Social Anxiety Disorder and Social Phobia

Generalized: In Generalized Social Phobia, a person fears judgment in, and avoids, most social situations.

Anxious behaviors, which can be triggered by anxiety, but can alAnxietyso make the anxiety worse over the long term:

Quite common. While the exact prevalence of Social Phobia remains to be determined, a recent survey of approximately 9,000 Americans suggested that approximately 12% of the general public will experience social anxiety to a clinically significant, diagnosable degree at some point during their lives (Kessler, Berglund, Demler, Jin, &owever, benzodiazepines may still be appropriate, particularly for short term use. This category includes several miliar medications, though clonazapam and alprazolam are the two that have been studied most in the treatment of Social Phobia. Benzodiazepines that are often used to treat anxiety problems include:

Interoceptive Exposure: Some individuals with Social Phobia are fearful not only of social situations, but also of the anxious physical sensations (such as blushing, shaking, sweating, etc.) that can accompany them. Interoceptive exposure practices deliberately bring about these sensations through such activities as wearing a warm sweater to induce sweating in social situations. Just as exposure to feared situations leads to reductions in situational fear, exposure to feared sensations will lead to a reduction in anxiety over experiencing these feelings in social situations.

Andrew M. Jacobs, Psy.D.

Anxious sensations in our bodies, such as:

Trying to direct peoples attention away from ones performance (e.g., by jokes, dressing in a particular way, etc.)

Social Skills Training: In the midst of a tense social situation, many people with Social Phobia fear that they do not have the necessary social skills to successfully navigate the exchange. While this may be due to negative self-talk and self-consciousness (rather than an actual lack of skill), many people find it helpful to discuss such topics as carrying on conversations, being assertive, and effective listening. Social skills training provides a chance to work on these areas in therapy.

Shyness, social anxiety, social phobia…these terms are often used interchangeably, although their meanings are often quite different and can lead to confusion and misunderstanding. The following definitions are provided to clarify how each term is used in this article.

Dr. Jacobs is a psychologist in the Anxiety Treatment and Research Centre at St. Josephs Healthcare in Hamilton, Ontario, Canada. His professional interests focus on interpersonal and motivational ctors in cognitive behavioral therapy for anxiety and mood disorders, cultural minority considerations in psychotherapy, and the dissemination of empirically-based psychological knowledge to the general public.

Psychoeducation: Perhaps one of the most difficult aspects of coping with Social Phobia is simply understanding what it is, where it came from, why its so hard to change, and how it keeps coming back with a vengeance. Psychoeducation involves you and your therapist working together to develop a better way to understand your Social Phobia, and subsequently, how to work with it.

CBT is structured. Each session, as well as the overall course of treatment, has specific objectives and agendas that you develop in cooperation with your therapist.

Martin M. Antony, Ph.D., ABPP

Yes! As mentioned earlier, learning to become your own therapist is one of the primary goals of CBT. While it is often most helpful to work through these strategies with the help of a psychotherapist, many people are able to achieve significant gains using self-guided therapy manuals. One such book, The Shyness and Social Anxiety Workbook: Proven Step-by-Step Techniques for Overcoming Your Fear by Martin M. Antony, Ph.D., and Richard Swinson, M.D., has recently been demonstrated to be an effective treatment for individuals with mild to moderate Social Phobia (Abramowitz, Moore, Braddock, &ingen, Germany: Hogrefe.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602..

Cognitive-Behavioral Therapy

In a sense, social anxiety and Social Phobia are probably caused by the same ctors that are responsible for any strong human emotional experience: our genetic makeup, biological ctors, and the culmination of learning experiences throughout our lives (Antony &ather, it is more likely to be a combination of contributing causes that come together in the right place, at the right time. Below we discuss three ctors that are believed to play a role: Our genes, our brains, and our life experiences.Social Anxiety Disorder and Social Phobia

Our Life Experiences: Experiences in our life, and our reactions to them, can also contribute to the development of Social Phobia. If we repeatedly are put in situations where we are made to feel different, to fear the judgment of other people, or are somehow singled out in a negative way, we can understandably develop beliefs about ourselves and the world that are more consistent with social anxiety. As these experiences continue, we may also begin to selectively pay attention only to those parts of our environment that reinforce our negative beliefs – for example, a public speaker may focus on the two people in her audience who appear bored, while she may hardly notice the 38 others who are watching and nodding with great interest. As these beliefs and attention filters get strengthened, the tendency toward acting, feeling, and thinking in a socially anxious way becomes more automatic. After a while, these beliefs can also lead us to make unhelpful assumptions in otherwise neutral situations. If a person glances at us on the sidewalk, we may automatically assume that he thinks we look strange or have an odd walk. We might not even consider the possibility that he appreciated our way for him to get past, or that he simply likes to make eye contact with everyone he encounters. Naturally, if we believe most social situations are going to go poorly or create a great deal of discomfort, we are going to avoid them. The catch here is that while we are successful in temporarily escaping our unpleasant feelings of anxiety, we also confirm our beliefs that we are unable to handle social situations. At the same time, we miss chances to find out that our negative assumptions may not always be correct. As another illustration, a person who enjoys singing but fears the judgment of others will never find out he has an excellent voice if he continually avoids singing in public. Avoiding more and more situations for fear of evaluation will strengthen our negative biases and beliefs and prevent us from going into an increasing number of situations where we might otherwise want or need to go. As this pattern starts to interfere with our overall functioning, the warning signs of Social Phobia can become more apparent.

