32 Chapter 2 Before discussing the potential role of these hormones and peptides in social psychopathologies, we will introduce two types of pathologies that show marked alterations in social motivational processing: social anxiety and psychopathy. Social psychopathology Social anxiety disorder Social anxiety disorder (SAD) is one of the most common mental health disorders (e.g., Bandelow & Michaelis, 2015). SAD is characterized by an intense fear of social situations in which the individual may be scrutinized by others (American Psychiatric Association, 2013). The affected individual fears that he/she will behave, or show anxiety symptoms, in a way that will be negatively evaluated and will lead to rejection by others. Social situations, such as social interactions, are therefore avoided or endured with intense fear or anxiety. Avoidance behavior plays a crucial role in the persistence of the disorder and hinders extinction of fear in social situations as it reduces the opportunity for accommodation to and reevaluation of the situation (Clark & Wells, 1995). In addition, when engaging in social interaction, someone with SAD typically tends to avoid eye contact (Stein & Stein, 2008). As eye contact is important in social communication, this characteristic hinders social interactions and influences how others respond to the person with SAD, reinforcing the social fear–avoidance cycle. Furthermore, there is evidence that SAD persists because of biased processing of social information, favoring disorder-relevant information, which leads to interpretation of the situation as more negative than it was in reality (Heeren, Lange, Philippot, & Wong, 2014; Stein & Stein, 2008). With a lifetime prevalence rate of 7–12%, SAD is the most common anxiety disorder and among the most common psychiatric disorders (Kessler et al., 2005). Onset occurs in childhood or early adolescence, and SAD affects more women than men. The disorder typically leads to significant distress and, when left untreated, tends to follow a chronic, unremitting course leading to substantial impairments in vocational and social functioning. Treatment of SAD consist of pharmacotherapy and/or psychotherapy, mainly cognitive behavioral therapy aiming at acquiring the behavioral and cognitive skills to function effectively. Exposure therapy is part of the latter and aims at fear extinction by repeated or prolonged exposure to feared social situations, leading to a reduction of anxiety and avoidance behavior. Notwithstanding the efficacy of current evidence-based psychological and pharmacological treatments in SAD, nonresponse rates in large clinical trials have been up to 50% (Hofmann & Bögels, 2006; Stein & Stein, 2008), leaving considerable room for improvement.
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