May 23, 2005
iranian.com

Ask Shokooh about your problem
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QUESTION
Social phobia

Dear Shokooh,

I am hoping you can tell me about social phobia. This past year, I have had to visit the emergency room nearly once a month after having attacks. These panic attacks come on whenever I face very crowded and busy social situations, especially weddings or similar large parties. My heart beats fast, I sweat, and I feel dizzy. It’s awful.

My doctor diagnosed me as having social phobia and he offered me medication. I want to avoid medication because I am scared of all the side effects. Also, this is a new problem that started suddenly last year. I tried to get information about social phobia from the net, but it all seems to be advertisements for different pills. What can you tell me about my situation? Is there an alternative to medication for this problem?

Signed,
Anonymous

REPLY

Dear Anonymous,

I am sorry that you are having difficulty finding information about social phobia online. From the frequency of your emergency room visits, it is clear that this issue is having a significant impact on your life. It also sounds like it is a relatively new problem for you, and I can only imagine how frightening it must be to suddenly in the midst of panic attack symptoms that are so intense.

First of all, please know that you are not alone. Approximately 5.3 million Americans are affected by social phobia.

Social phobia is an anxiety disorder characterized by an overwhelming anxiety and self-consciousness in social situations. People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed by their own actions. The fear goes beyond mild nervousness or discomfort -- it is so severe that it interferes with work, school, or other activities.

The physical symptoms you described as a panic attack often accompany the intense anxiety of social phobia. These physical symptoms may include: blushing, profuse sweating, trembling, and other symptoms of anxiety, including difficulty talking, a racing heart, and nausea or other stomach discomfort. It’s a painful cycle -- as you worry about experiencing the physical symptoms, your chances of developing them increases.

A diagnosis of social phobia is made only if his avoidance, fear or anxious anticipation of a social or performance situation interferes with daily routine, occupational functioning, social life or if he is markedly distressed by having the phobia. Please note that these guidelines are provided for information only; they cannot substitute a visit to a
doctor or mental health practitioner.

-- Fear of one or more social or performance situations if the person is exposed to unfamiliar people. And the individual fears that she will behave in a manner that causes embarrassment
-- Exposure to social situations causes intense anxiety
-- The level of anxiety is recognized by the individual as excessive
-- The feared situation must be avoided, or endured with anxiety and distress
-- The avoidance, anxious anticipation, or distress interferes significantly with the person's social, academic or occupational functioning

In your letter, you specifically ask if there is treatment other than medication for social phobia. The answer is a resounding YES! Research has shown that short-term psychotherapy called cognitive behavioral therapy is highly effective in treating social phobia. Cognitive-behavioral therapy works by focusing on two components. The cognitive component helps people change the thinking patterns that keep them from overcoming fear.

A person with social phobia, for example, may think that others are judging them. The behavioral component typically involves exposure, in which a therapist will guide you in confronting your fears while assisting you in managing your anxiety and panic symptoms. While this may sound scary, know that the therapist will work with you to determine the pace and move forward only when you are ready.

Psychotherapy has been proven to be very effective for social phobia. I wish you all the best as you begin your journey to overcome your fears and alleviate your anxiety.

Shokooh

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About
Shokooh Miry is a doctoral student in clinical psychology.

Shokooh welcomes your questions on any psychological issue. Please note that this column is for educational purposes only -- it is not a substitute for medical attention, counseling, or therapy of any kind. Shokooh and the staff of this website urge you to seek immediate medical attention if you are in a difficult or potentially dangerous situation.

All urgent matters should be handled by calling 9-1-1 or going to the nearest hospital emergency room. Also remember that Shokooh will keep your letters strictly confidential -- unless you discuss hurting yourself or others, in which case she is obligated to contact the authorities." Top

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