Social Anxiety Disorder (Social Phobia)

Introduction 

Social anxiety disorder (social phobia) is a persistent and overwhelming fear of social situations. It's one of the most common anxiety disorders. Social anxiety disorder is much more than "shyness". It can be intense fear and anxiety over simple everyday activities, such as shopping or speaking on the phone.
Many people sometimes worry about certain social situations, but someone with social anxiety disorder will worry excessively about them before, during and afterwards. They fear doing or saying something they think will be embarrassing or humiliating, such as blushing, sweating or appearing incompetent.
Social anxiety disorder is a type of complex phobia.

This type of phobia has a disruptive or disabling impact on a person's life. It can severely affect a person's confidence and self-esteem, interfere with relationships and impair performance at work or school. Social anxiety disorder often starts during childhood or adolescence and tends to be more common in women. It's a recognised disorder that can be effectively treated, so you should see your GP if you think you have it. 

Signs of Social Anxiety Disorder (SAD)

A child with social anxiety disorder may cry more than usual, freeze, or have tantrums. They may fear going to school and taking part in classroom activities and school performances.

Teens and adults with social anxiety disorder may:

Dread everyday activities, such as:

• meeting strangers
• talking in groups or starting conversations
• speaking on the telephone
• talking to authority figures
• working
• eating or drinking with company
• shopping

they may also:

• have low self-esteem and feel insecure about their relationships
• fear being criticised
• avoid eye-to-eye contact
• misuse drugs or alcohol to try to reduce their anxiety  

Panic attacks

The fear of a social situation can sometimes build up to a panic attack, where you feel an overwhelming sense of fear, apprehension and anxiety. This usually only lasts a few minutes. You may also experience physical symptoms, such as feeling sick, sweating, trembling and heart palpitations. These symptoms often reach a peak before quickly passing. Although these type of symptoms can be alarming, they don't cause any physical harm.

This fear or anxiety is out of proportion to the actual threat posed. Although anxiety about some social situations is common in the general population, people with social anxiety disorder can worry excessively about them and can do so for weeks in advance. They may also ruminate on social events they perceive have gone wrong for weeks afterwards. Usually the condition causes significant impairment in social, occupational, or other areas of functioning.

Symptoms of Social Anxiety Disorder

Examples of situations that can provoke social anxiety are:

• Any situation that involves human interaction
• Inviting people into the home
  
• Eating or drinking while being observed
• Using public toilets
• Attending parties
• Starting conversations or not being able to think of something to say
• Shopping when interaction is required, such as at checkouts or in smaller shops
• Swimming, gym or exercise classes
• Talking to authority figures
• Working or going to school
• Activities with peers
• Being the centre of attention
• Signing documents or writing in front of people
• Social interaction and meeting people, including strangers
• Public performance including speaking in groups
• For children and young people; participating in classroom activities, asking for help in class and participating in school performances

Feelings and emotional symptoms:

• Anxiety, stress or worry
• Embarrassment, shame or humiliation
• Loneliness
• Acting ir feeling foolish
• Feeling panicky or having panic attacks
• Fatigue
• Frustration or anger
• A fear of negative observation/evaluation

Physical and cognitive symptoms:

• Feeling hot, blushing, sweating, developing a rash
• Dry mouth and throat
• Facial freezing or tension
• Hand tremor
• Racing heart or palpitations
• Trembling
• Headache
• Grinding teeth
• Nausea or butterflies, a churning stomach
• Unable to think straights or the mind goes blank
• Stumbling over words
• Racing thoughts
• Poor concentration and short-term memory
• Easily distracted and uncoordinated
• Self-criticism
• Urgency to use the toilet
• Tightness in the chest or hyperventilation
• Crying
• Feeling light-headed or faint

Behavioural symptoms and safety behaviours

• Distraction (not listening, fidgeting)
• Housebound
• Not speaking or speaking quietly
• Avoiding eye contact
• Leaving/avoiding the situation
• Talking excessively
• Avoiding initiating conversations
• Non-assertive behaviour
• Missing appointments, events or classes
• Choosing solitary hobbies or careers

Treatment for Social Anxiety Disorder (SAD)

There is a robust body of evidence, based on large randomized controlled trials, to support the efficacy of both medications and cognitive-behavioral therapy (CBT) for the treatment of SAD.

Both pharmacotherapy and CBT are empirically supported choices for first-line management of SAD.

Cognitive-behavioural therapy (CBT) is currently one of the most accepted and practiced psychotherapies used to treat social anxiety. CBT is a research-based therapy, meaning its accepted strategies and methods come from numerous clinical studies that yielded high success rates and proven effectiveness. While treatment will vary by therapist and by the needs of the client, these are some core features of CBT:

• Client and therapist work as a team, collaboratively developing strategies for overcoming anxiety 
• A focus on learning new skills and strategies to deal with the anxiety
• A brief therapy consisting of usually 12 - 16 sessions
• A focus on changing the present and looking at current cognitive and behavioural patterns, rather than the past
• Client and therapist work together to create specific goals and agendas that allow the client to become his/her own therapist
• Identifying and understanding thought patterns to gain better control and flexibility over them in social situations
• Homework in the form of real-life experiences in between sessions that allow clients to practice new ways of thinking and behaving

Social skills training

As a supplement to CBT, many people find some form of social skills training very helpful. Obtaining practice and training in skills such as speaking in public, carrying out a conversation and maintaining eye contact can be very beneficial and can build confidence and increase comfort in social and performance situations.