Social phobia is, like all phobias, an anxiety disorder. Social phobia is defined as a intense and persistent fear of social situations in which the person is exposed to the evaluation of others and thinks it will be negative.
It is worth mentioning that we are social beings and we appreciate being well valued by others and being part of the group, so it is normal to take into account the reaction and perception of others. However, in social phobia, the worry is much higher than one would expect in relation to the situation. The anguish and discomfort felt by the person with social phobia are not justified by real danger.
The symptoms presented by a person with social anxiety are the following:
- Avoidance of social situations. A person with social phobia will do everything possible to avoid events that cause anxiety.
- Great discomfort. If she cannot escape the situation, she will experience it with great anguish and discomfort. The typical symptoms of anxiety are: tachycardia, feeling of suffocation, muscle tension, nausea, chills, dizziness, diarrhea, flushing, sweating, trembling, urgency to urinate or defecate…, which can reach a .
- Blocking. The anguish makes them unable to speak fluently.
- Affectation at an academic or work level. We speak of a disorder when the symptoms presented negatively and significantly affect the person’s life.
- Impact on a social level. People with social phobia have great difficulty interacting, so it will be difficult for them to make and maintain friendships. It will also be more difficult for them to meet new people and have a partner.
- Intention to go unnoticed. People with social phobia do not want to stand out, something that also affects their social and work life.
- Unsafety. The lack of security is the origin of the fear of being judged.
- Fear of rejection. Exaggerated fear of criticism from others.
- Catastrophic thinking about social situations. An irrational belief that provides an extremely negative evaluation to social interaction situations.
- Error in performance perception. The person with social phobia considers his performance in social situations much worse than it really is.
- Anticipation. Anxiety does not only occur at the moment of the feared situation, but also when thinking about it.
This reaction occurs in situations such as having a conversation, attending a party, being in a group, making a phone call, talking to strangers, conducting an interview, speaking or acting in public, being exposed, talking to superiors…
Like most psychological disorders, the cause or causes of social phobia are not yet known. There are various factors that increase the vulnerability to presenting it. Next, we will see the variables and factors that are related to the origin and maintenance of this anxiety disorder:
- Genetic heritage. Studies with twins, such as that of Nelson et al. (2000) demonstrate that genetic inheritance influences and predisposes the development of phobia.
- Psychopathology of parents. Whether parents have a mental disorder is also related to the predisposition to present social phobia, especially if it is the same.
- Tendency towards high activation of the autonomic nervous system. A greater production of adrenaline and norepinephrine in the face of stress produces the typical symptoms of anxiety such as tachycardia, sweating, tremor…
- Behavioral inhibition. This temperament trait consists of isolation and quietness, and is also related to social phobia.
- Anxiety sensitivity. In relation to the activation of the autonomic nervous system, sensitivity to anxiety also refers to the importance given to these bodily symptoms.
- Education. The information transmitted about how behavior should be forms beliefs and thoughts that can be distorted, such as the need to please others.
- Traumatic experiences in childhood. For example, a loss or separation from parents, an abusive situation…
- traumatic event. Whether it has happened in the first person, by observation or by transmission of information.
- Avoidance. After an unpleasant experience, if similar situations are avoided, fear is reinforced and the physiological anxiety response is maintained.
- Threat perception. The situation is associated with threats such as rejection or humiliation, so the body responds with the activation of the autonomic nervous system.
- High stress levels. Exposure to high levels of stress increases vulnerability to future stressful experiences and also sensitivity to current stressful experiences.
Some authors propose differentiating between various types of social phobia depending on the context in which the symptoms occur, although there is controversy in this regard. Some of the types are:
- In formal contexts
- In informal contacts
- When they require assertive behavior to express annoyance
- Observational
- Acting
- Interaction
- Interaction with the opposite sex
- Interaction with superiors
It seems that the most accepted classification is the one that differentiates:
- Social performance phobia: in cases where fear occurs only in situations of acting or speaking in public.
- Generalized social phobia: if the symptoms occur in the vast majority of social situations.
