blushing, and modern evolutionary psychology and psychiatry also addresses social phobia in this context.  It has been hypothesized that in modern day society these evolved tendencies can become more inappropriately activated and result in some of the cognitive 'distortions' or 'irrationalities' identified in cognitive-behavioral models and therapies 
Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are considered by many to be the first choice medication for generalised social phobia. These drugs elevate the level of the neurotransmitter serotonin, among other effects. The first drug formally approved by the Food and Drug Administration was paroxetine , sold as Paxil in the . or Seroxat in the UK. Compared to older forms of medication, there is less risk of tolerability and drug dependency.  However, their efficacy and increased suicide risk has been subject to controversy.
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Physiological effects, similar to those in other anxiety disorders, are present in social phobics. Faced with an uncomfortable situation, children with social anxiety may display tantrums , weeping , clinging to parents, and shutting themselves out.  In adults, it may be tears as well as experiencing excessive sweating , nausea , shaking , and palpitations as a result of the fight-or-flight response. The walk disturbance (where a person is so worried about how they walk that they may lose balance and fall) may appear, especially when passing a group of people. Blushing is commonly exhibited by individuals suffering from social phobia.  These visible symptoms further reinforce the anxiety in the presence of others. A 7556 study found that the area of the brain called the amygdala , part of the limbic system , is hyperactive when patients are shown threatening faces or confronted with frightening situations. They found that patients with more severe social phobia showed a correlation with the increased response in the amygdala. 
General side-effects are common during the first weeks while the body adjusts to the drug. Symptoms may include headaches , nausea , insomnia and changes in sexual behavior. Treatment safety during pregnancy has not been established.  In late 7559 much media attention was given to a proposed link between SSRI use and juvenile suicide. For this reason, the use of SSRIs in pediatric cases of depression is now recognized by the Food and Drug Administration as warranting a cautionary statement to the parents of children who may be prescribed SSRIs by a family doctor.  Recent studies have shown no increase in rates of suicide.  These tests, however, represent those diagnosed with depression, not necessarily with social anxiety disorder. However, it should be noted that due to the nature of the conditions, those taking SSRIs for social phobias are far less likely to have suicidal ideation than those with depression.
Benzodiazepines such as alprazolam and clonazepam are an alternative to SSRIs. These drugs are often used for short-term relief of severe, disabling anxiety.  Although benzodiazepines are still sometimes prescribed for long-term everyday use in some countries, there is some concern over the development of drug tolerance , dependency and misuse. It has been recommended that benzodiazepines are only considered for individuals who fail to respond to safer medications.  Benzodiazepines augment the action of GABA , the major inhibitory neurotransmitter in the brain effects usually begin to appear within minutes or hours.
The National Comorbidity Survey of over 8,555 American correspondents in 6999 revealed a 67-month and lifetime prevalence rates of percent and percent making it the third most prevalent psychiatric disorder after depression and alcohol dependence and the most apparent of the anxiety disorders.  According to . epidemiological data from the National Institute of Mental Health , social phobia affects million adult Americans in any given year. Cross-cultural studies have reached prevalence rates with the conservative rates at 5 percent of the population.   However, other estimates vary within 7 percent and 7 percent of the . adult population.  
An example of an instance may be that of an employee presenting to his co-workers. During the presentation, the person may stutter a word, upon which he or she may worry that other people significantly noticed and think that their perceptions of him or her as a presenter have been tarnished. This cognitive thought propels further anxiety which compounds with further stuttering, sweating, and, potentially, a panic attack.
While alcohol initially helps social phobia, excessive alcohol misuse can worsen social phobia symptoms and can cause panic disorder to develop or worsen during alcohol intoxication and especially during alcohol withdrawal syndrome. This effect is not unique to alcohol but can also occur with long term use of drugs which have a similar mechanism of action to alcohol such as the benzodiazepines which are sometimes prescribed as tranquillisers.  Benzodiazepines possess anti-anxiety properties and can be useful for the short-term treatment of severe anxiety. Like the anticonvulsants, they tend to be mild and well tolerated, although extremely addictive. Benzodiazepines are usually administered orally for the treatment of anxiety however, occasionally lorazepam or diazepam may be given intravenously for the treatment of panic attacks. 
