The dissertation titled Social anxiety and the process of relational family therapy addresses the phenomenon of social anxiety on a sample of randomly selected adults and examines the course and effects of a therapeutic program for treating social anxiety in a group of people with the disorder.
Social anxiety disorder has the lowest level of treatment among mood disorders and anxiety disorders. Despite the scale of distress and social impairment associated with social anxiety disorder, less than 20% of people seek professional help (Knappe, Beesdo-Baum and Wittchen 2010, 858-859). Treatment of social anxiety disorder has been most often integrative in the last period and there are several scientifically supported approaches (for example, cognitive-behavioral therapy, psychoanalytic psychotherapy, other forms of integrative treatments, group treatments that are cost-effective in the treatment of drugs), however, a survey that would include the model of relational family therapy in dealing with people with social anxiety disorder does not exist.
Although a lot of studies have been done, researches on the treatment of social anxiety, which include relational and family approach, are lacking and for better treatment outcomes, it is necessary to improve methods and to understand better the factors that influence social anxiety. Therefore, the dissertation was intended to supplement some of the ambiguities in the theory of social anxiety given in the first, theoretical part of the dissertation, to integrate theory and research to date in a relational family model, which has not been done so far, and to integrate in a research into the model of relational family therapy individual areas that can characterize the life of a socially anxious person: social anxiety and related social functionality, relationships in the original family, attitude to one’s body and self-image.
In the first, quantitative part of the study, based on a sample of 234 people from general population, a comparison with statistical tests was conducted among the group of people who achieved the criterion of social anxiety disorder on the LSAS scale and the group that does not meet the disorder criterion regarding functioning in the original family and self-esteem. For this purpose, the scales to measure the level of social anxiety LSAS (Liebowitz Social Anxiety Scale) were used, as well as the Family-of-Origin Scale (FOS - the scale measures functioning in the original family) and the Rosenberg Self Esteem (RSE) scale, the scale measuring self-esteem. It has been shown that individuals with a higher degree of social anxiety come from families where functioning among members is less healthy and have a lower self-esteem compared to individuals with lower levels of social anxiety. The findings regarding less healthy functioning among the members of the original family also suggest that autonomy and intimacy in the primary family can be important risk factors that indicate the non-functionality of the family of people with social anxiety. A statistically significant lower level in the field of autonomy in the original family in a group of people with a social anxiety disorder suggests that in these families they less clearly express their feelings, there is less responsibility, respect and openness among family members and the family members find it harder to face losses and divorces than in families of people without the disorder. Similarly, in families of people with social anxiety, the level of intimacy is lower in statistical significance, which may result in less encouraging expression of feelings, a less pleasant atmosphere in the family, in non-functional ways of dealing with conflicts, and lower empathy and less trust.
In the second, mainly qualitative part of the research, we were interested in the characteristics of the participants prior to the therapeutic process and the changes after the therapeutic process for the research fields of social anxiety, functioning in the original family, self-image and attitude to the body, as well as characteristics of the relational family therapy process for persons with social anxiety disorder. For this purpose, a seven-month therapeutic program for social anxiety was designed, involving five people with symptoms of social anxiety disorder. Data collection was in the form of logs of individual meetings and notes written by therapists, homework or notes of the participants in the group, as well as the LSAS, FOS and RSE scales, which were filled out by the participants when they entered the program, while the LSAS and RSE scales were also filled out at the end.
Before joining the program, socially anxious participants reported low self-esteem (e.g. self-criticism of their behavior, experience, opinions; very negative self-perception), they came from families with less healthy functioning among family members, especially with problems in the areas of autonomy and intimacy (e.g. unwanted expressions of their opinions and emotions, and defective and unclear communication; broken boundaries in relationships; parentification; parents' intrusiveness and reactive behavior; lack of interpersonal contact) and face problems in some areas to their bodies (e.g. frequent feeling of fatigue and exhaustion, irregular sleep and eating, physical reactions such as flushing, sweating, trembling of the voice, increased heartbeat, feeling of restlessness and tension).
We have found that changes in three areas have been shown in the process of relational family therapy.
a) in the field of experiencing family relationships: changing the current view of the family, a more in-depth understanding of the dynamics and importance in family relationships, understanding the dynamics of relations in the original families and their influence on the current experiencing of oneself, of one's body and relationships with others, of recognizing one's own systemic role in the family;
b) in the field of the body: activation and changes in habits in caring for the body; changes in the awareness of one's body, recognition of the importance of body sensations, consideration of bodily signs of fatigue, changed attitude to rest, sleep and eating;
c) in the field of self-esteem: reduction in self-criticism, less compulsive thoughts and excessive attention to oneself and one's mistakes, greater relaxation in society.
The level of social anxiety has also decreased in all participants except for one. The participants experienced less fear related to social situations, less avoidance and more exposure to difficult social situations.
The results and findings of the research can contribute to a better understanding of the family background in socially anxious people, focusing on intimacy and autonomy in the original family, a better understanding of the relationship to body and self-esteem, and with due consideration of research limitations (e.g. a small sample of the clinical group), help assess the choice and adaptation of therapeutic interventions.