Does this scenario sound familiar? The boss says you need to do a presentation in front of some high-powered executives. A week later, you're facing 25 cold, stony faces. You begin to sweat. Your throat tightens and you feel like you're choking. Your heart is doing a tap dance against your ribcage. You begin to feel dizzy and wonder if you're going to be able to stand up. Or how about this: Every time you go out to dinner with someone you're interested in, you freeze up with anxiety. You feel the sweat forming on your brow; your breathing becomes rapid and shallow. The words stick in your mouth, and you feel like a complete idiot. You are very sure the person you're with also thinks you are a complete idiot. As a result, you now keep to yourself, avoiding contact with anybody except business connections.
If these descriptions sound like you or someone you know, you may already know something about social-anxiety disorder, also called social phobia. This disorder is defined as the intense and persistent fear of being scrutinized, judged adversely or humiliated in social situations. When social-phobia sufferers find themselves in the feared situation, they often experience panic attacks. As much as 13 percent of the general public suffers from social phobia over the course of a lifetime, and many will suffer impairment in their educational, financial and vocational lives. Nearly one third of social-phobia sufferers wind up abusing alcohol, probably as "self-medication" for their anxiety. Some even consider suicide, especially if social phobia is accompanied (as it often is) by another psychiatric disorder.
Some studies show that social phobia is more common in women than in men; however, in most clinical settings, the sexes are about equally represented. Social phobia typically has its onset in the mid-teens, sometimes in a youngster with a history of shyness. Onset of social phobia can follow a specific, humiliating event, or develop insidiously over many years. Children who show "selective mutism" (refusing to speak in certain social situations) may suffer from a form of social phobia. For some, social phobia is confined to a few very specific situations, such as public speaking. For others, social phobia is more pervasive and extends to nearly all social situations. The bad news is that, if left untreated, social phobia is usually a chronic, unremitting, lifelong disease. The good news is that there are now several effective treatments for this debilitating disorder.
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.