HEALTH PLUS:People tend to suffer for a long time before seeking help for their social phobia, says Marie Murray
SOCIAL PHOBIA is an anxiety disorder. It is characterised by marked and persistent fear of social or performance situations. This fear primarily arises out of a person's belief that they will do or say something that will cause embarrassment, ridicule or rejection by other people.
The person comes to fear excessively, and then to avoid assiduously, all situations in which this might happen. Imperceptibly, the person becomes incapacitated by their fear: the greater the avoidance, the greater the fear and the more catastrophic the imagined social situations become. Eventually this can isolate people.
It can cut them off from school, college or workplace activities as their fear of embarrassment develops into a full-blown phobia.
Social phobias are very common. This is not surprising, given how daunting it can be to have to perform in front of other people.
Social phobia usually involves fear of scrutiny by other people in comparatively small groups. It may, for example, involve speaking or reading out loud in class, having to present information at a college tutorial, having to play an instrument or to perform in front of other people in a group.
Any experience of being criticised or rejected, of being unable to answer a question or of being overwhelmed by nerves can be sufficient to induce social phobia. It is easily acquired. People may become terrified of blushing: the fear, of course, inducing what is feared. People may be afraid that the tremor in their hands or the trembling of their lips or shake in their voice will be evident and, as they focus on their fear of these giveaway signs, the signs, of course, appear.
As they notice them appearing, they increase. As they notice the increase, there is a loss of control over them, so that what is most feared is then experienced.
The fear of appearing to be awkward or odd also induces behaviour that can appear to be awkward and odd. Again, what is feared is encountered.
This is the vicious cycle of social phobia, in that the more it is feared, the greater the experience of fear with consequent validation of fear and of avoidance.
Social phobia usually begins in the mid-teens to early 20s, although it can begin in childhood, particularly if a child has even one experience of being laughed at in a group. The shy child may be more at risk of later social anxiety, particularly when the complex interactional social demands of adolescence are encountered.
Social anxiety itself is along a continuum, from the normal feelings of discomfort that many people have when meeting a new group of people, to incapacitating and intense fear of almost any social encounters. Some people will specifically fear public speaking, but will be able to manage all other social interactions. Others will be unable to manage in any social context and they require compassion and support.
People tend to suffer silently for a long time before they seek help for social phobia. What usually precipitates the search for help, is when the social phobia interferes with ordinary life to the extent that a person feels that they cannot continue without some help.
It is not unusual for people who suffer from social phobia to be depressed: whether the depression precedes or is a consequence of the social phobia can be difficult to determine. What is clear, however, is the degree of suffering this condition imposes on people, yet how well it is helped when appropriate intervention is provided.
One of the most interesting discoveries with regard to social phobia is the degree to which people become trapped by their false belief of how they appear to other people and how they are unable to see evidence of when they are being successful in social encounters and in performance.
The feedback they receive, then, is their own negative feedback rather than the positive feedback they may be getting from the group.
The other interesting observation is that the so-called safety behaviours people with social phobia may engage in to make themselves feel more confident, can be the kind of behaviours that cut them off from others, eg not making eye-contact, speaking in clipped ways, feigning indifference. These behaviours can, in fact, cause the problems they seek to resolve.
A significant part of social skills training for social phobia often involves helping people to identify how their fears of rejection can cause them to be rejected until they re-learn how to give and receive appropriate feedback in social situations.
Whether psychotherapy, pharmacotherapy or a combination of both approaches is most effective, it is important for anyone suffering from social phobia to know how common it is and that it can be overcome.
Clinical psychologist Marie Murray is director of Student Counselling Services in UCD