Social Phobia (Social Anxiety Disorder)

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.

Symptoms include:

• 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 give a talk or presentation, take 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.
  • 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.
  • may blush easily.
  • may have an intense desire to get away from the situation.
  • may even have a panic attack (see separate leaflet called 'Panic Attacks').
• 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'.

What are the treatment options for social phobia?

Cognitive-behaviour therapy (CBT)
Some studies suggest that cognitive-behaviour therapy 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.
   
• Behaviour 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 gradually face up to feared situations, 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 behaviour 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 non-verbal skills to help you in social situations. For example, how to start and maintain a conversation, appropriate eye-contact with other people, etc.

Self help
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, SSRI antidepressants (selective serotonin reuptake inhibitors) are the ones most commonly used to treat social phobia.
     
• A beta-blocker 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. Beta-blockers 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.

A combination of treatments such as cognitive-behaviour therapy 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.

Further help and advice

National Phobics Society
Zion Community Resource Centre, 339 Stretford Road, Hulme, Manchester, M15 4ZY
Tel: 0870 122 2325   Web: www.phobics-society.org.uk

NO PANIC (National Organisation For Phobias, Anxiety, Neuroses, Information & Care)
93 Brands Farm Way, Randlay, Telford, Shropshire TF3 2JQ
Helpline: 0808 808 0545    Web: http://nopanic.org.uk

Triumph Over Phobia (TOP UK)
PO Box 3760, Bath, BA2 3WY
Tel: 0845 600 9601    Web: www.triumphoverphobia.com
Runs a national network of structured, self-help groups for adults (16+) suffering from phobias.

First Steps to Freedom
1 Taylor Close, Kenilworth, Warwickshire, CV8 2LW
Helpline: 0845 120 2916    Web: www.first-steps.org
For people with general anxiety, phobias, obsessional compulsive disorder, panic attacks, anorexia and bulimia, and those who wish to come off tranquillisers. Services include, telephone self-help groups, leaflets, booklets, videos, audio tapes including relaxation audio tapes.

© EMIS and PIP 2005   Updated: August 2005