Social phobia

Social phobia is a type of anxiety disorder. People who have social phobia experience extreme and persistent anxiety associated with social or performance situations. A person with social phobia experiences anxiety in situations where they are likely to be scrutinised and observed by others. They may have persistent fears about being judged, criticised, ridiculed or humiliated.

Most people feel shy or nervous in certain social situations. Public speaking or entering a roomful of strangers can cause anxiety in many people. However, this kind of common apprehension doesn’t indicate a social phobia. For people with social phobia, social situations provoke feelings that extend beyond simple anxiety or nervousness.

A social phobia occurs for a person when:

• there is a persistent fear of one or more social or performance situations where they are exposed to unfamiliar people or to possible scrutiny by others. The person fears that they will act in a way that will be embarrassing and humiliating
• feared situations are avoided or endured with intense anxiety and distress
• a person realises that the social anxiety is excessive and unreasonable, but feels they are unable to change or control the feelings or behaviour
• it interferes significantly with their daily life including work, education, family and social life
• fear or avoidance isn’t due to a general medical condition or the physiological effects of a substance (such as drugs or medications).

It is estimated that around three per cent of the Australian population experience social phobia in any one year. Up to 13 per cent of the population may develop social phobia during their lifetime. Men and women are equally affected, though a higher number of men seek treatment.

In many cases, social phobia begins with shyness in childhood and progresses during adolescence. The onset of social phobia generally occurs around ages 11 to 15. Social phobia is also known as social anxiety disorder.

Symptoms of social phobia

When exposed to a feared social situation, a person with social phobia may experience symptoms of extreme anxiety, including:

• blushing
• trembling
• feeling as if you have nothing to say
• accelerated heart rate
• shallow, fast breathing
• sweaty palms
• nausea
• tense muscles
• dry throat
• stomach pain
• feeling faint or light-headed
• feelings of self-doubt and uncertainty
• negative thoughts such as ‘I’m making a fool of myself’
• difficulty concentrating on anything other than physical sensations of anxiety, negative feedback from others and negative thoughts
• an overwhelming urge to flee the situation
• the realisation that these feelings are irrational and out of proportion.

Social phobia – feared social situations

Some people with social phobia fear and avoid specific situations (such as public speaking), while others may feel generalised anxiety about several social situations (generalised social phobia). A person with social phobia can fear (and try to avoid) a range of situations, including:

• crowds and parties
• public speaking
• starting or having a conversation
• talking to a large group
• voicing opinions
• meeting someone new, shaking hands
• dating
• using public toilets
• shopping
• talking with someone who is in a position of seniority or authority
• being watched while doing something, such as eating, signing papers or talking on the telephone
• situations that put them in the spotlight, such as parties to celebrate their own birthday.

Social phobia – underlying fears

Some of the fears commonly aroused by social situations can include:

• worry that others will notice their physical symptoms of anxiety, such as blushing, sweating, and stammering
• fear of looking stupid, silly, or ridiculous
• fear of appearing quiet, boring and uninteresting to others
• fear of being judged as socially inadequate.

Social phobia can extend beyond the social event

A person with social phobia can feel anxious while simply anticipating an upcoming social event. After the event, the person may replay the conversations they had and rate their performance. Brooding on these feelings of social failure can make the person feel even worse, and reinforce the desire to avoid social situations in the future.

Common complications of social phobia

If left untreated, social phobia can severely affect quality of life. Some of the common complications may include:

• using alcohol to cope with anxiety during social events
• alcohol abuse
• misuse of prescription and non-prescription drugs
• difficulty forming and maintaining relationships
• curtailed education or employment opportunities
• depression
• suicidal thoughts
• isolation from family, peers and community
• reluctance to leave the house.

Treatment options for social phobia

Recovery from social phobia is possible with appropriate treatment. Depending on the individual, treatment options may include:

• cognitive behaviour therapy (CBT)
• anxiety management techniques
• social skills training
• medication.

Cognitive behaviour therapy (CBT)

Cognitive behaviour therapy aims to help people change the way they think, feel and behave in social situations. These techniques may help people to confront their fears. In time, people come to realise that others are unlikely to judge them harshly – and even if it does happen, they realise it’s not a major tragedy. They will also learn that they can exert some control and choice over their thoughts and feelings.

Treatment using CBT may include:

• education about the nature of social anxiety
• challenging and changing false or distorted thoughts and beliefs
• gradual exposure to feared situations
• attention training.

Anxiety management techniques

Relaxation training and breathing techniques may help a person manage their anxiety symptoms. Some physical anxiety symptoms may be triggered by hyperventilation (overbreathing). Taking slow, deep breaths from the abdomen – rather than fast, shallow breaths from the chest – can reduce anxious feelings.

Relaxation techniques include:

• progressive muscle relaxation
• mindfulness
• meditation
• visualisation
• isometric relaxation exercises.

Social skills training

Some people who have suffered with social phobia for many years may develop habits that make it difficult for them to take steps towards recovery. For example, they may:

• find it difficult to make or maintain eye contact
• use soft or hesitant speech
• display closed body language
• have rigid facial expressions
• need a large personal space
• have difficulty listening or keeping a conversation going.

Social skills training methods include modelling the appropriate behaviour, role-playing and then practising in real-life situations.

Medication

Some medications, such as selective serotonin re-uptake inhibitors (SSRIs), can help if the person is also suffering from depression. In the short term, drugs such as beta-blockers may be used to help manage some of the symptoms of anxiety.

Where to get help

• Your GP (doctor)
• Psychologist
• Anxiety Recovery Centre Victoria Helpline Tel. (03) 9830 0533 or 1300 ANXIETY (269 438)
• Australian Psychological Referral Service Tel. (03) 8662 3300 or 1800 333 497