RespondingtotheneedsofapersonexperiencingSocialAnxietyDisorder

Monday20July2020

Tonight’s panel

MsCatherineMadiganPsychologist

AssociateProfessorLisaLampePsychiatrist

DrCarolineJohnsonGeneralPractitioner

Facilitator:ProfessorStephenTrumble

GeneralPractitioner

Learningoutcomes

Throughanexplorationofsocialanxietydisorderthewebinarwillprovideparticipantswiththeopportunityto:

• Identifyassociations,comorbiditiesandpatternsoftreatment-seekingbehaviourofpeopleexperiencingsocialanxietydisorder.

• Describetipsandstrategiesthatcanassistsomeoneexperiencingsocialanxietydisorder.

• Demonstratetheimportanceofcollaborationandappropriatereferralswhensupportingapersonexperiencingsocialanxietydisorder.

The15minutehour

DrCarolineJohnsonGeneralPractitioner

• Engagingthepatient

• What’sthediagnosis?

• Isthepatientsafe?

Theformulation

DrCarolineJohnsonGeneralPractitioner

• Presentingproblem(s)• Predisposingfactors• Precipitatingfactors• Perpetuatingfactors• Protectivefactors

TheroleoftheMHTP

DrCarolineJohnsonGeneralPractitioner

• AMedicarecompliancetaskoratoolforengagementandrecovery?

Homework• Twotothreepersonaltreatmentgoals• Anoutcomemeasure• Someonlineresources• +/- a‘lifestory’

Psychoeducation

DrCarolineJohnsonGeneralPractitioner

eMental Health

DrCarolineJohnsonGeneralPractitioner

DrCarolineJohnsonGeneralPractitioner

Item2712andbeyond

Assessmentofsocialanxiety

MsCatherineMadiganPsychologist

• LeibowitzSocialAnxietyScale• DavidClark'squestionnaires,Safetybehaviours,Socialcognitions,Socialattitudes• Assesslevelofdepressione.g.BeckDepressionScale• Assessmentofalcoholintake• CheckforPerfectionismOCPD,OCD,GAD,BDD

WorkwithclienttocomeupwithaCBTformulationofthemaintenanceoftheirsocialanxietydisorder

MsCatherineMadiganPsychologist

• Lookattheroleavoidanceandsafetybehavioursplayinmaintainingsocialanxiety• Lookattheroleselffocussedattentionplaysinmaintainingsocialanxiety- doattention

training• Lookattheroleofposteventprocessing(doingself-criticalpostmortemsafteraneventdoes

nothelp)• Stressthatimperfect isthenewperfect,it’soktomakemistakesandlet'sgooutandmake

them.

Behavioralexperiments

MsCatherineMadiganPsychologist

• Forexample;gooutsidetheconsultingroomwiththeclient toshops,cafesetc.

Theroleofsupportgroups

MsCatherineMadiganPsychologist

• InVictoriaADAVICandARCVICrunsupportgroups andevenhavesocialanxietyspecificgroups

• Perhapsalessthreateningplacetoabandonsafetybehaviours• Grouptherapymaybeanavailableoption• Joiningahobbyorcommunitygroup- e.g.quiltingviameetupwebsite

HelpfulCBTmanualsonsocialanxiety,perfectionism,self-esteem,selfcompassion

MsCatherineMadiganPsychologist

• Clientsmayneedmedicationasverydepressed• Clientsmaypresentwithgoalsthatcannotbemetinashorttimeframee.g.imminentjob

intervieworspeechsoreferraltoGPforbetablockersmightbeappropriate

Priority1– Diagnosticclarification

AssociateProfessorLisaLampePsychiatrist

Itisimportantto:• Developadiagnosticformulationtoguidetreatment• Identifycomorbidities• Notmissadisorderthatbetterexplainsthepresentingsymptoms

AssociateProfessorLisaLampePsychiatrist

InthiscaseIwouldparticularlywanttobeclearabout:• Anxietysecondarytopersonalitystylee.g.obsessivecompulsive,avoidant• Majordepressionasprimaryorco-existingdisorder• Complextrauma• Alcoholuse

Priority1– Diagnosticclarification

Priority2– Treatmentfocusedformulation

AssociateProfessorLisaLampePsychiatrist

Developingamodeltoexplain:1. Whysymptomsoccurredinthefirstplace

• Thiswillrequirehistorytosupportbiopsychosocialvulnerabilityfactors2. Whysymptomshavepersisted

• Cyclesofmaintenance/reinforcement• Cognitive,behavioural,interpersonalandenvironmentalreinforcers

Priority3– Treatmentplanning

AssociateProfessorLisaLampePsychiatrist

• Shareformulationwithpatientandseekherinput• Providepsychoeducation:

• Anxiety,flight/fight• Socialanxietydisorder• Evidence-basedtreatmentoptions:CBT,pharmacotherapy

• Determinepatient’spreferredtreatmentapproach/es• Considerbarrierstotreatment

Priority3– Treatmentplanningcontinued

AssociateProfessorLisaLampePsychiatrist

AssessmentandinitialmanagementAssesscomorbiddisorders,substanceuse,suicidalideation,psychosocialstressors,social/emotionalsupport.

Provideadviceonlifestyle(exercise,healthyeating,sleephygiene)AddresssubstanceabuseProvidepsychoeducation

Watchfulwaitingandreview

TreatmentplanningChooseinitialtreatmentincollaborationwiththepatient,withconsiderationofseverity,patientpreference,

previousresponsetotreatmentandavailability.Mobilizepsychosocialsupports

Continuedonnextslide

Priority3– Treatmentplanningcontinued

AssociateProfessorLisaLampePsychiatrist

Initialtreatmentbasedonseverity

Mild

CBT

Moderate

CBTor

medicationor

CBTplusmedication

Severe

CBTplusmedication

Originalchartappearsin:RANZCPCPGsforpanic,SADandGAD.Andrews,G.,etal.(2018)."RoyalAustralianandNewZealandCollegeofPsychiatristsclinicalpracticeguidelinesforthetreatmentofpanicdisorder,socialanxietydisorderandgeneralisedanxietydisorder.“AustralianandNewZealandJournalofPsychiatry 52(12):1109-1172.

Initialtreatmentbasedonseverity

Mild

CBT

Moderate

CBTor

medicationor

CBTplusmedication

Severe

CBTplusmedication

Q&A Session

MsCatherineMadiganPsychologist

AssociateProfessorLisaLampePsychiatrist

DrCarolineJohnsonGeneralPractitioner

Facilitator:ProfessorStephenTrumble

GeneralPractitioner

Beforeyougo

Pleasecompletetheexitsurveybyclickingtheyellowicon

Upcomingwebinars

Inpartnershipwith31PrimaryHealthNetworks

Olderpersons,primarycareandmentalhealth- Wednesday22July

www.mhpn.org.au

JoinanMHPNnetwork

Wouldyouliketocontinuethe‘SocialAnxietyDisorder’discussionwithlocalpractitioners?

Orperhapsstartdiscussingissuesoflocalrelevance?MHPNProjectOfficersareavailabletohelpyouestablishandsupportinterdisciplinarymentalhealthnetworksacrossmetropolitan,rural,regional

andremoteAustralia.

Wehave373networksaroundthecountry.Visitouronlinemaptofindoutwhichnetworksareclosetoyouatmhpn.org.auorcontactJacquiO’Loughlinatnetworks@mhpn.org.au.

Thankyouandgoodevening