Social Anxiety Disorder (also known as Social Phobia) is a type of anxiety disorder in which the people in question have an unreasonable and massive fear of social interaction, so they try to avoid it. Everyone feels stressed in certain social situations, but how much fear does it take to be too much? Are there effective treatments for social phobia? A correct understanding of social phobia can eliminate unnecessary fears and is an important step in overcoming this disorder.
People with social anxiety are afraid of social contact, especially social situations that require contact with strangers or being watched by many people, such as company anniversary dinners, wedding dinners, or addressing a large group of people.
People with social anxiety can be extremely worried about making a fool of themselves in front of others, such as saying something inappropriate or acting awkwardly, resulting in criticism or teasing from others. Although they realize that this anxiety is excessive and unreasonable, they cannot suppress it. Often, they already feel anxious weeks before such social occasions, even finding excuses to be absent on the day.
Even if they force themselves to attend, they usually remain silent, trying to hide themselves in the sea of people or a dark corner. If a close friend attends the event, the person with social anxiety will usually stick around the friend for some sense of security.
The 5% of adults
If the person with social anxiety cannot avoid contact with strangers, especially someone important, the feeling of fear may immediately overwhelm them. The result could include a flushed face, hot ears, profuse sweating, difficulty breathing, gastrointestinal discomfort, racing heartbeat, chest tightness, and dizziness. It feels like they are about to faint. When talking to others, their words become “constipated” and their mind confused. This embarrassing situation makes the person with social anxiety even more convinced that everyone present is watching them. They would think: “I have been exposed and embarrassed. My life is over!” This kind of thinking lets the anxiety flood in. The person will likely leave the scene right after.
According to a large-scale survey in the United States, about 5% of adults will suffer from social phobia in their lifetime. The average age of onset is 15 years old. Like most mental disorders, social phobia is caused by the interaction of genetic and environmental factors. Having a related history in the family will increase the risk of the disorder. Other factors like a shy personality, withdrawal from novel things, the experience of ridicule, exclusion, bullying, or excessive parental control and care in childhood will also increase the risk. If the parents display excessive anxiety behavior in social situations, their children might also learn those behaviors and become fearful of social situations.
Medication and psychotherapy are both effective treatments for social anxiety. Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRI) are both effective treatment drugs. Since the medication takes about 2 to 4 weeks to improve symptoms, the patient may still feel a slight discomfort at the beginning of taking the drug, but this usually subsides gradually.
Psychotherapy, especially cognitive behavioral therapy, is also an effective treatment and can be used in conjunction with medication. The purpose of psychotherapy is to help patients face the feared social situations and reduce future avoidance.
Avoidance is the core behavior of social phobia and the main reinforcement of this fear. Because the fear is very strong and uncomfortable, plus escape can immediately eliminate this fear, these safety behaviors are very tempting to patients. The feeling of relaxation after escape will encourage safety behaviors. As a result, the patient will still knowingly continue the vicious cycle, keeping their fear alive.
The therapist will discuss with the patient and try to overcome the fear step by step based on the distress level caused by different social situations. To defeat social phobia, they need to level up like in a video game. With each level, their courage and ability will improve. They won’t fight the “boss” right away.
Another important part of cognitive behavioral therapy is to help people with social anxiety examine the “automatic thoughts” and “cognitive biases” that naturally pop up in their minds. For example, when making a verbal report to a colleague, negative thoughts naturally pop up in the mind, such as “I will definitely make a fool of myself this time, and my colleagues think I am useless.” In terms of cognitive biases, people with social anxiety often think that they are the oracle from Ancient Greece, predicting that the worst situation will definitely occur, or thinking that they can read minds.
Examining Automation Thoughts
Rational discussion alone is not enough to correct these negative thoughts and cognitive biases. Facts speak louder than words. Therapists will guide patients through various behavioral experiments. The patients would try new behaviors in various real-life social interactions. This allows them to see and feel tangible results. They can even use video recordings to help patients understand more clearly and objectively that their performance is not as bad as imagined. They could also see that other people might not make the expected criticisms, or might not even pay any attention. This way, irrational and inconsistent negative thoughts and thinking patterns will be replaced, reducing anxiety.
On the other hand, many people with social phobia lack the self-confidence to face criticism and rejection from others, so another focus of treatment is to strengthen their ability in this area. If the patient had traumatic social experiences, these unpleasant memories can also be dealt with through psychotherapy to prevent past memories from interfering with the present life.
Many people have stigmas about social phobia, thinking that it is just a person who is weak-willed and timid. The stigma makes people ashamed to reveal their social anxiety, let alone seek treatment, causing them a lot of unnecessary long-term pain. The result? They miss out on their wonderful life. Quite a pity.
Social phobia is like a bluffing coward. The more you escape, the more it chases you. However, the more you face it bravely, the further it will go. Medication and psychotherapy can effectively help patients escape from the clutches of social phobia, so they are no longer fettered by fear and can start a better life.
Written by: Dr. William Chui
Originally posted on: Health HKEJ
Translated by: Cheuk Long Chan
