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Anxiety, Fears, and Phobias

Social Phobia

Friday, March 16, 2012 - 15:36

Contributing Author: Guy Slowik FRCS

In recent years, mental health specialists have been paying more attention to social phobia.

In its mildest form, social phobia - fear of certain social situations - is not much worse that feeling shy. But for millions of people, this type of phobia can make contact with other people extremely difficult or even impossible.

People with social phobia are usually afraid of behaving in a way that is humiliating or embarrassing.

  • They may convince themselves that everyone will notice their signs of unease, such as trembling or blushing.
  • They may imagine that people are talking about them or laughing at them behind their back because of their lack of social skills, or their appearance.
  • They may be afraid of losing control in public. For instance, they imagine they might vomit, or have problems with bowels or urination.
  • They may find it extremely difficult to do things that are normally considered routine, such as eating or drinking in public, writing in public, or using public restrooms.

Compared to people who are simply shy, people with social phobia may experience more physical symptoms, such as:

  • Blushing
  • Dry mouth and throat
  • Sweating
  • Heart palpitations
  • Tense muscles
  • Trembling
  • Sinking feeling in stomach
  • Feeling hot or cold

In addition, some will feel other symptoms such as headache, lump in the throat, dizziness, an urgent need to use the toilet, or weakness or twitching in the muscles.

In many cases, people manage to adjust their lives in order to avoid the situations that give them trouble, and they get along fine. In other cases, people with social phobia lead lives that are quite restricted.

  • Some avoid interaction with everyone outside their immediate families.
  • Some can't make progress professionally, because a better job would bring social demands they feel they could not meet.
  • Some drop out of school or quit work.
  • Many abuse alcohol or other drugs as they try to overcome their fears.

Treatment For Social Phobia

Social phobia is not always easy to treat. It may require a series of sessions with a psychiatristpsychologist or other type of counselor. There are a number of approaches to treatment, and your therapist may suggest using one or more.

  • Medication. As with other severe phobias or panic attacks, the doctor may prescribe medication. This may be given for just a short time, as people learn ways to get comfortable in situations that have been difficult.
  • Exposure Therapy. Starting with situations that are not too threatening, a therapist might arrange for you to practice surviving social encounters. Sometimes, a friend, relative, or other trusted person might be asked to observe what actually happens. For example, a social phobic may be convinced that everyone in the room will stare at a trembling hand. The observer can report that this doesn't happen.

    In some cases, people are instructed to make their hands shake or their voices tremble deliberately in situations where they are afraid of seeming nervous. This gives them a sense of control over the situation. And it shows that even when they seem really uneasy, people don't react strongly.

How To Information:

Changing Your Thinking

It may be possible for some people to change the way they think about their social fears.

  • It may be helpful to keep a diary of thoughts. Writing down what you imagine people think about you can sometimes put a new perspective on things.
  • Sometimes it is possible to prepare a script. Planning what to say at awkward moments, and practicing ahead of time, can make those moments less threatening.
  • Sometimes it may be helpful to have training in social skills or assertiveness. Many people with social phobias already have good social skills. But if they don't, a therapist may help with training. For example, you can learn to be more assertive, or make better eye contact. Or you may practice standing in a way that expresses confidence.
  • If you have a social phobia, you probably tend to see things in the worst light. Spend some time considering different explanations for situations that give you trouble. For example, if someone smiles in your direction, don't let yourself think, "That woman's laughing at me." instead, tell yourself, "She thinks I look nice."


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