Social phobia is a type of anxiety disorder. People who have social phobia experience extreme and persistent anxiety associated with social or performance situations. They may have persistent fears about being judged, criticised, ridiculed or humiliated.
Most people feel shy or nervous in certain social situations. Public speaking or entering a roomful of strangers can cause anxiety in many people. However this kind of common apprehension doesn’t indicate a social phobia. It becomes a social phobia when it:
Causes the person to avoid the feared situation
Means the person endures the situation with intense distress
Interferes significantly with their daily life including work, education, family and social life.
Men and women are equally affected, though a higher number of men seek treatment. In many cases, social phobia begins with shyness in childhood and progresses during adolescence. The onset of social phobia generally occurs around ages 11 to 15. Social phobia is also known as social anxiety disorder.
When exposed to a feared social situation, a person with social phobia may experience symptoms of extreme anxiety, including:
Blushing
Trembling
Feeling as if you have nothing to say
Accelerated heart rate
Nausea
Shallow, fast breathing
Sweaty palms
Tense muscles
Feeling faint or lightheaded
Dry throat
Stomach pain
Feelings of self-doubt and uncertainty
Negative thoughts such as ‘I’m making a fool of myself’
Difficulty concentrating on anything other than physical sensations of anxiety, negative feedback from others and negative thoughts
An overwhelming urge to flee the situation
The realisation that these feelings are irrational and out of proportion.
Some people with social phobia fear and avoid specific situations (such as performance anxiety), while others may feel generalised anxiety about several social situations (generalised social phobia). Situations may include:
Crowds and parties
Public speaking
Starting or having a conversation
Talking to a large group
Voicing opinions
Meeting someone new, shaking hands
Dating
Using public toilets
Shopping
Talking with someone who is in a position of seniority or authority
Being watched while doing something, such as eating, signing papers or talking on the telephone
Situations that put them in the spotlight, such as parties to celebrate their own birthday.
A person with social phobia can feel anxious simply anticipating an upcoming social event. After the event, the person may replay the conversations they had and rate their performance. Brooding on these feelings of social failure can make the person feel even worse, and reinforce the desire to avoid social situations in the future.
Some of the underlying fears commonly aroused by social situations can include:
Worry that others will notice their physical symptoms of anxiety, such as blushing, sweating and stammering
Fear of looking stupid, silly or ridiculous
Fear of appearing quiet, boring and uninteresting to others
Fear of being judged as socially inadequate.
If left untreated, social phobia can severely affect quality of life. Some of the common complications may include:
Using alcohol / drugs to cope with anxiety during social events
Difficulty forming and maintaining relationships
Curtailed education or employment opportunities
Depression
Suicidal thoughts
Isolation from family, peers and community.
Addressing social phobia can be approached in many ways.
This treatment aims to help people change the way they think, feel and behave in social situations. Techniques may help people to confront their fears. In time, people come to realise that others are unlikely to judge them harshly - and even if it does happen, they realise it’s not a major tragedy. They will also learn that they can exert some control and choice over their thoughts and feelings. Treatment using CBT may include:
Education about the nature of social anxiety
Challenging and changing false or distorted thoughts and beliefs
Gradual exposure to feared situations.
Relaxation training and breathing techniques may help a person manage their anxiety symptoms. Some physical anxiety symptoms may be triggered by hyperventilation (over-breathing). Taking slow, deep breaths from the abdomen – rather than fast, shallow breaths from the chest – can reduce anxious feelings. Relaxation techniques include:
Progressive muscle relaxation
Meditation
Visualisation.
Some people who have suffered with social phobia for many years may have developed habits that make it difficult for them to make change. Social skills training methods include modelling the appropriate behaviour, role-playing and then practising in real life situations. For example, they may:
Find it difficult to make or maintain eye contact
Use soft or hesitant speech
Display closed body language
Have rigid facial expressions
Need a large personal space
Have difficulty listening or keeping a conversation going.
Some medications, such as selective serotonin re-uptake inhibitors (SSRIs), can help if the person is also suffering from depression. In the short term, medications may be used to help manage some of the symptoms of anxiety.
