Severity Of Social Phobia Research Articles

The Management of Social Phobia In Residual-Type Schizophrenia with Cognitive Behavioral Therapy

Having negative symptoms is the basic feature of residual-type schizophrenia and there is a direct proportion between the neurocognitive impairments associated with negative symptoms. Among the approaches used for the treatment of patients with schizophrenia, cognitive behaviour therapy is the one with the most evidence of efficacy. Cognitive behaviour therapy is considered to be beneficial for the residual symptoms after drug treatment. The social phobia leads among the anxiety disorders accompanying schizophrenia. According to the cognitive model, the impairment of social performance increases the severity of social phobia. The leading factor of this vicious circle is that the patients pay attention selectively to such cases in order to find evidence for their thoughts and beliefs that they are going to be evaluated negatively. In this paper, the cognitive behavioural therapy and formulation carried out with a patient, who has been followed for a long time with the diagnosis of residual-type schizophrenia and social phobia is reported. The purpose of the treatment is to interfere with the impaired functionality of the patient through cognitive and behavioural techniques by dealing with the medical treatment-resistant symptoms. To this end, firstly coping mechanisms are examined through the identification of avoidance and security providers, and then, the patient’s automatic thoughts and false beliefs are discussed depending on the cognitive perspective. The main part of the treatment has been completed by carrying out various investigations in order to increase the patients’ social performance via applying behavioural techniques. As a result, false beliefs are the indicators of the relationship between cognitive inability and negative symptoms and related to social functioning. By addressing these beliefs through cognitive behavioural therapy, the necessity of increasing the patient’s social activities and the relationship between social performance and social phobia are distinguished.

Have we met before? Neural correlates of emotional learning in women with social phobia.

Altered memory processes are thought to be a key mechanism in the etiology of anxiety disorders, but little is known about the neural correlates of fear learning and memory biases in patients with social phobia. The present study therefore examined whether patients with social phobia exhibit different patterns of neural activation when confronted with recently acquired emotional stimuli. Patients with social phobia and a group of healthy controls learned to associate pseudonames with pictures of persons displaying either a fearful or a neutral expression. The next day, participants read the pseudonames in the magnetic resonance imaging scanner. Afterwards, 2 memory tests were carried out. We enrolled 21 patients and 21 controls in our study. There were no group differences for learning performance, and results of the memory tests were mixed. On a neural level, patients showed weaker amygdala activation than controls for the contrast of names previously associated with fearful versus neutral faces. Social phobia severity was negatively related to amygdala activation. Moreover, a detailed psychophysiological interaction analysis revealed an inverse correlation between disorder severity and frontolimbic connectivity for the emotional > neutral pseudonames contrast. Our sample included only women. Our results support the theory of a disturbed cortico limbic interplay, even for recently learned emotional stimuli. We discuss the findings with regard to the vigilance-avoidance theory and contrast them to results indicating an oversensitive limbic system in patients with social phobia.

Gender Differences in Young Adults with Social Phobia

Aim: To examine the gender differences in young adults with clinical manifestation of social phobia. Study Design: analytical, cross-sectional cohort study Place and Duration of Study: Psychiatric HospitalSkopje, Centre for Mental HealthCentre, between January 2012 and June 2013 Method: The severity of social phobia was measured with the Social Phobia Inventory (SPIN). The questionnaire was administered to 65 patients (age range 18 to 25, 53% female), diagnosed according to DSM-IV with social phobia, without co-morbidity of other mental disorders. Results: Statistically significant differences between the examined groups (male and female) were found. These findings confirm that female young patients with social phobia are showing more severe fear and avoidant behaviour in speaking to anyone in authority, giving speeches, talking to people they don’t know, activities in which they are the centre of attention, while male young patients with social phobia are showing more severe fear and avoidant behaviour if they are criticized, with statistical significance p<0.01. Conclusion: Female young adults with social phobia are showing more severe fear and avoidant behaviour if they assume that other people are looking and monitoring them, while male young adults are showing more severe fear and avoidant behaviour if they are criticized. Original Research Article International Neuropsychiatric Disease Journal, 2(2): 78-84, 2014 79

