Most people experience some uneasiness and stress when meeting new people, for example during job interviews, or performing in front of an audience. But this anxiety is quite normal. However, for some people these feelings are excessive, intense, and chronic.
Social anxiety disorder or social phobia is a very common anxiety disorder. It is characterized by the following features1,2:
- Fear of social interactions or performance in front of an audience. A person may fear observation or scrutiny by others. For example, engaging in public speaking or addressing a committee.
- Fear of being judged or rejected socially due to symptoms of anxiety
- Fear or anxiety experienced is out of proportion to the actual social context
- Due to fear or anxiety experienced, social situations are either avoided or endured uncomfortably.
Social anxiety tends to interfere significantly with one’s functioning in school, workplace, and social situations. This condition is associated with decreased levels of quality of life and well being. People suffering from social anxiety often come across as shy, withdrawn, unassertive, avoidant of eye-contact, and rigid in body posture. They may choose vocations that do not require significant social contact. Usually, the fear is about being negatively evaluated by others or making a fool of oneself in public.
Social situations that are avoided could include using a public bathroom, addressing a meeting, giving presentations, striking conversations with relatively lesser known people or strangers, forming new romantic relationships, etc. Past childhood negative experiences such as bullying, negative temperament, and family heredity are some of the risk factors associated with this disorder. Adolescents and young adults are more susceptible to developing this condition. Both males and females are diagnosed with this condition with equal frequency.
The assessment and diagnosis of social phobia is done by trained professionals such as psychiatrists and clinical psychologists. In depth clinical history including current issues and development of symptoms is key to a reliable diagnosis.
Psychosocial Interventions: Psychosocial interventions for social phobia are based on the cognitive behavioral perspective3. In this model, intense fear and anxiety is believed to be rooted in maladaptive patterns of thought and action that has developed over time. The following strategies are suggested treatment methods3:
- Exposure Strategies: Through repeated exposure to feared situations, an individual is guided to manage the attributions they attach to the stimulus. The therapist and client generate a list of feared situations. Each of these situations is addressed gradually by helping an individual become more comfortable with them.
- Cognitive therapy: Maladaptive thoughts and associated actions become the central focus of this therapy. Individuals in cognitive therapy are assisted in identifying underlying thought patterns related to the fear of social situations. This is followed by analyzing evidence for the older patterns of thinking, in order to devise behavioral strategies to improve coping.
- Social skills training: Social skills training is based on the premise that socially phobic individuals have weak skills related to effective social interactions4. Thus, various ways of improving social performance are taught. For example, certain behaviors or reactions are rehearsed in the therapy setting before applying in social settings.
- Progressive Muscle Relaxation: Relaxation training focuses on alleviating the physical arousal accompanied with social anxiety. In a typical relaxation session an individual is guided to relax each muscle group with different intervals for tensing and relaxing4.
Pharmacological Treatments: Currently applied modes of pharmacological management of social anxiety include the use of selective serotonin reuptake inhibitors (SSRI’s), benzodiazepines and monoamine oxidase inhibitors amongst other medications. Prescribed only under medical supervision, such management of social phobia has been found to be successful in symptom relief.
Social phobia is one of the most successfully treated anxiety disorders. It has been found to respond well to psychosocial and pharmacological treatment.
1. American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: Author.
2. World Health Organization (1993). Neurotic, stress related and somatoform disorders. In International classification of diseases-Classification of mental and behavioural disorders (5th ed.). Geneva: Author.
3. McCabe, R., & Antony, M.M. (2008). Anxiety disorders: Social and specific phobias. In Tadman, A., Kay, J., Lieberman, J.A., First, M.B., & Maj, M. (Eds.). Psychiatry (pp. 1409-1442). West Sussex;England:Wiley Blackwell.
4. Schneier, F.R., Luterek, J.A., Heimberg, R.G., & Leonardo, E. (). Social Phobia. In Stein, D.J. (Ed). Clinical manual of anxiety disorder (pp. 63-86). Arlington;VA:American Psychiatric Association.