Social
Phobia (Social Anxiety Disorder) This phobia centers on social or performance
situations. The patient is afraid of being embarrassed or humiliated by being
exposed to this situation.
Examples of Social
Phobias: One person who never had a problem in the
school system finds that when it comes to public speaking in front of a crowd
he/she clams up, cannot think while speaking and chokes up having to stop or interrupt
the speech. As a result it appears that the person would not know the subject
despite being a specialist in the area. Another case
maybe a University student who has problems because of failed tests. Under the
pressure of the exam the student simply cannot finish all of the tests in time
and whatever is finished is below standard, as the student can't concentrate.
Social phobias lead to underachieving in school, University
or at the work force. Patients with this type of phobia suffer much more inside
than they like the world around them to know. Figures of authority intimidate
them. They find it difficult to socialize as they may blush, particularly when
they want to socialize with the opposite sex. This leads to relationship problems
as they say inappropriate things just because they are so nervous, forget, can't
concentrate and often say things that they do not really mean. Adolescents
and adults usually are aware that their fear and anxieties are exaggerated and
not reasonable, but children usually do not have this insight. Instead children
may be observed to cry for no apparent reason, throw temper tantrums, freeze or
to quickly withdraw from social situations when they do not know the persons.
This can be embarrassing for the parents and they may inappropriately attempt
to discipline the child instead of seeking professional advice. Social
phobias infiltrate many aspects of life such as attending parties, starting and
maintaining conversations, dating, public speaking, school, work and others. |
Statistics and outcome of social phobias:
There are a wide variety of statistics depending on what severity of social
phobia is included. If moderately severe or severe symptoms are included, then
about 8% of the population have a lifetime episode of a social phobia.
Specifically,
in the case of fear of public speaking about 20% of people would say they have
it. But when this is put to the test by asking the interviewed people to give
a mini speech, only 2% actually do have a significant phobia. The others simply
have the normal amount of performance anxiety that still is within normal limits.
Social phobias are usually never so severe that they would lead to hospitalization,
but they are a significant factor in outpatient counseling clinics where they
account for about 15% of the overall clientele. There often is a family
history of social phobias. First degree relatives have a higher probability to
develop this as well when compared to the general public. Onset is usually
abrupt following a humiliating experience. But other cases occur in childhood
and then continue. It seems to mostly stay life long, but it waxes and wanes.
Even a positive work situation like a job promotion, where the worker moves up
into a management position, can trigger a social phobia when the worker is required
to do public speaking. A social dating phobia may disappear when the person marries,
but flare up again when the partner dies or gets a divorce. Social phobias can
develop into or be associated with obsessive-compulsive disorder panic disorder
with agoraphobia, mood disorders, somatization disorders or substance-related
disorders. Treatment of social phobias: Generally
speaking it is advisable to desensitize the patient through the use of exposure
therapy. For instance, a fear of public speaking is best overcome by joining Toastmasters.
With this self-help group there is a basic training program with 10 different
speeches, which the person can prepare for at a self-controlled pace. As all the
other members at one point also had a public speaking phobia, this is the ideal
club setting, where it is safe to make mistakes and learn from other people's
mistakes by listening to their speeches. In this fun setting the fear of public
speaking is soon replaced with an endeavor of becoming an accomplished public
speaker and this is rewarded at the end with an"Able Toastmaster" pin.
At this point the patient knows that the phobia is cured. This was achieved entirely
through the efforts of such a self-help group.
However,
with more specific social phobias it is more difficult to approach the subject.
If the boss is an intimidating type and the phobia is regarding meeting this boss,
then arranging meetings with him to get desensitized may not be the appropriate
therapy. Instead desensitization can be achieved with hypnosis using a protocol
similar to the one suggested in Ref. 6. Under hypnosis the patient can be asked
to meet his boss in his mind's eye and then a meeting can take place step by step
with the regular inappropriate emotional reaction, followed by the appropriate
emotional response. By rehearsing a fictitious meeting under hypnosis in the therapist's
office followed by a posthypnotic suggestion that the actual meeting will bring
back all the good memories of this session, will often achieve the desired result
of coping better when the boss is met again. In case the patient cannot
take hypnotherapy sessions, can't find the right therapist or wants medication
instead, the SSRI sertraline (brand name: Zoloft), the MAO inhibitor phenelzine
(brand name: Nardil) or the long-acting benzodiazepine clonazepam (brand name:
Rivotril) can be used. Often patients attempt to solve social situations themselves
with substance abuse, but this leads to alcohol abuse (or drug abuse) and this
has to be treated as a separate additional problem by the doctor. For more
info on social phobia click here. |
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