Assessing Anxiety in Youth with the Multidimensional Anxiety Scale for Children

The present study examined the psychometric properties, including discriminant validity and clinical utility, of the youth self-report and parent-report forms of the Multidimensional Anxiety Scale for Children (MASC) among youth with anxiety disorders. The sample included parents and youth (N = 488, 49.6% male) ages 7 to 17 who participated in the Child/Adolescent Anxiety Multimodal Study. Although the typical low agreement between parent and youth self-reports was found, the MASC evidenced good internal reliability across MASC subscales and informants. The main MASC subscales (i.e., Physical Symptoms, Harm Avoidance, Social Anxiety, and Separation/Panic) were examined. The Social Anxiety and Separation/Panic subscales were found to be significantly predictive of the presence and severity of social phobia and separation anxiety disorder, respectively. Using multiple informants improved the accuracy of prediction. The MASC subscales demonstrated good psychometric properties and clinical utilities in identifying youth with anxiety disorders.

Psychometric Properties of Farsi Version of the Social Phobia Inventory (SPIN)

This study investigated the psychometric properties of Farsi version of SPIN in Iran. The measures were administered to a sample of 330 participants with (n=30) and without social phobia (n=300) ranging from 18 to 38 years of age. The mean (SD) of the SPIN total score for clinical and nonclinical subjects was 41.87 (6.32) and 14.18 (9.56). Internal consistency (Cronbach's α=0.66 and 0.87 for clinical and non-clinical group respectively) and 2-week test–retest reliability in non-clinical sample (r = 0.89) were both good. A cut-off score of 29 resulted in balanced sensitivity (0.96) and 1-specificity (0.087). Good convergent and discriminant validity were established by examining correlations with other conceptually related and unrelated scales. Also, factor analysis supported a four factor solutions in non-clinical group. Although the cut-off is different from those in other countries, the SPIN is a both reliable and valid measure for screening and evaluating social phobia severity.

1964 – EMI (equipe mobile d'intervention), a mobile intervention team, a means to facilitate access to psychiatric care

Rapid access to psychiatric care is a major public health issue. It may be reduced by social factors (homelessness), age or the disease itself (psychotic symptoms together with self-isolation, severe social phobia). Concerning the first two factors, mobile teams have been set up throughout Europe in recent years. In the third instance, people knowing the patient (often family, in psychological distress too) notify psychiatric authorities about a person not known to them. An early contact with patients increases their chances of improving, provided treatment can be organized quickly. This also prevents the family becoming exhausted, trying to cope with these psychiatric disorders. Over the past three years, a mobile intervention team (EMI) made home visits to unrecorded patients who were reclusive or had previously refused care. Specific protocolized psychiatric assessment and a clinical, contextualized approach in the patient's daily environment maximize access to care and allow for day-care treatment or hospitalization in better conditions. Organizing public psychiatric care in catchment areas has enabled patients to live outside institutions and has helped develop structures linked to a reference hospital, which allows for follow-up care after a hospital stay. However, entering the system may still be problematic, hence the home visits. Thanks to innovative organization at a time when French psychiatric departments are having their budgets cut, this team provides rapid treatment at home for psychiatric emergencies and facilitates access to care.

The Pathology of Social Phobia Is Independent of Developmental Changes in Face Processing

While social phobia in adolescence predicts the illness in adulthood, no study has directly compared the neural responses in social phobia in adults and adolescents. The authors examined neural responses to facial expressions in adults and adolescents with social phobia to determine whether the neural correlates of adult social phobia during face processing also manifest in adolescent social phobia. Blood-oxygen-level-dependent (BOLD) responses were compared in 39 medication-free participants with social phobia (25 adults and 14 adolescents) and 39 healthy comparison subjects (23 adults and 16 adolescents) matched on age, IQ, and gender. During fMRI scans, participants saw angry, fearful, and neutral expression stimuli while making a gender judgment. Significant diagnosis-by-emotion interactions were observed within the amygdala and the rostral anterior cingulate cortex, as has previously been hypothesized. In these regions, both the adolescent and adult social phobia patients showed significantly increased BOLD responses relative to their respective age-matched comparison subjects, and there was no evidence of age-related modulation of between-group differences. These enhanced responses occurred specifically when viewing angry (rostral anterior cingulate cortex) and fearful (amygdala and rostral anterior cingulate cortex) expressions but not when viewing neutral expressions. In addition, the severity of social phobia was significantly correlated with the enhanced rostral anterior cingulate cortex response in the adults. The neural correlates of adult social phobia during face processing also manifest in adolescents. Neural correlates that are observed in adult social phobia may represent the persistence of profiles established earlier in life rather than adaptive responses to such earlier perturbations or maturational changes. These cross-sectional observations might encourage longitudinal fMRI studies of adolescent social phobia.

