Algorhythm of psychological correction of social anxiety among student youth

Размещено на http://www.allbest.ru/

Vinnytsya National Medical University named after N.I. Pirogov

Algorhythm of psychological correction of social anxiety among student youth

Pshyk N., Stukan L., Kaminska A.

Vinnytsya, Ukraine

Abstract

The article presents results of studying the prevalence and severity of social anxiety among medical students. The study involved 120 students of the National Medical University named after Pirogov. the average age was 20.4 years.

The Social Phobia Inventory (SPIN), Social Phobia Rating Scale (SPRS); Liebowitz Social anxiety Scale (Lsas) were used to estimate the level of social anxiety.

After the screening survey of students with the use of the SPIN scale, it was found that 38 students (31.7%) had social anxiety of various degree of severity. thus, a mild level of social anxiety was detected in 15 students (39.5%) (scores from 20 to 30 points), a moderate level of social anxiety was detected in 12 students (31.6%) (30 to 40 points), and 11 students (28.9%) had severe level of social anxiety (indicators from 40 to 50 points).

During the course of research, the program of psychological correction of social anxiety based on the principles of cognitive-behavioral psychotherapy was developed and tested. In all members of the group, there was the decrease of the general level of social anxiety. the introduced program consists of three consecutive stages: psychodiagnostics, psychocorrection and psychoprophylaxis. Each stage of this program has clear goals and means of their implementation. the main components of work with social anxiety within this program are psychoeducation, cognitive and behavioral interventions, social skills training and self-esteem correction.

Keywords: social anxiety, students, psychological correction, psychoeducation.

Резюме

Алгоритм психологической коррекции социальной тревоги среди студенческой молодежи

Пшук Н.Г., Стукан Л.В., Каминская А.А.

Винницкий национальный медицинский университет имени Н.И. Пирогова, Винница, Украина

В статье представлены результаты изучения распространенности и степени выраженности социальной тревожности среди студентов-медиков. В исследовании приняли участие 120 студентов Винницкого национального медицинского университета имени Н.И. Пирогова. Средний возраст 20,4 года.

Для оценки уровня социальной тревожности использовались шкала социальной фобии (SPIN), шкала оценки социальной фобии (SPRS); шкала социальной тревожности Либовица (Lsas).

В результате скринингового опроса студентов с использованием шкалы SPIN было установлено, что 38 студентов (31,7%) имели социальную тревогу различной степени выраженности. Так, умеренный уровень социальной тревожности был выявлен у 15 студентов (39,5%) (от 20 до 30 баллов), умеренный уровень социальной тревожности - у 12 студентов (31,6%) (от 30 до 40 баллов), и 11 студентов (28,9%) были диагностированы с тяжелым уровнем социальной тревожности (показатели от 40 до 50 баллов).

В ходе исследования была разработана и апробирована программа психологической коррекции социальной тревожности на основе принципов когнитивно-поведенческой психотерапии. У всех членов группы наблюдалось снижение общего уровня социальной тревожности. Представленная программа состоит из трех последовательных этапов: психодиагностического, психокоррекционного и психопрофилактического. Каждый этап этой программы имеет четкие цели и средства их реализации. Основными компонентами работы с социальной тревожностью в рамках этой программы являются психообразование, когнитивно-поведенческие вмешательства, обучение социальным навыкам и коррекция самооценки.

Ключевые слова: социальная тревожность, студенты, психологическая коррекция, психообразование.

Problem of mental health of the Ukrainian population in present situation comes to the fore in its significance and relevance. Special concern for professionals is the state of mental health of young people. Negative factors that influence development of various neuropsychiatric disorders of neurotic level include, in the first place, the rampant pace of life, high demands on personality that derive from the modern image of "successful person", social and economic instability, lack of individual understanding of person's own place in life, significant mental tension, and so on.

According to the results of survey provided by the Institute of Children and adolescents Health Care of National academy of Medical Sciences of Ukraine, level of non-psychotic mental disorders is recorded in one-third of people aged 15-17 years [1].

And according to the state statistical reporting, estimation of indicators of mental health disorders in 2009 included 42.1 adolescents per 1.000 population, among them about 70% - disorders of non-psychotic nature [2].

Unfortunately, there is no relevant statistics regarding prevalence and structure of non-psychotic mental disorders among young people aged 20-25, but it can be assumed that there will be a little difference among this population group.

The total expences associated with mental disorders are quite tangible for the economy (the European Union spends around 170 billion euro a year; in the United States, direct treatment expences are $ 148 billion, or 2.5% of gross national product, depressive and anxiety disorders annually cost one trillion dollars to the global economy [1].