Social anxiety is a feeling of discomfort, fear, or worry that is centered on our interactions with other people and involves a concern with being judged negatively, evaluated, or looked down upon by others. While it can often happen during the social exchange itself, it may also pop up in anticipation of a social occasion, or afterward when we review our performance in a given situation.

Because social anxiety can often seem unwieldy or even overwhelming to understand as a single concept, it is often helpful to view it in terms of three separate components that are interrelated and can strengthen one another, leading to a cycle of anxiety:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.

There are two subtypes of Social Phobia:

Maybe…or maybe not. If you find that your social anxiety is above and beyond what you would consider normal or appropriate and it significantly interferes with your quality of life, you may have Social Phobia. However, because social anxiety is something many of us experience from time to time, it is critical not to self-diagnose. If you think you have Social Phobia and would like this assessed, your best bet would be to consult with a mental health professional about your concerns.

Non-generalized: In Non-generalized Social Phobia, a person is normally not excessively anxious unless they are in particular types of social situations (such as public speaking)

Hofmann, S.G., & Otto, M.W. (2008). Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder specific treatment techniques. New York: Routledge.

Our Brains: Medications that are used to treat social phobia affect levels of neurotransmitters in the brain (neurotransmitters are chemical messengers that transmit signals from one brain cell to the next). However,Queens asian escorts the verdict is still out on whether differences in these chemicals can cause social phobia. Similarly, several studies (such as that of Blair et al., 2008) have found that certain areas of the brain, such as a small, almond-shaped area called the amygdala, can be more active in individuals with social phobia.

When Does Social Anxiety Become a Problem?

Cognitive Restructuring: As discussed earlier, individuals with Social Phobia frequently hold negative beliefs about themselves and others, which often show up as unhelpful thoughts in social situations. Cognitive restructuring is an important component of CBT, and it involves working with your therapist to identify these thoughts and look for patterns within them. As you become skilled at noticing these thoughts, you then develop strategies for gaining flexibility in your thinking and considering more helpful ways of looking at your experiences.

Andrew M. Jacobs, Psy.D.

Abramowitz, J. S., Moore, E. L., Braddock, A. E., & Harrington, D. L. (2009). Self-help cognitive-behavioral therapy with minimal therapist contact for social phobia: A controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40, 98-105.

CBT emphasizes between-session exercises (often referred to as homework) that you complete on your own. These tasks are planned with your therapist and are intended to provide you with actual, real-life experience working with new ways of thinking and behaving.

CBT includes a focus on developing new skills. You will learn several strategies for counteracting Social Phobia.

Hope, D.A., Heimberg, R.G., & Turk, C.L. (2006). Managing social anxiety: A cognitive behavioral therapy approach (therapist guide). New York: Oxford University Press.

Monoamine Oxidase Inhibitors (MAOIs): MAOIs are another type of medication that is occasionally used to treat Social Phobia. One MAOI in particular, phenelzine (Nardil), has shown strong effectiveness in treating the disorder. Unfortunately, the MAOI medications also have a number of significant side effects and require a strict diet that eliminates several common foods to avoid life-threatening reactions. As a result, MAOIs are relatively uncommon as a treatment for Social Phobia.

CBT is research-based. The strategies used in CBT to address symptoms of Social Phobia have been subjected to numerous clinical studies and have been shown to be effective.

Heimberg, R.G., & Becker, R.E. (2002). Cognitive-behavioral group therapy for social phobia: Basic mechanisms and clinical strategies. New York: Guilford Press.

Shyness is a feeling of timidity, apprehension, or discomfort in at least some social situations. This term is often used to describe a personality disposition or temporary event, and less frequently in reference to a mental health concern.

CBT is brief and time-limited. You and the therapist will set specific goals and remain focused on these goals throughout treatment, which generally lasts 12 to 16 sessions. The ultimate aim is to assist you in becoming your own therapist.

