Dr James Schaller
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Causes and Various Treatments

Social Phobia: Part 3

Basics Reminder:

Social anxiety or social phobia is the fear of social interactions. Certain people or situations make you feeling too self-consciousness. You expect to be judged or critisized. You also expect negative evaluations from people, and easily can feel shamed or embarrassed. Since these feelings can be common in many situations, one test is to compare how you are in public or in new settings vs. how you feel when alone. If your shame is caused by biological depression, it will occur in most settings. Yet if you are only feeling anxiety during speeches or while meeting new people during small talk, that sounds more like social phobia or social anxiety.

Social Phobia effects millions of people and is very common. Since it is often quiet suffering, many people go it alone in pain and discomfort. Triggers for discomfort and anxiety include: "small talk," performing or speaking, being introduced, public evaluations, being looked at or stared at, interacting with "powerful" people, and unfamiliar social gatherings.

Sometimes social anxiety is mild and you are mildly uncomfortable. For some it can cause a panic attack.

These feelings include being short of breath, palpitations, a rapid heart, sweating, trembling, a dry "cottony" mouth, feeling light headed or dizzy or feeling you will lose control.

Social Phobia Treatment

I trained in both medicine and non-medicine treatment for social phobia. I was lucky enough to be trained a center which gave me access to many forms of training.

Currently, psychiatrists are able to give medication for this problem and some have some limited experience with non-medical treatments. Psychologists do not prescribe medications and are usually well-trained in non-medical treatments. My experience is that some patients can be successfully treated with either, and some need both modes of treatment.

Medication works faster. Therapy treatments take more time. Both create brain changes to reduce anxiety. You may want to think what fits your philosophy of treatment. Ask any therapist if they have treated at least 15 people with your problem from start to finish.

If you go the therapy route, either alone or with medication, ask what type of therapy the practitioner uses. While I am a great believer in traditional talk therapy, for this type of problem you should have someone who has other training. Probably the most common counseling treatment in social phobia is cognitive-behavioral therapy. You should meet with your therapist individually and not merely in a group. Some studies say it is important to have individual treatment.

Also, if you can be part of a social phobia group, with people who all have social phobia, you should attend. Notice I am not talking about a support group. In that type of group, people often have different problems. You want one that is focused and means business in addressing social anxiety with tailored exercises.

Typically in therapy treatment you must be educated about social phobia, determine to make a specific treatment plan, do the plan, and gradually practice your solutions in a group.

  • Treatment must be tailored. No treatment is identical.
  • You will feel some discomfort but should never feel overwhelmed.
  • Do your "homework exercises." This treatment is related to practice and action, not merely abstract principles.
  • The treatment plan can be modified and adjusted.
  • Different role play tools are useful: video computers, video camera's, speech's in the group, practicing silliness, pretending to be a politician answering questions, acting, man on the street interviews, pretend job interviews and tape recorders.

Why Bother Treating?

At least 1/10 people experience social phobia during their life. So what do they lose by ignoring?

  • At work you will move away from all situations that will cause your anxiety to flare up. One of my patients was unable to speak in even very small groups. After treatment, he became the sought after speaker for a major corporation.
  • Some people relieve the anxiety with alcohol or other street drugs. Some become addicted
  • Some individuals may think you are shy. Others may think you are worse--rude, stuck-up, unfriendly and disinterested in them. This hinders relationships.
  • Many students leave school due to an anxiety disorder like social phobia. We all know that education is very important for most students in determining their future options vocationally.
  • The Great Clueless Masses: Handling People Who Mess Up Treatment

    Unfortunately, caring friends, relatives, parents, doctors and spouses may say things that do not help you. They may feel that if you get treatment, they are flawed or messed up. It may scare them into feeling they have to also grow in some area. They may see psychiatry and psychology through the eyes of someone from the 1940's.

    Amazingly, very intelligent people can be very ignorant about social anxiety. One doctor I knew told me he had never seen a case in 25 years. He was merely blind. I treated some of his patients with it. When I asked a few of them if he should be informed, they said not to bother. They knew he was blind and a few were annoyed.

    Do not be a pleaser or masochistic and allow yourself to suffer any longer because of a loved one's bizarre thoughts about health and contentment. If they love you and are rational, they will want you to heal your pain. If they are not open to your healing, that is their problem. Discuss it with your treating physician and/or therapist.

    Medication Options

    There are many medications that help social phobia.

    1. Probably the first types of medications that were shown to help were MAO inhibitors. American versions require diet restrictions, while moclobemide and brofaromine do not have diet restrictions. Moclobemide is used in dozens of other countries and has been in use since the late 1980's. The American MAO Inhibitor medications, e.g., phenelzine, may be more effective, especially if only low doses of moclobemide are used.
    2. Serotonin Medications like the commonly known antidepressants Prozac and Zoloft have been found to be helpful. Yet I personally suspect every serotonin antidepressant works, and side effects and possible interactions may be important in picking a medication. (Please look at my articles on Lexapro on this site).
    3. Anti-anxiety medications like Klonopin have been used for years successfully. It has effects on the GABA anxiety system. If they are taken daily for months they cannot be suddenly stopped. Some feel cognitive- behavioral therapy does not as well if you are on this class of medications.
    4. Other medications that may be worth considering include Neurontin, Gabatril, Pregabalin and Effexor.

    Social Phobia treatment with medication is not short-term treatment. When patients stop a medication that works, they usually relapse.

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