Social Phobia

12-9-04

Social Phobia is an anxiety disorder characterized by the unreasonable and persistent fear of certain social situations; thus it is also called Social Anxiety Disorder.  It is calculated as the third most common mental illness—the most common being Severe Depression—with about 7% of Americans having endured it in their lifetime and 4% suffering currently.  The prevalence of cases between males and females is about even, although there is a rise in the number of Caucasian males with Social Phobia.  It typically develops in adolescence as a result of either a conditioned fear of embarrassment in a social setting or lack of social skills and shyness with an increased likelihood if genetically predisposed (Stein 1995).

The fear in Social Phobia is of being judged or watched so that you may act or speak in a way that is embarrassing.  This fear causes anxiety in most social situations, and it is exacerbated by particular events in different people.  Some of these events are public speaking; using public restrooms; eating in front of people; being in crowded places; going around in a group and having to say something; being the center of attention; meeting new people; talking to people in authority; or just any social contact in general.  Not only is there anxiety elicited when events occur but also in the anticipation of events occurring after a person has associated the events with the anxiety.  Further intensifying the fear and anxiety is the fear of possibly showing symptoms of anxiety itself.  There are many possible symptoms of anxiety that social phobia sufferers may exhibit:  palpitations, sweating, trembling hands, gastrointestinal discomfort, diarrhea, muscle tension, blushing, confusion, chest pains, timid speech, and further symptoms associated with panic attacks, such as difficulty breathing, choking sensation, dizziness, chills, or fear of dying or going crazy (Marshall 1994).

Although, typically adults understand that their fear and the inherent anxiety are irrational, they can not consciously inhibit the fear.  Then, they either choose to reluctantly tolerate the symptoms of anxiety and continue with their life as normally as possible, or they give in to the anxiety and try to avoid social situations altogether—sometimes even becoming reclusive in their homes.  Most people with Social Phobia feel that their lives are significantly affected by it (DSM-IV).

Treatment of Social Phobia patients can be done by two means: Pharmacological and Psychological.  Both have been shown increasingly affective; however, it is generally more effective not to mix the two courses except in extreme cases (Beidel & Turner 1998).

There are a number of drugs that have been tested for pharmacological treatment effectiveness in Social Phobia patients.  The most effective of these has been the Monamine Oxidase Inhibitor (MAOI) Phenelzine (Nardil).  It shows improvement from 60 to 90%; however, it is not the most popular for strict dietary restrictions and numerous possible side-effects.  Benzodiazepines and Buspirones like Xanax and Klonapin have also been tried with mixed results.  Of them, Conazepam (Klonapin) had the highest response of ~70% effectiveness at improvement.  It has not gained widespread use, though, because relapse rates after discontinuation are high.  Selective Serotonin Reuptake Inhibitors (SSRIs) are the up and coming method of pharmacological treatment because of their low possibility of side-effects and respectable improvement effectiveness.  Studies with the SSRI Prozac have concluded roughly 70% effective, and newer SSRIs such as Zoloft and Paxil also look promising (Beidel & Turner 1998). 

There is no single drug that alone can treat Social Phobia, nor is there an official methodology to find the appropriate drug.  As such, it may be wiser to begin with psychological treatment in the form of cognitive-behavioral therapy.  Ironically, these have been equally effective in group sessions as in individual ones.  The treatment looks at many different parts of Social Phobia and cognitively improves the behavioral response.  This is accomplished with social skills training; exposure to fear both in sessions and out of sessions with homework; and reducing anxiety symptoms by relaxation and social practice.  Sessions usually last for three months and are held once a week.  This treatment has been shown to be very effective, especially in the long run, as long as it has been followed though (Beidel & Turner 1998).

 

 

Works Cited

Beidel, Deborah C. & Turner, Samuel M.  (1998).  Shy Children, Phobic Adults: Nature and Treatment of Social Phobia.  Washington, DC:  American Psychological Association.

 

Marshall, John R.  (1994).  Social Phobia: From Shyness to Stage Fright.  New York:  Basic Books.

 

Stein, Murray B.  (1995).  Social Phobia: Clinical and Research Perspectives.  Washington, DC:  American Psychiatric Press.