CBT is focused on the present. While a CBT therapist is likely to agree that the roots of Social Phobia may be due, in part, to experiences during childhood, the emphasis of treatment is on uncovering the current cognitive and behavioral patterns that are maintaining symptoms and on changes in your present life.

Antony, M. M., & Swinson, R. P. (2008). The shyness and social anxiety workbook: Proven, step-by-step techniques for overcoming your fear (2nd ed.). Oakland, CA: New Harbinger Publications.

Cognitive behavioral treatment draws on a number of therapeutic strategies when addressing Social Phobia. While the specific approaches used may vary based on your symptoms, your therapist, and the setting in which you are being treated, CBT for Social Phobia often includes many of the following components:

The most effective psychological treatment for Social Phobia currently available is called cognitive behavioral therapy, or CBT. Numerous research trials have demonstrated a clear advantage for CBT, and the treatment is now widely accepted as a first choice treatment for Social Phobia. While the specific ways in which CBT for Social Phobia can be administered may vary somewhat between therapists, a number of features distinguish this approach from other commonly used psychotherapies:

Social anxiety is a feeling of uneasiness, dread, or apprehension about social interaction and presentation. Frequently, the primary concern fueling social anxiety is a concern that one will be (or is being) judged negatively by other people, regardless of whether this is actually the case. The experience of occasional, mild social anxiety is quite common, as is the experience of anxiety in general. Social anxiety can range from a relatively benign, infrequent level of severity to being a major hindrance in everyday life. Social Anxiety Disorder or Social Phobia are mental health diagnoses used to describe a level of social anxiety that is so distressing, excessive, and/or pervasive that it is significantly interfering with an individuals quality of life. The feared or avoided situations in Social Phobia can be very narrow and specific, or may extend to the majority of ones interactions with others.

Blair, K., Shaywitz, J., Smith, B. W., Rhodes, R., Geraci, M. R. N., Jones, M., et al. (2008). Response to emotional expressions in generalized social phobia and generalized anxiety disorder: Evidence for separate disorders. American Journal of Psychiatry, 165, 1193-1202.

Social anxiety becomes a problem only when it is so severe that it is excessive or outside the norm, and when it causes major problems in our overall functioning and quality of life. When our social anxiety leads us to consistently avoid social situations, to be very distressed when exposed to them, to have excessive fears of being negatively judged by others,Anxiety or to miss out on things that we otherwise strongly want or need to do, mental health professionals may consider a diagnosis of Social Phobia (also known as Social Anxiety Disorder) (American Psychiatric Association, 2000).

Do I have Social Phobia?

Dr. Antony is Professor and Director of Graduate Training in the Department of Psychology at Ryerson University in Toronto, Ontario, Canada. He is also President-Elect of the Canadian Psychological Association. He has published more than 25 books and over 150 scientific articles and book chapters, mostly on the topics of anxiety disorders and cognitive behavioral treatment. His website can be found at

Department of Psychology, Ryerson University, Toronto, Ontario, Canada

Social anxiety can emerge in a wide range of situations – essentially, whenever we are in contact with other people or believe we may become a focus of others attention (Antony &or that job interview, well likely do better if were extra careful in choosing our words and our outfits.

CBT is collaborative – the client and therapist work together as a team. The therapist does not simply tell you what to do or think. Together, you and your therapist develop strategies for overcoming anxiety.

Anxiety is a feeling of uneasiness, apprehension, and/or dread about a real or imagined future event. It is tied to a sense that these unpleasant events are at least partially unpredictable and uncontrollable, and therefore accompanied by an uncomfortable level of uncertainty.

Beta-Blockers: Beta-blocker medications such as propanolol (Inderal) can be used to lower the physical symptoms of social anxiety, such as shaking, sweating, and racing heart. Because of this, they are commonly used for anxiety in performance situations such as public speaking or performing music. They do not usually have significant effects on anxious thoughts or anxious behaviors. Nor are they an effective treatment for generalized Social Phobia.

Anxiety Treatment and Research Centre, St. Josephs Healthcare, Hamilton, Ontario, Canada

Martin M. Antony, Ph.D., ABPP

In Vivo Exposure: In vivo (real life) exposure is another core element of CBT for Social Phobia. You and the therapist identify situations that you avoid because of Social Phobia, and then gradually enter these situations while accepting your anxiety and allowing it to naturally dissipate. While this step probably sounds quite intimidating, it is important to know that exposure is done at a very gradual, planned pace, and that your therapist will support you throughout the process. Many clients report exposure practices as being among the most useful elements in their treatment.

Our Genes: Ongoing research on the genetic foundations of physical and mental health suggests that a tendency toward anxiety, and social phobia in particular, has a moderate level of heritability – in other words, if your parents have Social Phobia or another anxiety disorder, you are somewhat more likely to have an anxiety disorder yourself, because of genes inherited from your parents.


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