Social phobia is a fear of behaving in an embarrassing way whilst you talk or meet with other people, especially strangers. It can greatly affect your life. Treatment works well in many cases. Treatment options include cognitive behavioural therapy (CBT) and medication, usually with a selective serotonin reuptake inhibitor (SSRI) antidepressant.
What is social phobia?
Social phobia is sometimes called social anxiety disorder. Social phobia is not just shyness, it is more severe than this. With social phobia you get very anxious about what other people may think of you, or how they may judge you. As a result you have great difficulty in social situations, which can affect your day-to-day life.
- A marked fear or dread of social situations. You fear that you will act in an embarrassing or humiliating way and that other people will think you are stupid, inadequate, foolish, etc.
- In some cases the fear is only for certain situations where you will be looked at by others even if they are known to you. For example, you become very anxious if you have to 'perform' in some way, such as giving a talk or presentation, taking part in a discussion at work or school, etc. But, you are OK in informal social gatherings.
- In other cases the fear occurs for most social situations where you may meet strangers. This can even include eating in public places as you fear you may act in an embarrassing way.
- You may have weeks of anxiety prior to a social event or an event where you have to 'perform'.
- You avoid such situations as much as possible.
- If you go to the feared situation:
- You become very anxious and distressed.
- You may develop some physical symptoms of anxiety such as: a fast heart rate, palpitations, shaking (tremor), sweating, feeling sick, chest pain, headaches, stomach pains, a 'knot in the stomach', fast breathing.
- You may blush easily.
- You may have an intense desire to get away from the situation.
- You may even have a panic attack (see separate leaflet called 'Panic Attack').
- However, you will usually know that your fear and anxiety is excessive and unreasonable.
Social phobia can greatly affect your life. You may not do as well at school or work as you might have done, as you tend to avoid any group work, discussions, etc. You may find it hard to get, or keep, a job as you may not be able to cope with the social aspects needed for many jobs, such as meeting with people. You may become socially isolated and find it difficult to make friends.
Who has social phobia?
It is one of the most common mental health conditions. Up to 1 in 10 adults have social phobia to some degree. It usually develops in the teenage years and is usually a lifelong problem unless treated. Just over twice as many women are affected than men.
What causes social phobia?
The cause is probably a combination of your genetic makeup which makes you more prone to this condition, and bad experiences as a child. In one study about half of affected people said their phobia began after one memorable embarrassing experience. The other half said it had been present 'as long as they could remember'.
How is it diagnosed?
You must have three features to be diagnosed with social phobia:
- Your symptoms must not be the result of some other mental health condition (for example, a delusion).
- You feel anxious entirely or mostly in social situations.
- One of your main symptoms will be the avoidance of social situations.
What are the treatment options for social phobia?
Cognitive behavioural therapy
Some studies suggest that cognitive behavioural therapy (CBT) works well in up to 3 in 4 cases of social phobia. (However, it may not be available on the NHS in all areas.)
Cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as phobias. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and false ideas or thoughts which you have that can make you anxious. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful. Therapy is usually done in weekly sessions of about 50 minutes each, for several weeks. You have to take an active part, and are given homework between sessions. For example, you may be asked to keep a diary of your thoughts which occur when you become anxious before a social event.
Behavioural therapy aims to change any behaviours which are harmful or not helpful. Various techniques are used. For social phobia the therapist will usually help you to face up to feared situations gradually, a little bit at a time. The therapist teaches you how to control anxiety when you face up to the feared situations. For example, by using deep breathing techniques. This type of behavioural therapy is called exposure therapy where you are exposed more and more to feared situations and learn how to cope. The therapist may also teach you certain social skills such as verbal and nonverbal skills to help you in social situations. For example, how to start and maintain a conversation, appropriate eye contact with other people, etc.
You can get leaflets, books, tapes, videos, etc, on how to relax and how to combat anxiety. They teach simple deep breathing techniques and other measures to relieve stress and anxiety. A longer leaflet in this series, called 'Shyness and Social Anxiety - a Self Help Guide'' is a good start.