Childhood history of behavioral inhibition and comorbidity status in 256 adults with social phobia

Background Behavioral inhibition (BI), a heritable temperament, predisposes one to an increased risk of social phobia. Recent investigations have reported that BI may also be a precursor to anxiety as well as depressive and alcohol-related disorders, which are frequently comorbid with social phobia. In the present study, we explored the relationship between BI and psychiatric disorders in 256 adults with a primary diagnosis of social phobia. Methods BI severity was retrospectively assessed with the Retrospective Self-Report of Inhibition (RSRI). The severity of social phobia and the presence of comorbid diagnoses were evaluated with the Liebowitz Social Anxiety Scale (LSAS) and the Mini-International Neuropsychiatric Interview, respectively. Results The RSRI score was significantly and positively correlated with both the LSAS score and the occurrence of a major depressive disorder. No significant association was found with other anxiety and substance-related disorders. Limitation The assessment of BI was retrospective and self-reported. Conclusion A childhood history of BI was associated with an increased risk of depressive comorbidity in social phobia.

Two Method Approach: A Case Conceptualization Model in the Context of EMDR

This article outlines a comprehensive model that helps to identify crucial target memories for EMDR treatment. The “Two Method Approach” can be used for conceptualization and treatment implementation for a broad spectrum of symptoms and problems, other than those related to PTSD per se. The model consists of two types of case conceptualizations. The First Method deals with symptoms whereby memories of the etiological and/or aggravating events can be meaningfully specified on a time line. It is primarily aimed at the conceptualization and treatment of DSM-IV-TR Axis I disorders. The Second Method is used to identify memories that underlie patients’ so-called dysfunctional core beliefs. This method is primarily used to treat more severe forms of pathology, such as severe social phobia, complex PTSD, and/or personality disorders. The two methods of case conceptualization are explained step by step in detail and are illustrated by case examples.

PW01-48 - Clinical and vulnerability characteristics of social fears and social phobia subtypes among community youth

Introduction/objectivesThe DSM-IV indicates severity of social phobia (SP) by the “generalized subtype”, when “most social situations” are feared. This specifier refers to the number of feared social situations, perhaps ignoring quantitative differences. We therefore compared specific and interaction-related vs. performance-related social fears according to clinical (age of onset, avoidance, impairment, comorbidities) and vulnerability characteristics (behavioural inhibition (BI), parental psychopathology and rearing).MethodsSix social situations and SP along with their clinical characteristics were assessed using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI) in a population-based sample of N=3,021 14-24 year olds. BI and parental rearing were assessed using self-report questionnaires. Parental psychopathology was assessed directly in parents via DIA-X/M-CIDI, supplemented by offsprings’ family-history reports.ResultsIsolated social fears were rare, except for fear of taking tests and public speaking. The majority reported to fear two or more social situations. Compared to isolated fears of either interaction or performance situations, their co-occurrence was associated with lower age of onset, severe avoidance and impairment, more comorbid anxiety and depressive disorders. All social fears (in particular interaction-related fears) were associated with higher BI. Associations with parental psychopathology and unfavourable rearing were less consistent, albeit strongest for interaction-related fears.ConclusionsInteraction-related fears may represent a more familial form of SP, while performance-related fears might be less impairing and originate from non-familial factors. The DSM-IV specifier of SP may overlook these differences when individuals with predominantly interaction-related fears are categorized as generalized SP-cases. Findings suggest considering alternative specifiers for SP in future diagnostic systems.