Social phobia, like the rest of psychopathology, is evaluated through the general clinical interview, the diagnostic interview (such as the International Diagnostic Interview or the Interview for Anxiety Disorders), self-report measures, specific social phobia questionnaires. and self-records (in which the situation, thoughts, emotions, discomfort and behavior are captured).
Within the specific social phobia questionnaires, which we could call social phobia tests, we can find the Social Anxiety and Phobia Inventory (SPAI), the Liebowitz Social Anxiety Scale (LSAS), the Social Phobia Scale (SPIN), the Social Anxiety Questionnaire for Adults (CASE-A30) or the Watson and Friend Social Anxiety Scale (SADS). Here you will find one so that you can clarify if you identify with the symptoms of social phobia.
The most studied and validated psychological treatment for social phobia is CBT, although ACT has also been shown to be effective for . CBT defends that by changing behavior, we change thoughts and vice versa. For its part, the ACT proposes accepting the discomfort. In phobias, one of the main symptoms is avoidance and, precisely, ACT obtains especially good results with avoidant patients.
We are going to see several techniques and strategies to overcome social phobia coming from different psychological perspectives.
1. Group support
Due to the characteristics of this disorder, the effectiveness of the treatment increases with group sessions. Groups are usually between 4 and 9 people. The group also serves to practice the social skills learned.
2. Psychoeducation
It explains what an anxiety disorder is and what social phobia is. The cognitive and behavioral factors that cause and maintain anxiety and how psychology addresses it so that it does not disable are also explained. Treatment techniques, procedures and objectives are explained. The objective is for the patient to understand that avoidance maintains the symptoms and to understand why it is so important to expose oneself to situations.
It is also important to demystify some of the myths related to anxiety: anxiety is not dangerous, the anxiety attack ends, anxiety is not a sign of weakness, anxiety is not “bad”, sometimes it is adaptive.
3. Identification of automatic thoughts
What activates and increases the level of anxiety are the beliefs and thoughts about the situation, and not the situation itself. Therefore, it is vitally important to identify these automatic thoughts that run through your mind. To identify them, the person needs to pay attention to the internal dialogue and record the automatic thoughts that appear. Normally, supported by irrational beliefs about the world, about others or about himself or herself. For example, that he will never be able to express her opinion or that others will judge him. Irrational thoughts are illogical, cannot be proven, are absolutist, and produce disturbing emotions.
4. Cognitive restructuring
Once automatic thoughts and the irrational beliefs that support them are identified, they can be discussed and replaced with more rational and adaptive beliefs. Through debate and the application of logic and evidence, it is intended to change those beliefs. In this article, you can see the . It is one of the best exercises to overcome social phobia.
5. Behavioral experiments
Reality tests and behavioral experiments can also be used, such as asking other people for evaluation or videotaping a social interaction of the patient. Other ideas are to make a small mistake or expressly reveal yourself to verify that the consequences that occurred do not correspond to the severity of the imagined consequences. In this way, the person can verify that his or her anticipations do not occur.
6. Acceptance of discomfort
The treatment of anxiety disorders, such as phobias, involves accepting the symptoms of anxiety. Acceptance is about stopping fighting anxiety symptoms. Anxiety is an activation mechanism of the body that aims to put the body in optimal conditions to face a danger (which may be real or imaginary). Therefore, anxiety is a phenomenon that helps our survival. The problem is that when this information is not known and anxiety is not understood, it can generate a lot of fear because it is an unpleasant sensation. It is necessary to accept anxiety symptoms, as well as accept discomfort and discomfort as part of life.
7. Relaxation techniques
There are many relaxation techniques and they serve to reduce the activation of the prasympathetic nervous system, responsible for physiological symptoms. They are techniques that must be learned and practiced regularly for them to have benefits. The most used are:
- The , which consists of carrying out the breathing movement with the diaphragm instead of with the thorax. It is learned by placing one hand on the chest and the other on the abdomen, inhaling slowly, taking the air to the end of the lungs and noticing how the abdomen swells and not the chest. When exhaling, try to empty the air slowly, noticing how the abdomen deflates.
- It consists of learning to relax the body through tension relaxation exercise. It is learned by tensing and relaxing each area of the body, making these areas progressively wider, to finally be able to relax and relax the entire body.