Social Phobia.
What is the history?
First written description of social anxiety and shyness goes back to Hippocrates 400 BC. The first explicit references to social phobia were made early 1900s (Janet 1995). Later in the 1930 the term ‘social neurosis’ was used by Shilder (1938) to describe extremely shy patients. In 1950s interest grew in behaviour therapist and it was the British psychiatrist Isaac Mark who proposed that ‘social phobia’ could be as a distinct category. In 1980 by APA social phobia became as psychiatric diagnosis (DSM-III). The significant rise in the number of research studies of social phobia began in 1985.
What is social phobia?
Social phobia is “a mark and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing” (APA, 2000). There are two main types of social phobia. ‘Generalised social phobia’ is a fear of most social interactions together with a fear of most performance situations such as speaking in public or eating in public. ‘Non-generalised’ or ‘specific social phobia’ is fear of one type of performance situation or only a few rather then most situations.
Individuals are very concern how they are perceived and evaluated by others. Social anxiety my result from an excess of negative thoughts and unrealistic performance. The symptoms may manifest prior to, during or after leaving a particular settings.
There are three main categories of symptoms or any combination of them: cognitive, behavioural and physiological. Cognitive symptoms are negative thoughts such as perceived personal shortcoming, thoughts of excessively high standards or unrealistic beliefs. Behavioural symptoms are such as social avoidance, occupational or educational difficulty, ‘safety behaviour’ (alcohol, drugs, isolation, avoiding eye contact). Physiological symptoms are ‘fight or flight’ response such as palpitation, sweating, shakes and hot flushes.
Behaviour examples of social anxiety disorder signs and symptoms include intense fear of interacting with strangers, fear of situations in which you may be judged, worrying about embarrassing or humiliating yourself, fear that others will notice that you look anxious, anxiety that disrupts your daily routine, work, school or other activities, avoiding doing things or speaking to people out of fear of embarrassment, avoiding situations where you might be the centre of attention, difficulty making eye contact and difficulty talking.
Physiological examples of social anxiety disorder signs and symptoms include blushing, sweating, trembling or shaking, fast heartbeat, upset stomach, nausea, shaky voice, muscle tension, confusion, diarrhoea and cold, clammy hands.
How common is social phobia?
Approximately 4 to 14 percent of adult population suffer from social phobia (Ansseau at al, 1999, Kinglen et al., 2001). Social phobia is most likely to begin early to mid-adolescence, though there were found cases of younger children. There is 3:2 ratio for female to male. There is estimated 12 percent of the general public who will experience social anxiety to a clinically significant, diagnosable degree at some point during their lives (Kessler, Berglund, Demler, Jin, & Walters, 2005). It is believed that only 5 percent to 10 per cent of people with social phobia in the UK currently get treatment for social phobia. Studies over the last 12 years show that only a third of people with social phobia recover without intervention. Comparing to a 95 percent natural recovery rate for depression and an 80 percent rate for panic disorders. Social anxiety is a very common and distressing condition reported by as many as 40 percent of the general population (Edelmann 1992). Social phobia is often linked with at least one other type of mental disorder such as depression, other anxiety or alcohol misuse. Social anxiety isn't likely to go away on its own. People are less likely to recover from it naturally than other mental health problems. Some professionals believe that it's one of the most under-recognised and under-treated mental health problems of the modern age.
How social phobia is diagnosed?
The diagnosis of social phobia is made on the basis of patient’s history and the symptoms they have been experienced. The patient is screened to rule other disorders for example, other anxiety disorder or depression. There are various method and assessment tools used diagnose and assess social phobia for example, diagnostic interview, clinician-administered scales, self-report scales, behavioural assessments.
What causes social phobia?