Quality of Life in College Students with and without Social Phobia

Prior studies demonstrating quality of life impairment in phobia and anxiety disorders have relied upon epidemiological samples or clinical data. Using the same quality of life scale, the Short Form 36-item Health Survey (SF-36), in Iranian college students allowed us to study the impact of social phobia (SP) on quality of life among the college students. This report summarizes findings from a cross sectional study on Iranian students with social phobia studying at Shahed University. Quality of life was measured using the Short Form 36-item Health Survey (SF-36) which is a widely used and valid questionnaire to measure quality of life in cross-sectional and longitudinal studies. Three standard instruments were used to measure social phobia severity, namely Social Phobia Inventory, Social Interaction Anxiety Scale, and Brief version of the Fear of Negative Evaluation Scale. The sample consisted of 202 college students, 72 with SP and 130 without SP. The main finding of this study was that students with social phobia reported significantly lower quality of life, particularly in general health (P = 0.02), vitality (P < 0.0001), social functioning (P < 0.0001), role functioning—emotional (P < 0.0001), and Mental health (P = 0.001) dimensions. Standardized summed scores for mental health components of the SF-36 showed that 36.2% of all the s with SP were severely impaired while 16.0% of the students in control croup were severely impaired. Findings demonstrated that Iranian socially anxious college students reported extensive functional disability, and lower well-being compared to those without SP. These findings should encourage education officers to implement systematic efforts to prevent and treat social anxiety among students.

The Brief Fear of Negative Evaluation Scale (BFNE): translation and validation study of the Iranian version

BackgroundThe Brief Fear of Negative Evaluation Scale (BFNE) is a commonly used instrument to measure social anxiety. This study aimed to translate and to test the reliability and validity of the BFNE in Iran.MethodsThe English language version of the BFNE was translated into Persian (Iranian language) and was used in this study. The questionnaire was administered to a consecutive sample of 235 students with (n = 33, clinical group) and without social phobia (n = 202, non-clinical group). In addition to the BFNE, two standard instruments were used to measure social phobia severity: the Social Phobia Inventory (SPIN), and the Social Interaction Anxiety Scale (SIAS). All participants completed a brief background information questionnaire, the SPIN, the SIAS and the BFNE scales. Statistical analysis was performed to test the reliability and validity of the BFNE.ResultsIn all 235 students were studied (111 male and 124 female). The mean age for non-clinical group was 22.2 (SD = 2.1) years and for clinical sample it was 22.4 (SD = 1.8) years. Cronbach's alpha coefficient (to test reliability) was acceptable for both non-clinical and clinical samples (α = 0.90 and 0.82 respectively). In addition, 3-week test-retest reliability was performed in non-clinical sample and the intraclass correlation coefficient (ICC) was quite high (ICC = 0.71). Validity as performed using convergent and discriminant validity showed satisfactory results. The questionnaire correlated well with established measures of social phobia such as the SPIN (r = 0.43, p < 0.001) and the SIAS (r = 0.54, p < 0.001). Also the BFNE discriminated well between men and women with and without social phobia in the expected direction. Factor analysis supported a two-factor solution corresponding to positive and reverse-worded items.ConclusionThis validation study of the Iranian version of BFNE proved that it is an acceptable, reliable and valid measure of social phobia. However, since the scale showed a two-factor structure and this does not confirm to the theoretical basis for the BFNE, thus we suggest the use of the BFNE-II when it becomes available in Iran. The validation study of the BFNE-II is in progress.

Diagnostic Comorbidity in Adults With Generalized Anxiety Disorder: Impact of Comorbidity on Psychotherapy Outcome and Impact of Psychotherapy on Comorbid Diagnoses

The current study examined the impact of comorbidity on cognitive and behavioral therapies for generalized anxiety disorder (GAD) as well as the impact of these therapies on diagnoses comorbid to GAD. Seventy-six treatment-seeking adults with principal diagnoses of GAD received 14 sessions of therapy. Most ( n = 46; 60.5%) of the sample had at least one comorbid diagnosis. Although the presence of comorbid diagnoses was associated with greater severity of GAD symptoms at pretreatment, greater severity of comorbid major depression, simple phobia, and social phobia was associated with greater change in symptoms of GAD in response to treatment, with no effect on maintenance of gains during a 2-year follow-up. Further, psychotherapy for principal GAD led to a reduction in number of comorbid diagnoses and in severity of social phobia, simple phobia, and major depression at posttreatment. At 2-year follow-up severity of social and simple phobia remained below pretreatment levels, whereas severity of depression was no longer significantly below pretreatment levels. These results suggest that although people with comorbid disorders enter treatment with more severe GAD symptomatology, they demonstrate greater change, and therefore such comorbidity does not diminish the efficacy of cognitive and behavioral therapies for GAD. In addition, the impact of these treatments for GAD may generalize to reduced severity of simple phobia, social phobia, and major depression; however, gains in severity of major depression are not maintained.

