Social Phobia

What is Social Phobia?

Social phobia is the fear of one or more social situations where you can be evaluated negatively by other people. Commonly feared situations include public speaking, meeting new people, parties, asking for dates, eating in public, using public rest rooms, speaking to people in authority, and disagreeing with others. People with social phobia are afraid that they will act in ways that will make other people think badly of them. They often fear that others will see some sign of anxiety, such as blushing, trembling, or sweating. People with social phobia usually try to stay away from the situations that make them anxious. When they cannot, they tend to feel very anxious or embarrassed. Sometimes they may have panic attacks.

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Social phobia can cause problems in people’s lives. Sometimes the problems are minor — such as not being able to speak up in class. Sometimes, however, the problems can be very serious. People with severe social phobia often have few friends, feel lonely, and have trouble reaching their goals in school or at work.

Who gets Social Phobia?

Social phobia is very common. More than one out of eight people will suffer from social phobia at some point in their life. Many more people have symptoms of shyness that are not severe enough to be called social phobia. Social phobia is twice as common for women as for men. However, men are more likely to try to find help for the problem. Social phobia usually starts when people are in their early teens, but it can begin much younger. If people do not get help, the problem can last for years.

What causes Social Phobia?

The exact causes of social phobia are not known. However, some things are believed to contribute to the problem.

These include:

  • Prior experiences. Many people with social phobia remember having been embarrassed or humiliated in the past. This leads them to be afraid the same thing will happen again. Soon, they start avoiding social situations. Over time, this tends to make them feel even more afraid.
  • Negative thinking. People with social phobia often have negative thoughts about what will happen in social situations. Common thoughts are “I won’t be able to think of anything to say”, “I’ll make a fool of myself”, “People will see I’m anxious”. They also tend to have standards that are hard to meet, such as: “I should never be anxious”, “You have to be beautiful and smart to be liked”, or “I have to get everyone’s approval”. Often they have negative beliefs about themselves, such as: “I’m boring”, “I’m weird”, “I’m different from other people”.
  • Lack of social skills. Some people with social phobia never had the chance to learn social skills. This can cause them to have problems in social situations. Other people have good social skills, but they get so anxious that they have a hard time using them.
  • Genetics. People with social phobia often have relatives who are shy or have social phobia.

How does Cognitive-Behavioral Therapy for Social Phobia work?

Cognitive-behavioral therapy helps you change the things that cause your fear. Your therapist will teach you how to recognize your negative thoughts and to think more positively. He or she will also help you gradually face the situations you have been afraid of in the past. This allows you to discover that your fears usually do not come true. In addition, your therapist can teach you social skills and ways to relax, which can help you feel more confident.

What evidence is there that cognitive-behavioral therapy works?

A number of studies have shown that most people who get cognitive-behavioral therapy for social phobia feel less anxious. People usually continue to feel better even after therapy has stopped.

How long is therapy?

For people with mild to moderate social phobia, 20 sessions is usually enough. People with just one social fear, such as public speaking, may need fewer sessions. People with more serious symptoms may need more.

Can medication help?

Several different types of medication have been found to be helpful for social phobia. Your physician or a psychiatrist can recommend the one that would be best for you. One problem with medications for social phobia is that symptoms often return if the medication is stopped. For this reason, it is best that if you do take medication you also get therapy.

What do I need to do?

Many people feel anxious at the beginning of therapy and wonder if they can be helped. All you have to do is to be willing to give therapy a try. Your therapist will teach you things you can do to help yourself and ask you to practice them between sessions. Early exercises will be quite easy and will become more challenging as you feel more comfortable. The more you work on these exercises, the more likely it is that your social phobia will get better.

Recommended Readings:

Anxiety Free: Unravel Your Fears Before They Unravel You by Robert L. Leahy
The Worry Cure: Seven Steps to Stop Worry from Stopping You by Robert L. Leahy

Blog Posts on Social Anxiety:

Clinicians may find the following books on cognitive behavioral therapy to be helpful in treating anxiety:

Leahy, R. L., Holland, S. J., & McGinn, L. K. – Treatment Plans and Interventions  for Depression and Anxiety Disorders (2nd ed.)
Leahy, R. L. – Cognitive Therapy Techniques
Sookman, D. and Leahy, R. L. – Treatment Resistant Anxiety Disorders: Resolving Impasses to Symptom Remission

Cognitive Therapy
Substance Abuse Miniseries by
Dr. Graham Reynolds