26. February 2020
Sweaty hands, trembling voice, racing pulse – almost everyone knows this excitement when you have to speak in front of an audience. It’s normal to feel uncomfortable when other people’s attention is focused on us. Few people are completely confident in such situations. However, in people who suffer from social phobia, the tension in such situations is so extreme that anxiety and panic develop
Typically, a social phobia manifests itself in social interaction or performance situations. More specifically, this means that, among other things, lectures, presentations, oral exams and job interviews trigger great anxiety in sufferers. These fears can understand many non-affected still well. However, the anxiety takes on proportions that cannot be explained by normal excitement. In addition, those affected by social phobia also find everyday situations very stressful. Examples include visits to authorities, verbal orders, telephone calls, small talk or eating in company.
Fear of being judged or humiliated
Individuals affected by social phobia often have similar fears. They have a great fear of:
Sometimes just thinking about one of these situations is enough to trigger the anxiety. The fear can rise so quickly that it develops into a panic attack. At the same time, affected individuals certainly recognize that the fear is exaggerated and unreasonable. However, they do not manage to calm down effectively.
Vicious circle of avoidance
Such strong fears are very stressful. Therefore, it is understandable that individuals with social phobia begin to avoid the anxiety-provoking situations. This vicious cycle of avoidance is characteristic of social phobia. But avoidance is not always possible! Everyone must be exposed to some degree of social interaction. As a result, sufferers experience constant anxious anticipation and intense discomfort. The level of suffering is high in almost all sufferers.
Many affected persons were already rather shy and reserved in childhood. If such a personality meets an overprotective or but authoritarian upbringing style, this can be a risk factor for social phobia. In some cases, the caregivers were themselves anxious and socially awkward in childhood, so that the child could learn little from them. In technical language, it is said that the parents could not be a good model for social situations and interactions. However, social phobia can also result from one or more negative experiences related to interaction situations.
Increased self-attention Affected individuals are often very sensitive to social stimuli, i.e., they notice and interpret even very subtle behaviors of their peers in ways that are damaging to their self-esteem (e.g., “The bystander laughed, she must have meant me, I made a fool of myself”). Another factor is high self-attention. Affected persons observe themselves permanently and notice even the smallest change (e.g., a slight blush on the face or a small slip of the tongue).
Excursus: A psychological term in this context is the “spotlight” effect. It states that people in principle overestimate how strongly other people perceive and evaluate their behavior or appearance. We therefore see ourselves in the spotlight, although others probably do not perceive us in every detail. This effect is more pronounced in socially phobic people.
The level of suffering associated with social phobia is enormous. Often, individuals desire functioning social relationships, but fail to overcome their fears and come into contact with those around them. Loneliness and sadness result, which not infrequently end in an accompanying depression.
High risk for substance abuse
In order to better endure unavoidable interaction situations, many sufferers turn to tranquilizers, drugs or alcohol. They believe this is the only way they can face the situation. The risk of substance abuse is consequently particularly high for people with social phobia.
As with most anxiety disorders, the best-proven therapy is cognitive behavioral therapy. Core elements here are identification, modification, and confrontation.
Identification (Recognition): Individual thought and behavior patterns are recognized and traced in their development. For example, the parent’s parenting style or negative self-evaluation loops are inspected more closely. The affected person should develop a precise understanding of his or her disorder.
Modification (Changing): Through cognitive restructuring, i.e., changing thoughts, the high self-attention and negative self-appraisal should be reduced. Often a change of perspective also helps: we all know the phenomenon: on the spectator side we notice and evaluate the excitement of our counterpart much less than assumed by social-phobic persons.
Confrontation (juxtaposition): Social situations are practiced in psychotherapy and eventually performed in real life. The idea is that there will be a habituation and practice effect that will make it easier for the person to handle social situations in the future.
Psychotherapy can be accompanied by medication. This is particularly indicated if depression has already developed concomitantly. Many clinics also offer social skills training in groups. Here, those affected can practice various social situations in a protected setting.
There are some differences between normal excitement before social situations and social phobia. When sufferers or family members notice that social situations are deliberately avoided and the very thought of them triggers agonizing thoughts, professional help is important. If the social phobia is treated well, then social situations can finally be mastered without fear and life satisfaction can increase enormously.