Previously called social phobia the sufferer experiences anxiety in anticipation and performance in one or more social situations. The person is afraid others will see there anxiety and it will be humiliating.
It is one of the commonest emotional disorders affecting up to 12% of the population. It is most common in late adolescence and early adulthood. Shy inhibited children and persons with Autism Spectrum Disorders, as well as persons with Eating Disorders are more prone to social anxiety.
The common anxiety provoking situations are:
- speaking in front of a group
- speaking to persons in authority
- eating in public
- going to parties
- returning borrowed or purchased items
A vicious cycle sets up where the person avoid the situation or manages the situation with drug abuse – as a result of which a lack of social skill develops around the situation setting up the likelihood of negative outcomes (the self-fulfilling prophesy).
The typical underlying thoughts are- “My mind will go blank and I wont have anything to say” ; “It will be disastrous if people see I am nervous“; ” I can’t stand being nervous“; “Its not fair- other people don’t get nervous”
There is no diagnostic test for social anxiety though there is a scale called the Liebowicz Social Anxiety Scale which rates the severity and progress of social anxiety symptoms.
So the treatment goals for social anxiety are-
- Improve self esteem
- Get the person to fight their anxiety rather than surrender toit
- Learn to lower overall arousal levels so that panic attacks are less likely
- Improve social competency through practice
I favour the following treatment options:
Improving Self Esteem & lowering Arousal –Hypnotherapy -Addition of a low dose benzodiazepine Clonazepam 0.5mg twice to three times a day –Inositol 600mg twice a day (this is a health food item)
Fighting Anxiety and Improving Social Competency –Reduce safety behaviours and avoidance -Replace negative anticipation with positive self talk -Introduce the idea of a safe place to go to when nervous -Establish a regime of gradual exposure to the scary situation
Sometimes SSRI antidepressants such as Prozac or Aropax are helpful.
About 30% of people with social anxiety suffer from excessive sweating or blushing and there are separate treatments for these. Irritable bowel Syndrome can be another condition that needs treatment.
Brain imaging of persons treated successfully for social anxiety show increased activity in the inferior parietal lobe and precuneus which relate to being able to flexibly focus one’s attention to things (rather than to over-focus on ones anxiety). There is also decreased activity in the insula which is part of the brain that monitors bodily well being.
With treatment at 1 yr 20% are fully cured and 40% improved. At two years its 45% fully cured and 40% improved. There is also a significant spontaneous recovery rate over an average 8yr period.