Social phobia is a persistent fear of doing something embarrassing or humiliating which interferes with both personal and professional lives. People with social phobia think that other people judge them negatively. This fear may reflect a sense of being inferior, different, or unacceptable, and it goes with assumptions such as thinking that "if people knew what you were really like, then they would reject you".
Symptoms are often readily visible (blushing, sweating, trembling) and may be sufficiently severe to induce panic attacks. The fear may be triggered by specific situations such as speaking or eating in public, or by contact with specific groups of people such as authority figures or sexually attractive people, or by social interactions generally. Anticipatory anxiety is common, and after an encounter social phobics tend to dwell on their supposed failings.
Extent of the problem
Equal numbers of men and women suffer from social phobia, which affects between 3 and 13% of the population. Estimates vary as people find it difficult to seek help; occasional social anxiety is normal, and many mask the problem by using alcohol or other substances.
Causes
There is no single cause, and both biological factors and experiences like being teased, bullied or criticized may contribute to its development. Social phobia often begins in adolescence, but can occur at any time. Shyness and social phobia share many characteristics, and methods of treating social phobia are also helpful for reducing shyness. It can be treated without knowing its origins.
Consequences
In the short term, reactions to symptoms maintain the problem. People use 'safety behaviours', such as keeping quiet or trying not to offend anyone, to reduce the risk of the scrutiny and judgment that they fear (which is usually absent or rare). They avoid situations that they find difficult, or endure them with great distress. When interacting with others they become self-conscious, and focus on their symptoms and concerns about making the right impression. They may not notice others' reactions, or remember what has been said.
In the long term, social phobia can lead to isolation and loneliness, especially when people cannot make intimate relationships, or if they cope by confining their contacts to a few safe people. It can interfere seriously with occupational achievement. Low confidence, poor self-esteem, and periods of depression may also follow.
Treatment
Cognitive-behavioural treatment has been shown to be extremely effective. This makes sense as the focus on thoughts helps people to identify the risks that they fear and to modify their thinking, and the behavioural work helps them to change the safety-seeking behaviours, avoidance and self-consciousness that otherwise maintain the problem. This form of psychotherapy also provides practical suggestions for building confidence and for working with underlying beliefs and assumptions if necessary.
Some people can alleviate the problem themselves by using books and other self-help materials. Assertiveness or yoga classes may be helpful if people can overcome their fears of joining a group, and so are non-conversational activities such as sport. Counselling may provide valued support.
Medication for anxiety can be helpful, though problems may re-emerge when it is withdrawn. Research shows that treating the social phobia for people who have become depressed often alleviates both problems. If not, anti-depressant medication may help.
Useful books
- Burns, D. The Feeling Good Handbook: Using the New Mood Therapy. New York: Harper & Row, 1990.
- Butler, G. Overcoming Social Anxiety and Shyness. London: Robinson, 1999.