Therefore, recently in most countries of the world attention of scientists and professionals in the field of mental health has focused on psychohygiene and psychoprophylaxis of mental disorders in order to improve quality of life of people and reduce cost of treatment. For this purpose, diagnostics of pre-nosological forms of nonpsychotic mental disorders and use of early effective measures of psycho-correction and psychotherapeutic influence are extremely important.

Student youth is the personnel potential, that determines future of our state. Therefore, providing care for mental health of students should be a first place priority.

In view of the above, in present study our attention was drawn to social anxiety disorder, as one of the most common in structure of non-psychotic mental disorders [3-6]. Also, this disorder significantly reduces quality of life and is the basis for development of a range of comorbidities such as depression, alcohol and other substance use disorders, panic disorder, generalized anxiety disorder, other phobic disorders, etc. [4-7].

The aim of our study was to investigate prevalence of social anxiety among students of National Pirogov Memorial Medical University, Vinnytsya, to develop and to implement a program of psychological correction of social anxiety in a group format using methods of cognitive - behavioral therapy and to assess its effectiveness.

The study involved 120 students of 3-6 year of National Pirogov Memorial Medical University, among them 70 persons - male and 50 persons - female.

The average age within the group was 20.4 years.

As research methods were chosen the Social Phobia Inventory (SPIN),

Social Phobia Rating Scale (SPRS); Liebowitz Social Anxiety Scale (LSAS)

(Montgomeri, 2002) to evaluate attitude of adolescents towards 24 socially predetermined situations. The 4-point evaluation system was used to estimate fears and anxiety in case of collision with a particular social situation and avoidance of this situation. Statistical processing of results was performed using Microsoft Excel program.

As a result of screening survey of students with the use of SPIN scale, it was found that 38 students (31.7%) had social anxiety of varying severity degrees. Thus, a mild level of social anxiety was detected in 15 students (39.5%) (scores from 20 to 30 points), in 12 (31.6%) - moderate (30 to 40 points) and 11 students ( 28.9%) - severe (indicators from 40 to 50 points).

Obtained results demonstrated significant prevalence and high severity of manifestations of social anxiety among students and the need to provide timely adequate assistance to prevent development of comorbidities and maladaptation of young people.

According to the current protocols for treatment of social anxiety (Bieling, PJ, McCabe, RE, & Antony, MM (2009), Cognitive-behavioral therapy in groups, New York: Guilford Press, and Heimberg, R.G., & Becker, R.E. (2002), cognitive-behavioral psychotherapy has evidence-based effectiveness.

Therefore, our system of complex psychotherapeutic correction of this disorder in students was based on principles and methods of CBT [8-10].

This program consisted of three consecutive stages: psychodiagnostic, psychocorrective and psychoprophylactic.

At the psychodiagnostic stage, with each student who was diagnosed with signs of social anxiety as a result of screening survey, an individual consult was performed, during this meeting were identified following features of social anxiety such as its isolation, presence of comorbidities, impact on quality of life; these students were offered work in a group format to overcome social anxiety with observance of all ethical norms. Thus, a closed psychotherapeutic group was set up in the number of 17 people, in which diagnosis was mainly moderate or severe degree of social anxiety (SA).

The group worked with two coaches. Each session included both theoretical material and practical exercises. At the end of the group's work, proportion of theoretical material was decreased while, accordingly, the share of practice increased.

Group format: 17 participants. Sessions were held once a week (10 meetings). Each session lasted for 2 hours without a break. Also at this stage, within the framework of the group, the group rules were discussed - sincerity and frankness, acceptance, nonjudgmentalism, impartiality, if participants share personal experiences - confidentiality, no influence of students' participation in the program on academic performance. Using SPIN and Liebowitz Scale (LSAS), a more detailed study of social anxiety was performed for each of the participants in the group.

This program combined all the basic components of social anxiety treatment in the CBT model. Namely:

¦ Psychoeducation. Each session contained a theoretical block with the use of multimedia.

¦ Cognitive intervention

¦ Exposition

¦ Social skills training.

¦ Concept of self-esteem, core beliefs, intermediate beliefs/conditional assumptions, automatic thoughts, cognitive distortions.

Components of therapy for social anxiety treatment can be represented as follows:

The psychocorrection stage began with psychoeducation in relation to what is social anxiety, its evolutionary origin and ontogenetic significance, causes of social anxiety as a mental disorder, prevalence, phenomena of comorbidity, influence on quality of life, brain mechanisms, manifestations (cognitive, emotional, physiological, behavioral), understanding cognitive model of social anxiety based on core beliefs, intermediate beliefs, cognitive distortions, coping behavior, negative automatic thoughts and vicious cycles. The interconnection of all factors involved in social anxiety development in humans, and their impact on the emergence of core beliefs and the corresponding rules of life in this disorder has been explained to the members of the group.

