A reader from Seattle, Washington asks: 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.
Johns Hopkins psychiatrist Emily A. Bost-Baxeter, M.D. answers: 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.
Your treatment options: 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.
