Social Phobia

Sonia is a 30 year old lawyer who dreads participating in meetings at work. Whilst she is awaiting her turn to speak, her heart races and she feels as if she can’t breathe properly. Sometimes, when in meetings, her mind goes blank and she blushes. Sonia worries that people will notice that she is blushing and think that there is something wrong with her.

Sonia first experienced difficulty with public speaking activities back in high school. She dreaded having to read aloud to the class and didn’t want to participate in debates or presentations. Sonia also fears other social and performance situations such as job interviews, new people and dealing with authority figures such as bosses.

Avoidance symptoms
Avoidance of social or performance scenarios such as:

• Job interviews
• Public Speaking
• Meeting new people
• Initiating or maintaining conversations
• Dating
• Acting assertively
• Using public toilets
• Eating in public
• Being the centre of attention
• Being watched working
• Talking on the telephone
• Performing (eg, playing a musical instrument, playing sport)

Physical Symptoms

• Blushing
• Sweating
• Shaking
• Racing heartbeat
• Choking
• Mind going blank
• Nausea
• Dizziness
• Muscle Tension
• Headaches
• Feeling as if you can’t breathe

 
Behavioural Symptoms
Total avoidance of the feared social or performance scenario or partial avoidance by:

• Poor eye contact
• Mumbling
• Speaking too quickly
• Speaking excessively
• Laughing too much
• Not talking
• Defensive body language (eg. folding arms across body)

Cognitive Symptoms
Unhelpful and negative thoughts such as:

• ‘I’m going to look stupid/incompetent, like an idiot’
• ‘People will think I’m weird/mentally ill, defective, incompetent, stupid’
• ‘I’m a loser/failure’

People with social anxiety tend to avoid the social and performance situations they fear. For example, if someone fears public speaking they may avoid going for promotions as progressing in their career might require them to attend meetings and do presentations. Someone with social anxiety might stay in a job they dislike because they fear attending a job interview. Therefore it is not surprising that people with social anxiety, compared to the general population, tend to be less educated, unemployed, single, less well-off financially, socially isolated, and more likely to have additional psychological conditions such as depression and alcoholism.

Social anxiety affects men and women in equal numbers and it is thought that 3% of the population have social anxiety at any one time. People from all walks of life can have this disorder. Social anxiety sufferers may be: barristers, teachers, trades-people, homemakers, children, teenagers, university students.

Social anxiety typically starts in childhood or adolescence, with 95% of sufferers developing the condition before the age of 20. Without appropriate management or treatment it may be a lifelong issue. Sufferers of social anxiety may develop drug or alcohol problems if they attempt to self-medicate. Sufferers of social anxiety are approximately twice as likely as the general population to commit suicide.

• Cognitive Behavioural Therapy (CBT) is used in the treatment of social anxiety. The basic premise of this form of treatment is that how you think influences how you feel. So if you think calm, helpful thoughts you will feel less anxious and therefore be able to function better. CBT also involves changing one’s behaviour in order to change one’s thinking, such as writing down your unhelpful thoughts and challenging them; practising relaxation techniques and; confronting feared social scenarios.
• People need to be active participants in their own recovery. Your counsellor, psychologist or psychiatrist may suggest numerous helpful strategies, but you can’t benefit form them unless you make them part of your daily life. If you lack motivation to engage in CBT or it doesn’t appeal to you, you may be better suited to medication.
• Avoid stimulants such as caffeine and nicotine. If it is recommended that you decrease your consumption of coffee and cola drinks or switch to de–caffeinated coffee, caffeine free cola or herbal tea. Smokers are advised to cut down the number of cigarettes they smoke or eliminate smoking altogether.
• Regular aerobic exercise such as walking or running, or playing sport, is a good way to reduce stress and anxiety. Daily meditation can also be a helpful tool.
• Social anxiety sufferers can engage in graded, repeated and prolonged exposure to their feared situations: in other words, it is helpful to start off with social situations that are not too difficult to attempt. It is helpful to practice several times a week and to stay in the feared social situation until your anxiety has subsided significantly.

Social anxiety is a treatable and manageable condition. It may take approximately 2 months before you would reap the full benefit of antidepressant medication. CBT techniques may start producing some decrease in anxiety quite quickly (such as slow breathing and progressive muscle relaxation which people may obtain some relief the first time they try these strategies). However its effectiveness depends on the person actively implementing and practising the techniques learnt in therapy. You can probably learn how to manage and decrease your social anxiety in 8 to 10 sessions.           

Remember, anxiety is a normal part of life: a certain amount of anxiety is to be expected when public speaking or having a job interview, for example. It can help us to perform at our best provided it does not exceed a certain level.

This information was provided by Catherine Madigan, Clinical Psychologist.