What beliefs are most commonly encountered in social anxiety?

¦ Perceiving social group as one that either accepts or despises/rejects;

¦ perception of most people as ready to condemn and disdain;

¦ perception of condemnation, ridicule, and own reaction to this as something horrible, intolerable;

¦ perception of visible manifestations of anxiety in social situations as signs of "disgrace";

¦ negative perception of oneself and own social skills;

¦ rules: "I have to enjoy, make a positive impression, look/speak flawlessly," etc.

Fig. 1. Components of cognitive-behavioral therapy for social anxiety

The next step was to use cognitive techniques (identification and cognitive restructuring of negative automatic thoughts, work with cognitive distortions, etc.). A separate session was devoted to behavioral experiments.

Behavioral experiments (BE) are planned experiental activities based on experimentation or observation carried out by clients during or between sessions of psychotherapy. Their design comes directly from the thoughts that produce the problem, and their main purpose is to get new information that might be helpful to:

¦ verify the validity of present thoughts about oneself, other people and the world;

¦ build and/or test new, more adaptive persuasions;

¦ contribute to the development and testing of cognitive formulation.

AIso, the attention of students was drawn to the fact that BE often

contain elements of exposition, and in fact, by conducting an experiment, two goals can be achieved (to check cognition and to manage own anxiety).

One of the types of such experiments in social anxiety management is the exposure to the worst case scenario - «You are really looking funny, and what will happen as a result?» Another important point in planning a BE is taking into account own capabilities without taking too big steps and planning a behavioral experiment that would «be scary» to be implemented.

Sometimes it is better to make smaller steps, but effective. Therefore, it's needed to move from easier experiments to more complex ones.

Behavioral techniques with exposure to phobic stimuli and rejection of protective behavior - are the next important component in social anxiety treatment. The final point at this stage of work with students is social skills and assertive behavior training. Confidence (assertiveness) involves accepting responsibility for own life, feelings and actions. It may require changes - in perception of oneself and in relationships with others.

An interesting and important addition to working with students was the use of techniques of mindfulness-oriented cognitive therapy. Consciousness (as a feature of cognitive style of personality) acts as a powerful nonspecific factor in psychological well-being [11-13]. Students were explained about the difference between mindfulness and relaxation and the high efficiency of mindfulness, proved by numerous empirical studies. Researchers received data that has shown connection of awareness with a higher level of satisfaction with life, viability, psychological well-being, optimism, competence, self-control, positive self-esteem, empathy, etc. [11, 13].

Thus, there are three fundamental aspects that can be distinguished in mindfulness: social anxiety medical student

¦ the first is the maximum disclosure in the field of attention to personal experience, including everything that happens in thoughts, moment after moment: perception of breathing rhythm, body feelings, everything that is seen or heard, emotional state, thoughts that come and go;

¦ the second is rejection of tendency to evaluate and control everything that is happening, while focusing on the present moment;

¦ and, the last but not the least, mindfulness is the "unprocessed" state of consciousness, in which person does not try to analyze, put into words, but rather try to observe and experience what is going on.

At the final of the program, students performed training of assertive behavior, since in many people with SA anxiety in social situations arises to high level due to lack of assertive skills. Participants should be aware of both benefits and risks associated with the development of confidence. Effective training, of course, guarantees that the first ones will dominate over the last.

Salter's list includes the most important characteristics of confident behavior:

1) emotionality of speech (feeling talk): open, spontaneous and true expression of feelings in speech;

2) speech expressiveness (facial talk): clear manifestation of feelings in a non-verbal plane and correspondence between words and non-verbal behavior;

3) resist and attack: direct and frank expression of own thoughts, without looking at others;

4) deliberate use of the word "I": as an expression of the fact that the person stands by words, absence of attempts to hide behind indeterminate wording;

5) acceptance (expressing agreement, when you are praised): a refusal to self-destruct and underestimate own strengths and qualities;

6) improvisation as a spontaneous expression of feelings and needs, everyday worries, rejection of foresight and planning.

The last session summarized the whole program and held a discussion on healthy self-esteem and its role in developing and maintaining proper social anxiety. the main components of healthy self-esteem were highlighted, namely: objective understanding and acceptance of own possibilities and limitations; honesty with oneself; faith in oneself, objective recognition of own strengths, successes, achievements, mistakes, failures, benevolence towards oneself and others, sense of dignity, nonjudgementalism, etc.

