A Systems Level Intervention for Unemployed Persons with Social Anxiety Disorder

描述（由申请人提供）：拟研究的目的是设计和开发一种认知行为干预，以减轻焦虑症状，从而使有社交焦虑障碍的失业人员能够寻找和获得就业。这种干预将是一种文化上适当的、以职业为重点的、可持续的、认知行为干预，适用于失业的、经济上处于不利地位的、城市居民的社交焦虑障碍。最近一项具有全国代表性的流行病学研究表明，DSM-IV SocAD的终生患病率为12.1% （Kessler et al., 2005）。社交焦虑障碍与显著的社会功能障碍有关（Kessler, 2003; Stein and Kean, 2000）。绝大多数社交焦虑障碍患者报告有显著的职业功能障碍（Stein, et al., 2000; Turner et al., 1986）。具体的损害包括拒绝工作机会和晋升（Stein, Torgrud, & Walker, 2000），生产力和工作绩效降低（Wittchen, et al., 2000），教育程度降低和早期辍学（Stein & Kean, 2000），失业率增加（Heimberg等人，1990a），经济依赖（Scheier等人，1992）和收入减少（Magee等人，1996）。社交焦虑障碍可能会由于逃避面试、面试时过度焦虑以及提供工作线索的社交网络有限而干扰工作成就。我们对接受福利的母亲进行的纵向研究发现，社交焦虑障碍的诊断是长期依赖福利支持的最强精神预测指标。我们还完成了一项研究，该研究确定社交焦虑症是唯一一种严重干扰参加国际测试，最佳实践，职业服务干预计划的个人获得工作的精神障碍。我们已经开始在密歇根州底特律市的犹太职业服务中心（Jewish Vocational Service）对出现社交焦虑的人进行筛查，那里的主要客户是经济上处于不利地位的、正在找工作的非洲裔美国人。我们的筛查工作证实了这一人群中疑似社交焦虑障碍与失业之间的联系。我们的调查团队将与犹太职业服务机构的工作人员和选定的犹太职业服务消费者合作，制定有效和可持续的干预措施，以改善这一服务不足人群中社交恐惧症和失业成员的生活。社交焦虑症是一种非常普遍的影响就业的疾病。先前的研究表明，社交焦虑障碍会干扰福利接受者的工作成就。本研究旨在设计及发展一套以社区为基础的认知行为干预，以减少失业人士的社交焦虑，并改善他们的就业结果。

DESCRIPTION (provided by applicant): The goal of the proposed research is to design and develop a cognitive-behavioral intervention to reduce anxiety symptoms and thereby enable unemployed persons with social anxiety disorder to seek and obtain employment. This intervention will be a culturally appropriate, vocationally focused, sustainable, cognitive- behavioral intervention for unemployed, economically disadvantaged, urban-dwelling persons with social anxiety disorder. A recent nationally representative epidemiological study places the lifetime prevalence of DSM-IV SocAD at 12.1% (Kessler et al., 2005). Social anxiety disorder is associated with notable impairments in social functioning (Kessler, 2003; Stein and Kean, 2000). A large majority of people with social anxiety disorder report significant impairment in occupational functioning (Stein, et al., 2000; Turner et al., 1986). Specific impairments include turning down job offers and promotions (Stein, Torgrud, & Walker, 2000), reduced productivity and job performance (Wittchen, et al., 2000), lowered educational attainment & early school dropout (Stein & Kean, 2000), increased unemployment (Heimberg et al.,1990a), financial dependence (Scheier et al, 1992), and reduced income (Magee et al., 1996). Social anxiety disorder likely interferes with job attainment due to job interview avoidance, excessive anxious arousal during job interviews, and limited social networks to provide job leads. Our longitudinal study of mothers receiving welfare found that the diagnosis of social anxiety disorder was the strongest psychiatric predictor of reliance on welfare for support over time. We have also completed a study that identifies social anxiety disorder as the only psychiatric disorder that significantly interferes with attaining work among individuals who participated in an internationally tested, best-practice, vocational services intervention program. We have begun to screen individuals for the presence of social anxiety at Jewish Vocational Service in Detroit Michigan, where the primary clientele are economically disadvantaged, African Americans who are seeking work. Our screening efforts confirm the association between suspected social anxiety disorder and unemployment in this population. Our investigative team will collaborate with Jewish Vocational Service agency staff and with selected Jewish Vocational Service consumers to develop an effective and sustainable intervention that will improve the lives of socially phobic, unemployed members of this underserved population. Social anxiety disorder is a highly prevalent condition that interferes with employment. Prior research indicates that social anxiety disorder interferes with work attainment among welfare recipients. This project involves the design and development of a community-based cognitive-behavioral intervention to reduce social anxiety and improve employment outcomes among unemployed persons with social anxiety disorder.