اضطراب اجتماعی
اضطراب اجتماعی
فوبی اجتماعی به این صورت تعریف می شود: ترس آشکار و پایدار از یک یا چند موقعیت عملی یا اجتماعی که در آنها شخص با افراد غیر آشنا مواجه شود یا احتمال داشته باشد که مورد توجه و مشاهده دیگران قرار بگیرد. فرد از این می ترسد که در این موقعیت ها به گونه ای عمل کند (یا علائم اضطراب را نشان می دهد) که پریشان یا تحقیر شود. مردمی که فوبی اجتماعی دارند، ممکن است واقعا کاری که باعث تحقیر آنها شود انجام ندهند و پریشان هم نشوند، آنها فقط می ترسند که این طور عمل کنند. بنابراین، فوبی اجتماعی فقط در ذهن فرد اتفاق می افتد. اضطراب اجتماعی می تواند منجر به انزوا و تنهایی شده و فرصت های صمیمی با دیگران را کاهش دهد و همچین باعث ناامیدی شود، زیرا شخص کمتر از سطح توانایی های بالقوه خود، عمل می کند. اضطراب اجتماعی با درون گرایی تفاوت دارد. درونگرایانی که اضطراب اجتماعی دارند اغلب از فعالیت به تنهایی لذت می برند و بنابراین شاید از یک زندگی که در آن منزوی تر و تنهاتر باشند رضایت بیشتری داشته باشند و آن را بر تعامل با دیگران ترجیح دهند. اما برون گرایانی که اضطراب اجتماعی دارند، بسیار رنج می کشند، زیرا آنها به طور طبیعی در جمع خوشحال ترند، اما فوبی (ترس) مانع میشود که آنها بتوانند به این منبع لذت بخش دست پیدا کنند.
ملاک های تشخیصی اختلال اضطراب اجتماعی:
ترس یا اضطراب قابل ملاحظه درباره یک یا چند موقعیت اجتماعی که در آنها احتمال دقت نظر به فرد و موشکافی دیگران وجود دارد. نمونه ها عبارتند از: تعاملات اجتماعی، مشاهده شدن و اجرا کردن در حضور دیگران.
_ فرد از این می ترسد که کاری انجام دهد یا علائم اضطرابی بروز دهد که دیگران برداشت منفی از آن داشته باشند.
_ از موقعیت های اجتماعی اجتناب می کند و یا تحمل آن با ترس و اضطراب شدیدی همراه است.
_ ترس، اضطراب یا اجتناب موجب ناراحتی و افت کارکرد اجتماعی- شغلی و سایر جنبه های مهم کارکردی فرد می شود.
نکته: موقعیت های اجتماعی تقریبا همیشه سبب بروز اضطراب یا ترس می گردند، لذا کسی که مثلا گهگاه در موقعیت های اجتماعی مضطرب می شود نباید تشخیص اختلال اضطراب اجتماعی دریافت کند.
شیوع:
حدود %6/8افراد در آمریکا مبتلا به این اختلال هستند. سن متوسط شروع اضطراب اجتماعی 13 سالگی است و در 75% موارد بین 8 تا 15 سالگی شروع می شود.
عوامل خطرساز:
ژنتیک، محیطی، عوامل عصب- شیمیایی و آسیب های روانشناختی در طول زندگی.
با توجه به شیوع این اختلال شایع روانشناختی که پیش آگهی نسبتا نامناسبی دارد، یعنی در صورت عدم درمان کل زندگی فرد را تحت تاثیر قرار می دهد. توجه به این نکته بسیار مهم است که اگر چه ظاهر اختلال بسیار ساده است، یعنی فرد از ارزیابی دیگران می ترسد، ولی مشکل حقیقتا دشوار است. سادگی اختلال باعث می شود خود-درمانی در مورد این اختلال زیاد شود که این مسئله، بر شدت مشکل می افزاید. در درمان این اختلال، درمان شناختی- رفتاری(CBT) درمان انتخابی است.
تعدادی از مولفه های اصلی که در طول درمان شناختی- رفتاری(CBT) مورد توجه قرار می گیرند، در زیر شرح داده شده اند:
فقط انجامش بده:
درمان به طوری طراحی شده است که فرصت های منظمی را فراهم آورد تا افراد بیاموزند، موقعیت های اجتماعی آن قدرها تهدیدآمیز، اشتباهات اجتماعی آن قدرها ترسناک و اشتباه در عملکرد اجتماعی آن قدرها که فکر می کردند مهلک نیستند.
انتخاب استانداردهای اجتماعی:
اشخاص مبتلا به این اختلال برای خود هنجارهای اجتماعی بالایی در نظر می گیرند. اغلب اعتقاد دارند که در موقعیت های اجتماعی از انتظار بیشتری از آنها می رود و فکر می کنند افراد دیگر نیز همین استانداردهای اجتماعی را برای خود دارند.
متمرکز کردن توجه بر خود:
در اضطراب اجتماعی، کانون اصلی توجه شخص بر خودش متمرکز می شود به طوری که علائم آنقدر خطرناک احساس می شوند که بازبینی آنها( و تلاش برای پنهان کردن شان) در الویت قرار می گیرد و این فعالیت های شناختی، مانع تمرکز و عملکرد مناسب شده و لذا تعاملات اجتماعی را آلوده می کنند. فرد کمتر به دیگران و رفتارهای آنها توجه می کند. سوگیری هایی که در ادراک و تفسیر و یادآوری اطلاعات اجتماعی مربوط به آنها ایجاد می شود باعث برانگیختن طیف وسیعی از چنین افکاری می شود: هیچ کس مرا دوست ندارد، من دارم از خجالت سرخ می شوم.
جست و جوی امنیت:
افکاری که باعث می شوند امنیت جویی فعال شود، نشان می دهند که این افراد از اینکه مورد توجه و مشاهده دیگران قرار بگیرد، می ترسد( مثلا، من باید اضطرابم را پنهان کنم، نمی توانم بگذارم دیگران آن را ببینند) و همچنین انعکاس دهنده باورهای فرد در مورد اهمیت رفتارهای ایمن می باشند. افراد اغلب اعتقاد دارند که بدون این رفتارها، بیشتر مضطرب شده و علائمشان آشکارتر می شود یا عملکردشان بدتر شده و حتی احتمال طرد شده هم بیشتر می شود.
سوگیری در خودپنداره:
تمرکز بر خود و استفاده از رفتارهای ایمن و این فکر که یک موقعیت اجتماعی خطرناک است، یک زمینه شناختی را ایجاد می کنند که در تشکیل یک مفروضه شایع در این افراد سهیم است و آن اینکه: (همان طور که می بینیم احساس می کنم). چنین عقایدی در اضطراب اجتماعی نقش مرکزی دارند و هنگامی که مردم ادراکشان را بر اساس اطلاعات سوگیری شده بنا می کنند، این عقاید افزایش پیدا کرده و برای مثال در تصوراتی که از خودشان دارند، انعکاس پیدا می کنند.
تهیه و تنظیم : عاطفه پویا، روانشناس بالینی
منابع:
_ کتاب اختلال اضطراب اجتماعی، نویسنده استفان هوفمان، میشائل اتو
_کتاب خلاصه روانپزشکی کاپلان و سادوک
_کتاب راهنمای تشخیصی و آماری اختلال روانی DSM-5
-راهنمای آکسفورد برای تمرین های رفتاری در شناخت درمانی، نویسنده: جیمز بنت – لوی و همکاران
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