Social Phobia and Social Anxiety

Approximately 2% of the population suffer from social phobia to the extent that it is debilitating, and as such this represents a significant mental health problem.  For 91% of sufferers, social phobia develops before the age of 25.  In sufferers, interaction with others and of forming relationships provokes overwhelming fear, and is avoided as a consequence.  The effect on career and quality of life can be devastating.

A key fear in social phobia is that of being negatively evaluated by others.  Possible feared situations range from fear of public speaking at the mild end of the continuum, to fear of one-to-one conversations in its most severe form.  Some social phobics fear, and thus avoid, almost any interpersonal contact.

Panic attacks may be experienced in a variety of social situations, and additionally there may be a particular fear of blushing, sweating and tremors, and other physical symptoms, that the sufferer believes will be visible to others, thereby compounding his or her social anxiety.  Very often such situations will be avoided in future if found intensely unpleasant, and social isolation is therefore common.  A vicious cycle of avoidance may be set up.

Psychological Symptoms

• Fear of being negatively evaluated by others
• Fear of social and performance situations
• Fear of physical symptoms such as sweating and blushing that may be apparent to others
• Lack of concentration
• Fear of rejection
• Low self esteem
• Impairment of occupational functioning
• Taking part in fewer social activities and avoiding contact with friends
• Social isolation

Physical Symptoms

• Blushing
• Sweating
• Tremor
• Palpitations
• Sensations of shortness of breath
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy or faint

Diagnosis

Self-report questionnaires are often used to assess social phobia, such as The Social Avoidance and Distress Scale.  Such questionnaires assess anxiety and avoidance in a variety of social and performance situations, as well as concerns about being negatively evaluated by others in those contexts.  The practitioner may also ask the client to self-monitor the occurrence of anxiety and avoidance behaviour on a day-to-day basis, and use this information to build a bigger picture of the social phobic’s overall experience.  Physiological responses to situations (such as heart rate measurements) may also be taken into account.

Medical Treatment

In some cases of social phobia, medication may be prescribed.  Monoamine oxidase inhibitors can be effective in reducing symptoms.  Beta blockers are another alternative, being effective in reducing speaking and performance anxiety, and these have the advantage that they can be taken as and when needed (ie just before entering a feared situation).  Benzodiazepines (eg valium) are sometimes used, but there is a risk of dependency on this group of drugs, and symptoms tend to recur on withdrawal of the medication.  It is likely that psychological treatments will be offered in addition to, or instead of, medication.

Psychological Treatment

Cognitive Behavioural Group Therapy (CBGT) is the most likely psychological treatment strategy that will be offered, as the group approach allows for the testing of new skills in a social setting along with other sufferers.  There are three primary components to CBGT: exposure to feared situations, challenging distorted thoughts and beliefs, and homework assignments which incorporate the other two components.

Individuals will be asked to rate their anxiety in a variety of stressful social situations, ranging from mildly threatening situations, to those found most threatening (eg from talking with one individual, to addressing a group of strangers).  The client will then be encouraged to approach those situations they have previously been avoiding, starting with the least stressful, and building up gradually to face those most feared, until eventually a sense of mastery and control is achieved.  It may be unrealistic to expect complete relief from anxiety related symptoms, but the list of avoided situations should diminish over the weeks of therapy, and consequently a release from social isolation can be anticipated.

The second component of CBGT – cognitive restructuring – involves identifying automatic negative thoughts and challenging them, so that they can be replaced with more realistic appraisals of the self, and of feared social situations.  For example, a client concerned that their physical symptoms such as blushing and sweating will be apparent to others, can be helped to see that their judgement of the visibility of the symptoms is in all probability exaggerated.  This will involve self monitoring, and coming to understand the irrationality of some beliefs that are contributing to the social anxiety.  This will be done both within the supportive group atmosphere, and as homework assignments set during the therapy sessions.  As a result of reducing their social phobia in CBGT, clients are likely to begin to create new opportunities to face their fears in their everyday lives.

Return to top.

Sorry, we do not have a personal experience story to place here at this time.

Please feel free to contribute a story for inclusion on this website. Your anonymity is assured if that is what you wish. We value your input.

Send emails, with the subject heading, 'Personal Experience' (and the relevant illness) to:

admin@dorsetmentalhealthforum.org.uk

*Unfortunately we cannot guarantee that all material submitted will be published.

Sorry, we do not have a carer's perspective story to place here at this time.

Please feel free to contribute a story for inclusion on this website. Your anonymity is assured if that is what you wish. We value your input.

Send emails, with the subject heading, 'Carer's Perspective' (and the relevant illness) to:

admin@dorsetmentalhealthforum.org.uk

*Unfortunately we cannot guarantee that all material submitted will be published.