There is no clear definitive answer to this question. It is believed that there are two types of explanation what can cause social phobia. First explanation can be psychological and environmental. According to classical conditioning, past negative experience (trauma, ignored, bullied, rejected, not fitting in, isolation) may create feelings of anxiety or fear in the future. Culture influences (how society reacts to shyness, avoidance, shame) also have been shown to be related to social phobia. The western cultural values of individualism, assertiveness and competitiveness serve to reinforce the idea that to be socially withdrawn or too self-conscious is a bad thing and should be fought against. Shyness is a quality that is often judged negatively in our fast-paced, extraverted society. Social factor such as lack of confidence, social skills and social competence may be related to social phobia. Expectation of poor outcomes and negative thoughts relating to future situations will generate emotional and physiological responses for as anxiety and avoidance. Family factor are also link to future development of social phobia for example parents with depression, anxiety, overprotective, with specific parenting style as modelling behaviour. Second explanation to social phobia can be a biological such as genetic factors and neural mechanisms. Twin studies have found that there is a modest genetic role in the development of social phobia. Heritability is estimated 0.65 (Beatty 2002) and 0.4 to 0.5 (Ollendic & Hirshfeld, Beck, 2002). There has been growing amount of research of specific neurochemicals and specific parts of brain. It is known that sociability is associate with dopamine neurotransmission. Social phobia is also link with imbalance of serotonin. Amygdala as part of the limbic system is related to fear cognition and emotional learning. Anterior cingulated cortex is involved how people experience physical pain.
What treatments options?
There are two types of treatments – psychological and biological. Social phobia is generally treated with psychotherapy, medication, or both. CBT – the cognitive model is especially useful for treating social phobia. CBT uses for example simulated exposure, cognitive restructuring, group therapy, negative self-processing, video feedback or catastrophic belief.
It teaches a person different ways of thinking, behaving and reacting to situations that helps him or her feels less anxious and fearful. It can also help people learn and practice social skills. Doctors also may prescribe medication to help treat social phobia. The most commonly prescribed medications for social phobia are anti-anxiety medications and antidepressants . Many types of SSRIs to start with are for example paroxetine, sertraline, fluvoxamine or citalopram. Another type of medication called beta-blockers can help control some of the physical symptoms of social phobia such as excessive sweating, shaking, or a racing heart. They are most commonly prescribed when the symptoms of social phobia occur in specific situations, such as "stage fright." However half of patients will relapse.
In conclusion
Social phobia was known for centuries but it did not start to be recognised as mental disorder until 20th century. There are variations of symptoms – cognitive, behaviour and psychological. Social phobia is likely to begin in mid-adolescence and is more common in females. However, the cause of social phobia is likely to be the result of variation of genetic and environmental and psychological factors. We have now great ability to diagnose, assess and treat it. Psychological treatments such as CBT with cognitive model and drug treatments are most common way to treat social phobia. However 50 percent of treated patients will relapse. There is still lot of research to be done on combination of both psychological and drug treatments. There is a strong belief that social phobia persists only because the underlying reasons are not properly addressed. What we learn changes the neural associations in our brain. What is in those neural pathways or associations becomes permanent. Medication or pills can change our brain chemistry temporarily but medication have no power to change neural pathways or associations. There is no cure for social anxiety in medication. The human brain is not limited in terms of learning. We can learn all we want, and keep learning until the day we die. Cognitive therapy, if used correctly, creates permanent changes in our brain neurology, and these changes affect our brain chemistry. Everyone, barring brain diseases, can learn to overcome social anxiety. It takes practice, persistence and repetition. Continuing forward until social anxiety disorder is a thing of the past.
References
Phobias, Heather Buchanan and Neil Coulson, First publication, 2012, chapter 5 http://www.nhs.uk/ipgmedia/national/Anxiety%20UK/Assets/SocialPhobia.pdf
http://www.mentalhealthy.co.uk/anxiety
http://news.bbc.co.uk/1/hi/magazine/7274825.stm
http://www.thepsychologist.org.uk/archive/archive_home.cfm?volumeID=25&editionID=212&ArticleID=2069
http://www.anxietycare.org.uk/docs/social.asp
http://socialanxietyinstitute.org/social-anxiety-chemical-imbalances-brain-neural-pathways
Social anxiety institute 2013 www.wow.com/social phobia www.medicalnewstoday.com
