Weekly Column

March, 2008

David Prescott, Ph.D. – Acadia Hospital

Social phobia, or social anxiety disorder, is characterized by intense and excessive fear about everyday social situations.  People with social phobia have more than a nervous moment or two when they interact with other people.  The anxiety they experience is overwhelming. 

It would be difficult, if not impossible to count all of the social encounters that most of us have each day.  Imagine watching a movie of yourself as you go about your day and noting every single social interaction.  Surely the number is often in the hundreds.  Now, imagine that for most of these interactions - every swing through the coffee drive through, each greeting of a co-worker, or each episode of casual banter in the check-out line at the store - imagine that every interaction made you wish you could be doing anything else.

For me, social phobia is one of the more difficult psychological disorders to imagine.  I'm pretty much an extrovert, and for the most part I look forward to social interactions.  People just usually strike me as intriguing and enjoyable.  So, I try to think about those times when I have been immensely embarrassed.  Those times when what I said or did left me simply speechless or feeling like I could easily start crying.  Now, I try to then imagine having that feeling each time I call someone on the phone or see a friend approaching me across my back yard.

One of my colleagues and friends, Bob, taught me some good early lessons about social phobia.  Bob has been a counselor pretty much since the beginning of time, and he is one of the most empathic people I know.  When we worked together I noticed Bob checking the clock several times one morning, then just as we were about to start our first group he started to take off.  "Hey, we're about to start!" I called.  "I know," said Bob, "but we have a new person starting today, and she's going to need a little extra help getting through the front door."  I thought maybe she was in a wheelchair or something, but that was not the case.

A few minutes later, Bob and the new woman arrived.  Describing her as completely pale and frightened would have been understating the case.  But, she and Bob had planned her entire arrival over the phone the day before and developed a game plan to overcome the complete and total state of anxiety that she felt coming into a room with other people.  Bob was calm, reassuring, and talked her through her anxiety, just as they had planned. 

As with many psychological problems, one of the most tragic things about social phobia is that many people never receive the help that is available.  Anxiety disorders, including social phobia, are disorders with a remarkably high treatment success rate.  Part of treatment involves learning and practicing skills in physical relaxation. It is surprising how quickly people are able to learn the skill of putting themselves in a calm state if they are willing to put in a little practice time each day. 

Treatment also involves focusing on the internal monologue that runs through our mind throughout each moment of each day.  Often we don't pay attention to it, but our own thoughts and interpretations play an enormous role in determining our moods and actions.  Treatment for social phobia involves listening to what you are telling yourself and challenging those things that are not really true.  Things like "I know this person will think I'm stupid if I talk to them," or, "There is no way in the world I'll be able to walk in there and not fall apart." 

One core strategy for treating social anxiety, and many psychological problems, involves challenging and changing those thoughts which are, ultimately, unhelpful if not self-defeating.  While we don't need to blame ourselves if we struggle with anxiety, or any mental health problem, we do need to take advantage of the fact that it is often our own thinking patterns and beliefs which keep us stuck in our old patterns.