Each member of the group made a list of own personal resource states, and the "importance of the resource" for each person was discussed in the circle, and actually each student has talked about their resources and possibilities of their use.

Upon completion of this program students, in addition to subjective evaluation of personal changes that occurred in them generally and their social anxiety in particular, were proposed to re-fill the SPIN scale. Dynamics of their scores is presented in Fig. 2.

SA scores at the beginning of psychocorrection program

SA scores at the end of psychocorrection program

Fig. 2. Social anxiety levels in members of psychotherapeutic group within program (SPIN, scores)

As can be seen from Fig. 2, in all members of the group there was a decrease in general level of social anxiety. Given that the survey was conducted at the end of the group's work, level of improvement was defined as the minimum (30-35% reduction according to the SPIN), which is regarded as a positive result.

Psychoprophylactic stage of this program included measures at all levels of prevention of mental disorders, namely, social anxiety. It consisted of providing psychoeducational lectures for students in relation to social anxiety, its evolution, manifestations, degrees of severity and influence on quality of life, identification of risk groups for social phobia as a disorder, timely and adequate psychological correction of these violations, and development of preventive measures for the recurrence of these violations.

Thus, developed program of psychotherapeutic correction of social anxiety in medical students has shown its effectiveness and can be used in further work with youth and introduced into work of psychological services of various universities of the country.

References

1. Shafrans'kyy V., Dudnyk S. (2016) Psykhichne zdorov'ya naselennya Ukrayiny: stan, problemy ta shlyakhy vyrishennya [Mental health of the population of Ukraine: state, problems and ways to solve]. Ukrayina. Zdorov'yanatsiyi, vol. 36, no 39, pp. 12-18.

2. Korenyev M. (2011) Nahal'ni problemy okhorony zdorov'ya pidlitkiv v Ukrayini [Urgent problems of health care of adolescents in Ukraine]. Journal of NAMS of Ukraine, vol. 17, no 1, pp. 48-53.

3. Fehm L., Beesdo K., Jacobi F., Fiedler A. (2007) Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, vol. 43, no 4, pp. 257-265.

4. Leichsenring F., Leweke F. (2017) Social anxiety disorder. New England Journal of Medicine, no 376, pp. 2255-2264. doi: 10.1056/NEJMcp1614701

5. Khaustova E., Bezsheyko V. (2012) Sovremennyye predstavleniya o diagnostike i terapii trevozhnykh rasstroystv [Modern ideas about the diagnosis and treatment of anxiety disorders]. Mezhdunarozhnyy nevrologicheskiy zhurnal, vol. 2, no 48, pp. 52-60.

6. Stukan L. (2004) Deyaki faktory indyvidual'noyi psykholohichoyi predyspozytsiyi shchodo formuvannya sotsial'nykh fobiy u pidlitkiv [Some factors of individual psychological pre-disposition for the formation of social phobias in adolescents]. Arkhiv psykhiatriyi, vol. 1, no 36, pp. 167-170.

7. Montgomery S. (1999) Sotsial'naya fobiya [Social phobia]. Kiev: ООО ММК. (in Russian)

8. Crozier W. Ray, Alden E. Lynn (ed.) (2001) International Handbook of Social Anxiety: Concepts, Research and Interventions Relating to the Self and Shyness. New York: Wiley.

9. Nikitina I., Kholmogorova A. (2011) Sotsial'naya trevozhnost': soderzhaniye ponyatiya i osnovnyye napravleniya izucheniya [Social anxiety: the content of the concept and the main directions of study]. Sotsial'naya i klinicheskayapsikhiatriya, vol. 21, no 1, pp. 60-67.

10. Clark, D., Wells A. (1995) A cognitive model of social phobia. Social phobia: Diagnosis, assessment, and treatment, New York: Guilford Press, pp. 69-93.

11. Bieling P, McCabe R., Antony M. (2009) Cognitive-behavioral therapy in groups, New York: Guilford Press.

12. Pugovkina O., Shil'nikova Z. (2014) Kontseptsiya mindfulness (osoznannost'): nespetsificheskiy faktor psikhologicheskogo blagopoluchiya [The concept of mindfulness: non-specific factor of psychological well-being]. Sovremennaya zarubezhnaya psikhologiya, vol. 3, no 2, pp. 18-28.

13. Brown K., Ryan R. (2003) The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, vol. 84, no 4, pp. 822-848.

14. Zeidan F., Johnson S., Diamond B. (2019) Mindfulness meditation improves cognition: Evidence of brief mental training. Consciousness and Cognition, vol. 19, no 2, pp. 597-605.

Размещено на Allbest.ru