Medication for social phobia
- Antidepressant medicines are commonly prescribed. These are often used to treat depression, but have been found to help reduce the symptoms of social phobia even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing anxiety symptoms.
- Antidepressants do not work straight away. It takes 2-4 weeks before their effect builds up. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. You need to give them time to work.
- Antidepressants are not tranquillisers, and are not usually addictive.
- There are several types of antidepressants, each with various pros and cons. For example, they differ in their possible side-effects. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used to treat social phobia. Venlafaxine is another antidepressant found to be effective.
- A betablocker medicine such as propranolol is sometimes used. They can ease some of the physical symptoms of anxiety such as shaking and palpitations. This may be useful if your social phobia is not too severe, and you would like help to ease these symptoms if you go to a social event. Betablockers are not addictive, are not tranquillisers, and do not cause drowsiness or affect 'performance'. You can take them as required.
- Benzodiazepines such as diazepam work well to ease symptoms of anxiety. The problem is, they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Therefore, they are not a usual long-term treatment. However, a short course of up to 2-3 weeks may be prescribed from time to time.
- Antiepileptic drugs such as gabapentin or clonazepam, are sometimes useful.
A combination of treatments such as CBT and an SSRI antidepressant may work better in some cases than either treatment alone.
Alcohol and anxiety
Although alcohol may ease anxiety symptoms in the short-term, don't be fooled that drinking helps to cure anxiety. In the long run, it does not. Drinking alcohol to 'calm nerves' is often a slippery slope to heavier and problem drinking. See a doctor if you are drinking heavily (or taking street drugs) to ease anxiety symptoms.
What is the outlook (prognosis) for social phobia?
Not much is known about the natural progress of the condition. However, with treatment there is a good chance that symptoms can be greatly improved. Without treatment, social phobia can be associated with depression in later life.
Further help and advice
Zion Community Resource Centre, 339 Stretford Road, Hulme, Manchester, M15 4ZY
Tel: 08444 775 774 Web: www.anxietyuk.org.uk
A leading UK charity for anxiety disorders.
NO PANIC (National Organisation For Phobias, Anxiety, Neuroses, Information & Care)
93 Brands Farm Way, Randlay, Telford, Shropshire TF3 2JQ
Helpline: 0808 808 0545 Web: www.nopanic.org.uk
For people with panic attacks, phobias, obsessive compulsive disorder, and related disorders.
Helpline: 0845 2967877 Web: www.anxietyalliance.org.uk
If you have an anxiety disorder, such as general anxiety, phobias, panic attacks or obsessional compulsive disorder, or wish to withdraw from tranquillisers and anti-depressants, then Anxiety Alliance is there to help, advise and support you.
Triumph Over Phobia (TOP UK)
PO Box 3760, Bath, BA2 3WY
Tel: 0845 600 9601 Web: www.topuk.org
Runs a national network of structured, self-help groups for adults (16+) with phobias.
Further reading & references
- Fink M, Akimova E, Spindelegger C, et al; Social anxiety disorder: epidemiology, biology and treatment. Psychiatr Danub. 2009 Dec;21(4):533-42.
- Morris EP, Stewart SH, Ham LS; The relationship between social anxiety disorder and alcohol use disorders: a critical review. Clin Psychol Rev. 2005 Sep;25(6):734-60.
- Singh JS, Hope DA; Cognitive-behavioral approaches to the treatment of social anxiety disorder. Isr J Psychiatry Relat Sci. 2009;46(1):62-9.
- Hofmann SG, Smits JA; Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008 Apr;69(4):621-32.
- Preda A and Albucher RC. Phobic Disorders. eMedicine (July 2008)
|Original Author: Dr Tim Kenny||Current Version: Dr Laurence Knott|
|Last Checked: 12/07/2011||Document ID: 4662 Version: 39||© EMIS|
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