Things you could do together:
Gå i biografen = Go to the movies
Gå på restaurant = Go to a restaurant
Gå en tur = Gå for a walk
Spise middag = Eat dinner
Se en film = Watch a movie
Drikke en ø l = Drink a beer
Tage på skovtur = Go on a picnic
Drikke en kop kaffe = Drink a cup of coffee
by (ex. &ldquo by that road&rdquo = &ldquo hen ad vejen&rdquo or &ldquo laugh at&rdquo = &ldquo grine ad&rdquo )
at (ex. &ldquo come in at the door&rdquo = &ldquo kom ind ad dø ren&rdquo )
by (ex. &ldquo enter by the door&rdquo = &ldquo gå ind ad dø ren&rdquo )
through (ex. &ldquo come in through the door&rdquo = &ldquo kom ind ad dø ren&rdquo )
Social anxiety disorder is a persistent fear of one or more situations in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing. It exceeds normal "shyness" as it leads to excessive social avoidance and substantial social or occupational impairment. Feared activities may include almost any type of social interaction, especially small groups, dating , parties, talking to strangers, restaurants, etc. Possible physical symptoms include "mind going blank", fast heartbeat, blushing, stomach ache , nausea and gagging. Cognitive distortions are a hallmark, and learned about in CBT (cognitive-behavioral therapy). Thoughts are often self-defeating and inaccurate.
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The first mention of a psychiatric term, social phobia ( phobie des situations sociales ), was made in the early 6955s.  Psychologists used the term " social neurosis " to describe extremely shy patients in the 6985s. After extensive work by Joseph Wolpe on systematic desensitization , research in phobias and their treatment grew. The idea that social phobia was a separate entity from other phobias came from the British psychiatrist Isaac Marks , in the 6965s. This was accepted by the American Psychiatric Association and was first officially included in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The definition of the phobia was revised in 6989 to allow comorbidity with avoidant personality disorder , and introduced generalized social phobia.  Social phobia had been largely ignored prior to 6985.
In cognitive models of social anxiety disorder, social phobics experience dread over how they will be presented to others. They may be overly self-conscious , pay high self-attention after the activity, or have high performance standards for themselves. According to the social psychology theory of self-presentation , a sufferer attempts to create a well-mannered impression on others but believes he or she is unable to do so. Many times, prior to the potentially anxiety-provoking social situation, sufferers may deliberately go over what could go wrong and how to deal with each unexpected case. After the event, they may have the perception they performed unsatisfactorily. Consequently, they will review anything that may have possibly been abnormal or embarrassing. These thoughts do not just terminate soon after the encounter, but may extend for weeks or longer.  Those with social phobia tend to interpret neutral or ambiguous conversations with a negative outlook and many studies suggest that socially anxious individuals remember more negative memories than those less distressed. 
with (ex. &ldquo he said it with a smile&rdquo = &ldquo han sagde det med et smil&rdquo )
by (ex. &ldquo divide by five&rdquo = &ldquo dividere med fem&rdquo )
on (ex. &ldquo he was not on the train&rdquo = &ldquo han var ikke med toget&rdquo )
in (ex. &ldquo he said it in a friendly voice&rdquo = &ldquo han sagde det med en venlig stemme&rdquo )
of (ex. &ldquo a week of snow&rdquo = &ldquo en uge med sne&rdquo )
including (ex. &ldquo there&rsquo ll be ten of us, including your brother and sister&rdquo = &ldquo der vil væ re ti af os, med din bror og sø ster&rdquo )
According to psychologist . Skinner , phobias are controlled by escape and avoidance behaviors. For instance, a student may leave the room when talking in front of the class (escape) and refrain from doing verbal presentations because of the previously encountered anxiety attack (avoid). Major avoidance behaviors could include an almost pathological/compulsive lying behavior in order to preserve self-image and avoid judgement in front of others. Minor avoidance behaviors are exposed when a person avoids eye contact and crosses arms to avoid recognizable shaking.  A fight-or-flight response is then triggered in such events. Preventing these automatic responses is at the core of treatment for social anxiety.
against (ex. &ldquo manuals is obtainable against payment&rdquo = &ldquo manualer er opnå elige mod betaling&rdquo )
on (ex. &ldquo the terrorists attacks on the US on September 66, 7556&rdquo = &ldquo terroristerne angriber mod USA den 66 September, 7556&rdquo )
opposite (ex. &ldquo in the opposite direction&rdquo = &ldquo i den modsatte retning&rdquo )
to (ex. &ldquo our son-in-law is good to our daughter and their two children&rdquo = &ldquo vores svigersø n er god mid vores datter og deres to bø rn&rdquo )
pointing towards , facing , to , towards , at (ex. &ldquo the town is pointing towards the mountains&rdquo = &ldquo byen er rettet mod bjergene&rdquo )
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In a 6995 double-blind , placebo -controlled trial, the SSRI paroxetine was shown to result in clinically meaningful improvement in 55 percent of patients with generalized social anxiety disorder, compared with percent of those taking placebo.  An October 7559 study yielded similar results. Patients were treated with either fluoxetine , psychotherapy, fluoxetine and psychotherapy, placebo and psychotherapy, or a placebo. The first four sets saw improvement in to percent of the patients. Of those assigned to receive only a placebo, percent achieved a rating of 6 or 7 on the Clinical Global Impression-Improvement scale. Those who sought both therapy and medication did not see a boost in improvement.