What is social anxiety/phobia?
People with social anxiety or social phobia (the two terms are often, but not always, used interchangeably)1 feel nervous in social and performance-based situations, in situations in which they can be observed and judged.
People with social phobia or social anxiety disorder (SAD) fear that they might embarrass themselves or receive criticism from others. Therefore, they often try to avoid social situations.
SAD usually begins in adolescence. The lifetime prevalence of SAD in the US is 12%.2 What that means is that one of every eight people will meet the criteria for social phobia at some point in their lifetime.
The current DSM-5 diagnostic criteria for social anxiety disorder requires that fear and anxiety be present for at least six months, and result in marked distress or impairment in important areas of functioning, such as relationships, or work.3
Indeed, people with SAD usually try to find the kind of employment that does not require frequent socialization. And if they are unable to do so, they try to find excuses and avoid the more social aspects of their daily duties.
But social anxiety should not be mistaken for lack of interest in interacting with others, or a kind of social detachment, even though in both cases the person is likely to avoid situations that involve a lot of social interaction, such as parties.
People with social phobia do enjoy certain aspects of interacting with people, but they also happen to be very fearful of being judged negatively.
Treatment for SAD can consist of psychotherapy and/or medication. Let us briefly discuss medications first.
Selective serotonin reuptake inhibitors (SSRIs) are usually the first-line choices for social anxiety disorder. SSRIs include medications like Paroxetine (Paxil), Fluvoxamine (Luvox), and Sertraline (Zoloft).
Other medications, such as antipsychotics or beta blockers (blood pressure medications) might also be considered in cases of resistant SAD or situation-specific SAD (e.g., musical performers).4
What about therapy?
A popular form of psychotherapy is cognitive behavioral therapy (CBT).
As discussed in a previous post, CBT assumes that a person’s thoughts can cause emotions and behaviors. Therefore, in order to challenge our emotions (like high levels of anxiety) and changed our behaviors (like the avoidance of the social situation), we might need to challenge our thoughts.
For instance, a person’s thoughts, upon walking into a room crowded with people, might include:
- They will not like me
- I’m going to blush
- They will laugh at me behind my back
- They will think I’m clumsy/ugly/stupid/boring
A CBT therapist would likely challenge these thoughts, asking the patient for evidence that these thoughts are actually true. The therapist is also likely to ask the patient to imagine what it would mean if these thoughts were actually true? What would be the consequences? And what if they were not true, what would be the consequences of that? She might also ask what kind of evidence would be required for the patient to conclude that these beliefs are false.
A common element of psychotherapy for SAD is exposure. During exposure therapy, the client faces the feared situation (in this case, a social situation) but is instructed to remain in the situation until the anxiety subsides.
Repeated often enough, the person can learn that, first, the anxiety can be tolerated and that, secondly, the feared situation is not dangerous.
Eventually the person might be able to stay in the feared situation without experiencing a heightened level of anxiety; if interested, the person can then move on to face even more anxiety-provoking situations.
For instance, imagine a person named Joe, who is highly anxious about eating in public, fearing that people will judge him, thinking him clumsy or a messy eater.
At first, Joe can go to a small local restaurant with a good friend who is aware of his anxiety; he can ask for only a glass of water, and sit for 20 minutes and then leave. Next time he can stay longer, order coffee and cream, or go at a busier time. Eventually he might be able to enjoy a nice meal at a fancy restaurant.
To summarize, CBT, exposure therapy, and medications appear to be effective in the treatment of SAD.
If you believe you have social anxiety that interferes with your daily life, please see your doctor. As I have explained today, treatments for SAD are available and can be effective.
I hope you found today’s post helpful.
1. Liebowitz, M. R., Heimberg, R. G., Fresco, D. M., Travers, J. & Stein, M. B. (2000). Social phobia or social anxiety disorder: what’s in a name. Archives of General Psychiatry, 57, 191-192.
2. Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social fears and social phobia in the USA: Results from the National Comorbidity Survey Replication. Psychological Medicine, 38, 15–28.
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
4. Blanco, C., Bragdon, L. B., Schneier, F. R., Liebowitz, M. R. (2013). The evidence-based pharmacotherapy of social anxiety disorder. The International Journal of Neuropsychopharmacology, 16, 235-249.