The Mind-Body Connection
Social-phobia sufferers often show a characteristic pattern of thinking, which shapes the way they feel. For example, they may approach a public speech with thoughts like, "I just know I'm going to blow this. I'm going to break out into a sweat and everybody is going to be laughing at me. I'll lose my job if I blow this speech. And who would want to hire a jerk like me anyway?" This sort of negative "self-talk" may not be the cause of social phobia, but it almost certainly fuels the condition. These self-destructive thoughts can also lead to bodily symptoms such as sweating, shaking and choking.
Fortunately, cognitive behavioral therapy (CBT) helps social-phobia sufferers examine, challenge and change many of these irrational assumptions about themselves and others. CBT teaches people to examine the negative self-talk and to replace it with more rational, positive thoughts. Even if you have a problem with public speaking, does that really make you a jerk? And what is the evidence that nobody will ever want to hire you if you blow a single speech? CBT also helps social-phobia sufferers learn social skills, relaxation techniques and ways of confronting -- rather than avoiding -- the feared situation.
Recently, a number of commonly prescribed antidepressant medications have been found to be useful for social phobia. Selective serotonin reuptake inhibitors (SSRIs) such as Paxil, Zoloft or Prozac are now the medications of first choice, in most cases. Anti-anxiety agents such as clonazepam (Klonopin) may also be useful, but they pose some risk of dependency if taken for long periods of time. While CBT and medication seem to be about equally effective for social phobia, the benefits of medication wear off if the medication is stopped. CBT, on the other hand, may help protect the individual from relapses of social phobia over longer periods of time. For some patients, a combination of CBT and medication may be the best regimen.