* the individual fears they may behave in such a way that will be embarassing or humiliating, or that their anxiety symptoms may be obvious to others 

 

* exposure to the feared social situation almost always provokes anxiety, which may even lead to a panic attack

 

* in children, the anxiety may be expressed as crying, tantrums, freezing or shrinking from social situations with unfamiliar people

 

* individuals with Social Phobia recognize that their fear is excessive and unrealistic

 

* feared social situations are either endured with intense anxiety, or are avoided altogether

 

* the anxiety or avoidance of social situations interferes with the individual's normal routine, either:

* occupational or academic functioning

* social functioning

* personal relationships

(adapted from: Diagnostic and Statistical Manual of Mental Disorders IV, American Psychiatric Association, 1994). 

 

      As with Panic Disorder, the most effective form of treatment for Social Phobia is Cognitive Behavioral Therapy (CBT). The CBT focuses on identifying anxiety provoking thoughts, beliefs and self-talk. Once these thoughts, or cognitions, are identified the next step is one of challenging their validity and accuracy. The final step is to modify those ideas to make them more realistic and therefore more positive.

      An example: An individual has the belief that when he goes into a store, he may pass out and be humiliated. The bigger the store, or the farther he goes into the store, the further away he is from the exit. That triggers a "fight or flight" response. He doesn't have anyone or anything to fight, therefore his reaction is to take flight - therefore the need for quick access to an exit. Joe believes that if he cannot escape quickly enough, he may start to hyperventilate and pass out. The more he fears this happening, the more likely it is to happen. The purpose of CBT then is to identify the false belief that he may pass out if he becomes anxious or hyperventilates. Reviewing his history indicates that many times he has become similarly anxious but has not passed out. The false belief that passing out is possible is identified and challenged. The false belief that passing out is a disaster or a catastrophe is also identified and challenged. New thoughts and beliefs are established that end the start of the fear of fear cycle.

      Sometimes individuals with Social Phobia may also benefit from insight oriented psychotherapy in addition to CBT. This is the case when childhood influences or events have helped contribute to the development and maintenance of the cognitions that contribute to social anxiety.

      As with all patients I see with an anxiety or other mood disorder, I recommend "Bibliotherapy" i.e. reading material. This helps speed up the therapy process by helping the patient learn more about their anxiety between sessions. One of the best books on Social Phobia that I recommend is "The Shyness and Social Anxiety Workbook". It is available through the following Amazon.com link at a price significantly reduced from the store price.