Social phobia and number of social fears, and their association with comorbidity, health-related quality of life and help seeking

ObjectivesCommunity based data were used to examine the association between social phobia and comorbidity, quality of life and service utilization. In addition, the correlations of the number of social fears with these domains were studied.MethodData are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) (N = 7,076). Social phobia was assessed according to DSM-III-R with the Composite International Diagnostic Interview (CIDI); quality of life was assessed according to the Short-Form-36 Health Survey (SF-36).ResultsThe 12-month prevalence of social phobia was 4.8%. Being female, young, low educated, a single parent, living alone, not having a paid job and having a somatic disorder are associated with 12-month social phobia. Mean and median ages of onset of social phobia were 19.1 and 16.0 years, respectively, and mean and median duration were 16.8 and 14.0 years, respectively. 66% of respondents with social phobia had at least one comorbid condition. 12-month social phobia was significantly related to lower quality of life and higher service utilization. The mean number of feared social situations was 2.73 out of the 6 assessed. As the number of social fears increases, comorbidity and service utilization increases, and the quality of life decreases.ConclusionsThese findings suggest as the number of feared social situations increases, the burden of social phobia rises. In other words, like comorbidity or decreased quality of life, the number of social fears is also an important indicator of the severity of social phobia. We conclude that from a public health perspective, mental health care givers should pay attention to the number of social fears in order to check the severity of social phobia.

Treatment of social phobia through pure self-help and therapist-augmented self-help

Self-help for social phobia has not received controlled empirical evaluation. To evaluate the efficacy of pure self-help through written materials for severe social phobia and self-help augmented by five group sessions with a therapist. These conditions were compared with a waiting-list control and standard, therapist-led group therapy. Participants with severe generalised social phobia (n=224) were randomised to one of four conditions. Assessment included diagnoses, symptoms and life interference at pretreatment, 12 weeks and at 24 weeks. A larger percentage of patients no longer had a diagnosis of social phobia at post-intervention in the pure self-help group than in the waiting-list group, although this percentage decreased slightly over the next 3 months. Symptoms of social anxiety and life interference did not differ significantly between these groups. Augmented self-help was better than waiting list on all measures and did not differ significantly from group treatment. Self-help augmented by therapist assistance shows promise as a less resource-intensive method for the management of social phobia. Pure self-help shows limited efficacy for this disorder.

Generalized social anxiety disorder and avoidant personality disorder: structural analysis and treatment outcome

There has been considerable controversy about whether generalized social phobia (GSP) and avoidant personality disorder (APD) are redundant diagnostic categories. In light of the ongoing controversy, more data are needed to help determine whether GSP and APD are independent constructs. Data were obtained from 335 people seeking treatment for GSP at a two site clinical trial. Indicators of GSP and APD were obtained along with assessments of demographic factors, level of functioning, and indicators of related psychopathology. Confirmatory factor analyses of indicators of GSP and APD suggested a somewhat better fit for a two-factor solution. Comparisons of GSP patients with and without APD suggested that in addition to having more severe social phobia symptoms, patients with APD were more depressed on a self-report measure and had more functional impairment, thereby suggesting potential utility of the diagnostic category of APD. Furthermore, the presence of APD predicted treatment response, in that patients with APD had more change early in treatment than those without APD. APD and GSP remain highly related constructs, and different aspects of these data support and dispute the utility of the diagnosis of APD in GSP. Possible new directions in conceptualizing APD are discussed.

Social phobia in Swedish university students: prevalence, subgroups and avoidant behavior

Public speaking is a common situation that university students have to endure. This situation is feared or avoided by most individuals with social phobia, which has been associated with low levels of educational attainment. However, epidemiological data on social phobia in university students are scarce. The present study examined the prevalence of social phobia and its subgroups in a university student population. Demographic characteristics and avoidant behavior in educational settings were also examined. The Social Phobia Screening Questionnaire (SPSQ)--a validated and DSM-IV compatible instrument, was distributed as a postal survey to 753 randomly selected university students in Sweden. Interpretable questionnaires were obtained from 523 students (69.5%). To investigate subgroups, students who met the SPSQ diagnostic criteria of social phobia were analyzed by hierarchical cluster analysis. The point prevalence of social phobia among the Swedish university students was 16.1%, comparable with 15.6% previously reported for the general population. Two clusters were distinguished consisting of students scoring either low (discrete subgroup) or high (generalized subgroup) on all cluster variables. The discrete subgroup was more common representing 83% of the cases. Social phobia was associated with use of dysfunctional avoidant strategies in educational situations and in anticipation of public speaking. The disorder was less common among students following a pedagogic university program. Social phobia was highly prevalent among Swedish university students, most cases pertaining to a mild or discrete form of the disorder. The commonness and severity of social phobia in students did not deviate significantly from the general population suggesting that socially anxious individuals do apply for higher education. However, since avoidance and low educational attainment are commonly reported features, future studies should investigate whether sufferers of social phobia underachieve or abolish their studies prematurely.

