Johns Hopkins Health Alert
Talking About Social Phobia
In this Health Alert, psychiatrist Emily A. Bost-Baxeter, M.D. explains social phobia and discusses treatments.
Q. Where do you draw the line between shyness and social phobia? I get overwhelmed with anxiety in many social situations. It has affected my career and my ability to socialize and date. I am wondering whether medication could help me. I'd appreciate your input. Seattle, WA
A. A phobia, in general, is an irrational, intense, persistent fear of an object or a situation. Social phobia, also called social anxiety disorder, involves an irrational, intense, persistent fear of social situations in which embarrassment can occur. Individuals with social phobia are overwhelmingly concerned about being watched or judged by others and are exceedingly anxious and self-conscious in social situations. This anxiety frequently produces physical symptoms including sweating, blushing, nausea, shortness of breath, racing heart, and panic attacks, which often make the individual even more self-conscious.
Treatment for social phobia involves medication and psychotherapy. Medication management ranges from antidepressants (especially serotonin reuptake inhibitors, such as Paxil, Zoloft, and Effexor, which are used to reduce anxiety in general) to medications used specifically for stressful, social situations (benzodiazepines). Beta blockers, a type of blood pressure medication, are helpful in reducing the physical symptoms of anxiety by lowering heart rate and decreasing blushing. Reducing these physical symptoms helps patients to feel less self conscious.
Psychotherapy, particularly cognitive behavioral therapy, is as important as medication management for the treatment of social phobia. Cognitive behavioral techniques specifically aimed to help social phobia include relaxation training, gradual exposure to feared situations, and cognitive talk therapy, in which an individual learns to replace fearful thoughts with more realistic thoughts.
An evaluation by a primary care physician or a psychiatrist is necessary to exclude medical illnesses that can cause anxiety and to determine what type of treatment would be most helpful. If the doctor concludes that medication is not necessary, engaging in cognitive behavioral therapy to learn effective coping skills for anxiety would certainly be beneficial.
Posted in Depression and Anxiety on July 16, 2008
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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With respect, I would like to raise a couple of points:
Many of those who are social failures are Asperger's, and continued failure to understand the social dynamics or even to perceive them will lead to avoidant behavior and serious social phobia.
Talk therapy has been found to be somewhere between unproductive and counterproductive in many cases of Asperger's and love-shy individuals. The best treatment other than drug therapy seems to be practice dates with trained surrogates, up to and including sex. These people need to have actual success in life in order to reverse sometimes years or decades of frustration and failure. The surrogate needs to be capable of explaining the dynamics in a clinical way using straightforward language, in the same way as one might describe changing a tire.
Drugs such as meperidine are sometimes helpful under these circumstances - SSRI's can be a problem due to their likely sexual side-effects, and the benzodiazepines may not be effective in realistic therapeutic doses. True social phobia/love-shyness is incredibly refractory. A class of drugs that shows great promise is the methylenedioxymethamphetemine derivatives, though these are currently regulated as Schedule 1 or equivalent in most countries.
Posted by: docmike | July 19, 2008 4:09 PM