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Social phobia, or social anxiety disorder, is an often overlooked but very common mental disorder. Incepting from shyness, the disorder can affect the performance of individuals at school, work, and in establishing relationships. Medications, therapies such as cognitive behavior therapy (CBT), and training are the treatments available for social anxiety.

Medications

Drug therapies with monoamine oxidase inhibitors (MAOIs) are effective in helping to overcome social phobia. These medications provide fast relief to patients. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), or serotonin-norepinephrine reuptake inhibitor (SNRI) are prescribed for the general forms of social anxiety. Since a reduction in serotonin levels is observed in association with anxiety, the use of these drugs which increase the serotonin levels is bound to result in decreased symptoms. The drugs also target adrenaline action and help individuals to manage their fear and stress responses.

In general, patients who begin taking antidepressants take a few weeks to show signs of improvement; some of them may experience side effects such as insomnia or headache.

When patients do not respond to these drugs or if the social phobia is specific, other medication options may be offered:

• Betablockers: This type of medication can help to block the stimulating effect of epinephrine (adrenaline). It helps to reduce and control anxiety symptoms such as the heart rate, blood pressure, pounding of the heart, and a shaking voice and limbs. It may work in particular situations such as public speaking. Physicians, however, do not normally recommend this in the general treatment of social anxiety disorder.
• Anti-anxiety medications: Medications such as benzodiazepines calm down the symptoms of anxiety in the patients, although increased usage may make the individuals dependent on the drug. Benzodiazepines may reduce the anxiety level. Although these drugs often work quickly, they can be habit-forming and sedating. Therefore, physicians typically prescribe them for only short-term use.  

Benzodiazepines or betablockers are recommended just before the beginning of the anxiety-creating situation. Individuals may use these drugs to counter social anxiety symptoms.

Psychological Therapies

These therapies for social anxiety include psychotherapy and cognitive-behavioral therapy (CBT). Although CBT takes a longer time to produce significant effects than medications, its results are more tangible and long-lasting. Negative thoughts are addressed, followed by examination of the individual’s behavior and modification in accordance with the renewed patterns of thought. This leads to improvements in anxious thoughts and counterproductive behavior in response to these thoughts. The underlying premise of CBT is that change in behavior follows changes in the way in which an individual perceives the situation rather than alterations in the external situation.

In other words, the same event can trigger different emotions and reactions in different people. Some may be happy and excited to attend a party, while some others may not. A few may not be sure of what to say or how to react in a party, and this may cause sadness or anxiety in them. CBT recognizes these negative thoughts and provides therapy to patients with the aim of changing their thought processes.

The CBT process

The 3-step cognitive restructuring process involves identifying, evaluating, and replacing negative emotions with positive ones.

CBT draws together all techniques and strategies that work in assisting individuals to overcome their anxiety problems. The cognitive part of CBT focuses on replacing negative thoughts through learning to identify and correct the thought process. Hence the new learning produces an impact on the memory and the individual starts to think differently. This new thinking process becomes habitual with unrelenting practice. The behavioral part of the therapy introduces the individual to a group of socially anxious people in which all of them participate. The therapy helps the individuals to spot their negative thoughts, which are gradually turned into neutral thoughts and become realistic.

Individuals need to practice the process consciously to turn it into a habit with time. Therapists help the individuals to control their negative thoughts and follow the techniques for 3 months or more on a daily basis, in order to result in permanent change.

Sometimes, exposing individuals to a situation that creates anxiety may help; however, these traditional techniques may not always work. To succeed in social anxiety treatments, a combination of cognitive and behavioral therapy, motivating the individual constantly, and regular practice with persistence are required.

Training

Providing training in social skills can help persons with social anxiety to react in new ways, for example, looking into the eyes of a person while talking. The therapist subjects the anxious individuals to a variety of situations and thus gives them practice to overcome social anxiety. Applying relaxation training helps individuals to practice relaxing techniques when exposed to anxiety-triggering situations.

Support Groups

Support groups are extremely helpful when it comes to reducing or treating social anxiety. These groups comprise people who suffer from or who have overcome social anxiety disorder. The group renders comfort, sympathy, and unbiased honest feedback, all of which help individuals with anxiety disorder to develop and maintain positive thoughts about oneself, judge situations positively, learn how to approach social anxiety disorder, and most importantly, how to overcome fear.

References

• http://www.health.harvard.edu/newsletter_article/treating-social-anxiety-disorder
• https://socialanxietyinstitute.org/comprehensive-cognitive-behavioral-therapy-social-anxiety-disorder
• https://www.helpguide.org/articles/anxiety/therapy-for-anxiety-disorders.htm
• http://www.abct.org/Information/?m=mInformation&fa=fs_SHYNESS
• http://www.scielo.br/scielo.php?pid=s1516-44462008000600007&script=sci_arttext&tlng=en
• http://cogbtherapy.com/medication-for-social-anxiety/

Further Reading

• All Social Anxiety Disorder Content
• Social Anxiety Disorder (SAD) – Social Phobia
• When to Get Help for Social Anxiety
• Social Anxiety Disorder History
• Social Anxiety – Common Causes

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.