Generalized social phobia and avoidant personality disorder: meaningful distinction or useless duplication?

Participants with generalized social phobia (GSP) with (n=36) and without (n=19) avoidant personality disorder (AVPD) were compared via contrasts of group means and classification analysis on purported core features of AVPD. GSP-AVPD participants proved to be more severely impaired or distressed on some group contrasts. Cluster analysis identified two groups in the sample, with group membership significantly correlated to AVPD diagnosis. However, almost all significant findings were nullified when severity of social phobia was statistically controlled. Thus, at least where participants with social phobia are concerned, it seems most parsimonious to consider AVPD a severe form of GSP rather than a separate diagnostic category.

Internal consistency and factor structure of the Portuguese version of the Liebowitz Social Anxiety Scale among alcoholic patients

OBJECTIVE: Liebowitz Social Anxiety Scale is an instrument used to evaluate the severity of social phobia. It has been widely used in different contexts and cultures, presenting variable psychometric properties. The objective of this article is to investigate the internal consistency and the factor structure of this scale. METHOD: In a sample of 300 alcoholic patients hospitalized in 3 mental clinics in Southern Brazil, 74 of them were social phobics (24.6%). The Structured Clinical Interview for DSM-IV-Axis I Disorders - Patient Edition, a semi-structured clinical interview based on DSM-IV, was used to check for the diagnosis of social phobia. The internal consistency was measured by Cronbach's alpha. Data were subjected to a factor analysis with the principal component method of parameter estimation. Questionnaire items loading at 0.35 or above were considered in the final factor solution. RESULTS: The coefficient of internal consistency was 0.95. All items showed corrected item-total correlation coefficient above 0.15, considered the minimum requested index. The factor analysis resulted in 5 dimensions which corresponded to 52.9% of the total variance. The five factors extracted were: factor I - speaking in a group, factor II - activity in public, factor III - social interaction with unknown person, factor IV - attitude of disagreement or disapproval and factor V - social interaction in leisure activity. CONCLUSIONS: The scale proved to be reliable and structurally valid instrument for use in a population of alcoholic patients. The possibility of screening for social phobia through the use of the instrument may be helpful in identifying probable cases of the disorder among alcoholics.

Internal consistency and factor structure of the Portuguese version of the Liebowitz Social Anxiety Scale among alcoholic patients

OBJECTIVE: Liebowitz Social Anxiety Scale is an instrument used to evaluate the severity of social phobia. It has been widely used in different contexts and cultures, presenting variable psychometric properties. The objective of this article is to investigate the internal consistency and the factor structure of this scale. METHOD: In a sample of 300 alcoholic patients hospitalized in 3 mental clinics in Southern Brazil, 74 of them were social phobics (24.6%). The Structured Clinical Interview for DSM-IV-Axis I Disorders - Patient Edition, a semi-structured clinical interview based on DSM-IV, was used to check for the diagnosis of social phobia. The internal consistency was measured by Cronbach's alpha. Data were subjected to a factor analysis with the principal component method of parameter estimation. Questionnaire items loading at 0.35 or above were considered in the final factor solution. RESULTS: The coefficient of internal consistency was 0.95. All items showed corrected item-total correlation coefficient above 0.15, considered the minimum requested index. The factor analysis resulted in 5 dimensions which corresponded to 52.9% of the total variance. The five factors extracted were: factor I - speaking in a group, factor II - activity in public, factor III - social interaction with unknown person, factor IV - attitude of disagreement or disapproval and factor V - social interaction in leisure activity. CONCLUSIONS: The scale proved to be reliable and structurally valid instrument for use in a population of alcoholic patients. The possibility of screening for social phobia through the use of the instrument may be helpful in identifying probable cases of the disorder among alcoholics.