Social Phobia: Not Just Shyness

We all get butterflies at some point in our lives, but when fear of social interaction threatens to take over your life, it's time to seek help.

Suzanne, an intelligent woman in her thirties, had been lonely for much of her life. She'd been stuck in the same secretarial job because she was afraid of working with people above her job level. She wanted to meet a man, but was sure she'd say something stupid and be rejected. Her few good friends couldn't get her to go to restaurants or even parties because she was afraid other people might think she was a sloppy eater. The few times she agreed to go, her heart was pounding and she began to blush and perspire. When her primary care physician finally referred her to a psychologist with experience in anxiety disorders, she was relieved to discover she had a treatable condition with a name social phobia.

What Is Social Phobia?

Many people get nervous in certain social or business situations. There is nothing unusual about feeling anxious before making a presentation, going out on a first date, going to a party where you don't know many people, or having dinner with the boss.

What's different about social phobia, also known as social anxiety disorder, is that you have an extreme fear of being judged by other people and acting in ways that might embarrass or humiliate you. You are also afraid of becoming the center of attention and worry that everyone is looking at you. As a result, you go to great lengths to avoid the social situations you fear. If you find yourself in one of these situations, such as a party, you experience intense anxiety that is out of proportion to the event.

Social phobia usually begins in adolescence, although symptoms like extreme shyness may occur in earlier years. The disorder is chronic, although stress may cause the intensity to fluctuate.

Not Just Shyness

"Social phobia is not just shyness," says Stefan Hofmann, Ph.D., director of the Social Phobia Treatment Program at Boston University. "It's a disorder that causes significant interference with people's occupational, personal, and social lives, but treatment is available."

Although social phobia responds readily to treatment, many people remain undiagnosed or misdiagnosed, in part because many people who suffer from social phobia are embarrassed to admit it. In addition, many clinicians don't know how to recognize social phobia and provide appropriate treatment. Because a large number of people with social phobia also suffer from depression or alcohol or drug problems, diagnosis and treatment can become more complicated.

Two Types of Social Phobia

Some people are afraid of a specific situation, often involving public speaking or performing. This severe stage fright may dampen the career of a musician, actor, or salesman. Other people have generalized social phobia, which is a fear of several, if not most, social situations.

In both types of social phobia, anxiety before, during, and after events and avoidance of feared situations significantly interfere with everyday life. However, generalized social phobia usually has more serious effects because it occurs in a number of different situations.

In both types of social phobia, physical symptoms may occur. They may include:

• Heart palpitations
• Excessive sweating
• Blushing
• Dry throat and mouth
• Shaky voice
• Trembling
• Nausea
• Shortness of breath
• Dizziness

These symptoms, which may occur independently or together, are also associated with a panic attack, a condition associated with social phobia.

You also fear that others will judge you negatively for having these symptoms, which further fuels the symptoms.

Feared Social Situations

Common phobia-producing situations include:

• Performing or speaking to an audience
• Attending social gatherings
• Going on a date
• Entering a room when people are already seated
• Interacting with strangers
• Making eye contact
• Talking on the telephone, especially in front of others
• Dealing with authority figures
• Expressing disagreement or disapproval
• Eating in front of others
• Ordering food in a restaurant
• Writing in front of others
• Using public restrooms

What Causes Social Phobia?

The exact cause of social phobia has not yet been identified. However, researchers believe it is a combination of biological and environmental factors. Some people may be genetically predisposed to social phobia. When they experience negative social interactions or a particularly stressful event, the disorder may be set off or exacerbated.

Treatment With Therapy and/or Medication

About 80% of people treated for social phobia experience significant improvement and are able to get the disorder under control.

Therapy

Most people with social phobia can be helped by cognitive-behavioral therapy (CBT) , in which they learn how their thoughts affect their reactions to different situations, and how they can change the way they think about themselves and others in feared situations. In addition, they are gradually exposed to feared situations. After repeated exposures and practice coping with the anxiety, they begin to realize that there is no need to feel embarrassed and that they can succeed at the task at hand. As more positive experiences occur with less anxiety, they feel less need to avoid previously feared situations. Relaxation training also can help in coping with the anxiety.

CBT has the greatest impact on the treatment of social phobia when it is done in a group, because the main feature of the disorder is anxiety triggered by interactions with other people. Twelve to twenty sessions is the typical length of successful treatment. Training in social skills is a useful adjunct to CBT, as is learning new ways of acting in different situations.

Medication

For some people, medication is helpful when taken alone or in combination with CBT. Different medications work for different people. People with a specific social phobia may benefit from taking a beta blocker only before specific performances. However, people with generalized social phobia usually require medication on a regular basis.

Medications used include:

• Selective serotonin reuptake inhibitors (SSRIs), such as Paxil, Prozac, and Zoloft
• Antidepressants called MAO inhibitors
• Antianxiety medications such as Xanax and Klonopin
• Buspirone (Buspar)

Getting Help

Dr. Hofmann encourages people who think they may have social phobia to seek treatment. Suzanne is a good example of someone who benefited from treatment. Within several months of starting treatment, she began to feel more confident in new social situations. A year later she has a boyfriend and has just accepted a job promotion. She still gets anxious in some situations, but not enough to keep her from doing the things she wants to do.

If you think you or someone you know may have social phobia, seek help from a mental health professional who has experience treating this disorder. You can get help to overcome your fears, feel more comfortable interacting with other people, and lead a fulfilling life.

RESOURCES:

Anxiety Disorders Association of America
http://www.adaa.org

Social Phobia/Social Anxiety Association
http://www.socialphobia.org

CANADIAN RESOURCES:

Canadian Mental Health Association
http://www.ontario.cmha.ca/index.asp

Canadian Psychological Association
http://www.cpa.ca/cpasite/home.asp

References:

Hope D, Heimberg R, Juster H, et al. Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach. The Psychological Corporation; 1999.

Rapee R. Overcoming Shyness and Social Phobia: A Step-by-Step Guide. Jason Aronson Inc; 1998.