social phobia-causes and treatment

 social phobia

What is social phobia? 

Social phobia is an abnormal fear or aversion of social gatherings, where the affected person feels subject to public scrutiny and avoids such anxiety-provoking situations as much as possible.

It is sometimes referred to as social phobia disorder and is much more than shyness. It can vary from a predictable fear of a new social experience to an extremely morbid fear that significantly affects a person’s life. The basic fear is that of being regarded unfavourably by others and feeling embarrassed or humiliated by one’s appearance or performance. 

How common is it and who gets it? 

It is the most common of all the anxiety disorders. Studies indicate that about 1 in 7 people suffer from social phobia at some time in their lives. Anyone can develop it. It is usual to have an early age of onset, with almost 100% of sufferers having it by the age of 20 and many of these by the age of 10. 

What are the typical situations? 

Although the anxiety-provoking situations vary from person to person, the following are common:

• speaking engagements

• meeting people, especially for the first time

• dealing with authority figures or professionals

• sitting for examinations

• dating

• eating and drinking in public (e.g. in canteens)

• negotiating with others

• staff meetings

• using public toilets

• writing while being watched

• receiving visitors

• entering a room where others are seated.

A common factor in these situations is that people feel that they are in the ‘limelight’ and are being judged by other people. 

What is the cause? 

We often hear the term ‘adrenaline rush’ when people in a stressful or exciting situation describe how they feel adrenaline pumping around the body. It does indicate that the brain and other parts of the central nervous system are responding to stimulus.

We call it sympathetic activity because it involves this component of the autonomic nervous system. In people with social phobia there is sympathetic overactivity as the responsible chemicals, particularly adrenaline and serotonin, are released in large amounts.

The person cannot be blamed because the body goes into ‘automatic’ mode as a conditioned response. There may be a genetic (inherited) predisposition and there is evidence of a bad childhood experience in some people. 

What are the symptoms?

 Typical symptoms include one or more of the following:

 • palpitations

• sweating tremor or trembling

• hot and cold flushes

• light-headedness

• ‘butterflies’ in the stomach • nausea

• ‘lump in the throat’ or difficulty swallowing

• diarrhoea

• muscle tension or aching

• tension headache

• restlessness. 

What is the outcome? 

The symptoms can certainly interfere with a person’s life and make him or her miserable. A panic attack can occur. When a person experiences these symptoms it tends to affect their self-image and may make them feel ‘stupid’ or weak.

This response aggravates the problem, so a vicious cycle develops. It can also lead to other phobias such as agoraphobia (fear of open spaces or leaving home).

Serious consequences include relationship breakdown, depression, substance abuse, especially of alcohol, and loss of employment opportunities. 

What is the treatment? 

Self-help is difficult because the phobia does not usually go away on its own. Some people may be able to cope by avoiding certain stressful situations but this does not solve the basic problem. Professional help should be sought. This includes counselling techniques and medications, which can be used separately or in combination.

Medication

 Sometimes your doctor will prescribe medication to treat social phobia, especially if anxiety and depression are involved. 

For social phobia with performance anxiety, a betablocking agent taken 30–60 minutes before a social event or performance can be beneficial. Check with your doctor, but remember they are not permitted in some competitive sporting events. 

Counselling 

The main psychological technique used is cognitive behaviour therapy (CBT). Cognitions are thoughts, beliefs or perceptions and CBT involves the process of knowing or identifying, understanding or having insight into these thought processes. Certain thought processes in social phobia reinforce the belief that people are watching and judging you.

The techniques attempt to identify and break these patterns to help you feel more comfortable with other people.

The therapy then aims to help you change your behaviour, gradually face up to social situations and f ind them less threatening. Other techniques may include relaxation techniques and group therapy where other people share their experiences.