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Social Anxiety Disorder Counseling in Broken Arrow for Tulsa Area Residents

By Alina Morrow, LPC

Disclaimer: The article below is for informational purposes only and should not be considered as direct advice, a personal diagnosis, or as an individual treatment plan. Always consult with a mental health professional or medical doctor if you have concerns.

Introduction and Overview

Social phobia, also called social anxiety disorder, is an anxiety disorder characterized by "a marked and persistent fear of social or performance situations in which embarrassment may occur" (DSM). Social phobia can be limited only to one type of social setting (known as specific social phobia), such as fear of speaking in formal or informal situations, eating, drinking, or writing in front of other people, or can include any type of social contact (known as generalized social phobia).

Social phobia can be associated with the fear of negative evaluation. Individuals with social phobia, when exposed to feared situations, experience an intense fear and concern that others watch their actions and judge their performance as poor, and them as anxious, weak, crazy, or stupid. For example, individuals with social phobia that fear speaking in public are concerned that others notice their trembling hands or voice, while those that fear eating, drinking, or writing in public worry that those around them, notice that their hands are shaking.

Signs & Symptoms

The intense fear experienced during the encounter with feared stimuli invariably provokes an immediate anxiety response, which can be either a panic attack (palpitations, sweating, chills or hot flashes, trembling or shaking, sensation of shortness of breath, sensation of choking, chest pain or discomfort, nausea or abdominal discomfort, dizziness or lightheadedness, tingling sensations), or an anxiety attack (palpitation, tremor, sweating, gastrointestinal discomfort, diarrhea, muscle tension, blushing, confusion).

Individuals with social phobia tend to think that others are more socially competent than they are. They also believe that every little "mistake" they make is exaggeratedly judged. For example, if the person spills a drink on their clothes, he or she worries that others immediately notice the stain and judge him or her as a slob. Unfortunately, due to their behavior, individuals with social phobia are usually perceived as shy, nervous, aloof, unfriendly, and disinterested.

Many individuals with social phobia recognize that their fears are excessive and unreasonable, but are unable to overcome them. This typically leads to an avoidance behavior towards feared situations. In rare cases, the individual forces himself or herself to confront the feared situation. However, the event itself is marked by anticipatory anxiety (the person worries in advanced for the upcoming social event), is managed with intense fearful cognition and anxiety symptoms which lead to actual or perceived poor performance, and is followed by intense worry of how they were being judged.

Sometimes, social phobia is confused with being shy, self-conscious or nervous in social situations. Many people experience anxiety (racing heart, sweaty palms, fluttering stomach) as a normal response to performance related situations, feel shy or insecure in different social settings, but they manage to control these feelings and perform well. Individuals with social phobia are incapable to control the anxiety symptoms and avoid the confrontation. Social phobia becomes a disorder when the anxiety and avoidance behavior significantly interferes with the person's normal, day to day routine, occupational or academic functioning, social activities and relationships, or the person experiences an increased distress about having the phobia.

The essential feature of social phobia is an intense fear of being in social or a "performing situation." Some of the main symptoms of social phobia are:

  • Fear of specific or general social situations (speaking, eating, drinking, or writing in public, dating, informal conversations in small or large groups, interactions with authority figures).
  • Fear of being watched and judged by others.
  • Fear of public embarrassment.
  • Panic attacks or anxiety attacks.
  • Anticipatory anxiety.
  • Avoidance behavior.
  • Low self-esteem.
  • Interpersonal difficulties.
  • Academic or occupational difficulties.

Social phobia affects 15 million American adults. It is the third most common psychiatric disorder in the United States after depression and alcohol abuse. Social phobia affects 7 to 13 percent of American adults in any given year. Women and men are equally affected by this disorder. Adolescents and young adults are more susceptible to social phobia, because this age category is more concerned with their image and conformity, and are more unsure of themselves when surrounded by others. Social phobia is also diagnosed in children under 12 years old.

Social phobia seems to be more prevalent among white, married, and well-educated individuals. Left untreated, social phobia leads to social isolation in children, and is often accompanied by anxiety disorder, depression, and substance abuse (when the person tries to self-medicate the anxiety) in adults.

Causes and Risk Factors

The etiology of social phobia is not fully understood, but the likelihood of developing this disorder involves a combination of several factors, such as: environmental, biological, and psychological factors.

Biological Factors:
This category refers to genetic and neurological risk factors. Many studies suggest a minor genetic component in developing social phobia, however behavioral inhibition seems to be the highest inherited risk factor. This type of behavior is common among children.

Children with behavioral inhibition get easily upset by unfamiliar things, and are more likely to become fearful. By the time they reach adolescent years, these children show an increased risk to develop social phobia.

Social phobia is a fear reaction to something that by itself is not dangerous, but the body and brain perceive it as. This reaction recalls an inborn survival response, called fight-flight response, that helps the human body to deal with dangerous situations. The fight-flight response is controlled by a part of the brain, called the amygdala. Recent brain-imaging studies discovered that those people that frequently experience social anxiety have an overactive amygdala and an underactive prefrontal cortex (involved in social behaviors).

Other studies, focused on the implication of neurotransmitters in the development of social phobia, revealed a strong evidence of dopamine, serotonin, and GABA dysfunction in individuals with social phobia.

Environmental Factors:
Environmental factors might play a major role in the development of social phobia when the individual is exposed to them at a younger age. Some researchers believe that social phobia is a learned behavior that can be developed by observing, interacting, and imitating significant people (especially parents) that display anxiety or social phobia symptoms. A controlling and overprotective parenting style may also increase the risk of social phobia.

Another hypothesis that tries to explain social phobia considers that individuals can develop social anxiety when they are exposed to negative social experiences such as: being teased, bullied, or particularly embarrassed in public. Researchers also believe that speech or language impairments, sexual or physical abuse, family conflicts, and disfigurement can increase the risk of social phobia.

Psychological Factors:
Some researchers believe that there is a connection between social phobia and early-life emotional trauma. Also, they consider that a poor attachment between the child and parent or caretaker during early stages of development, can increase the risk of social phobia. Attachment specialists believe that an inadequate bond with parents or caretakers may lead to poor self-regulating skills in stressful or chaotic situations, and lead to social phobia.

Counseling & Treatment Options

Social phobia is a serious, highly disabling disorder if left untreated. Individuals with social phobia can benefit from different types of treatments. There are two effective treatments available for social phobia, medication and psychotherapy. However, the outcome of the treatment depends on the individuals and whether the social phobia is complicated by other conditions such as depression or substance abuse. Some people respond faster or better to the treatment than others.

Medication
There are three types of medication prescribed for individuals with social phobia:

Antidepressants: Antidepressants are considered to be the most effective medication for individuals with social phobia. The most prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs) (which is in the process of becoming the first-line medication for social phobia) and monoamine oxidase inhibitors (MAOIs).

Anti-anxiety medication: Benzodiazepines (also known as anti-anxiety medication) can be prescribed to control anxiety symptoms. Anti-anxiety medication is less often prescribed in people with social phobia because of its habit-forming side effects. When prescribed, benzodiazepines are a short-term treatment option.

Beta blockers: Beta blockers, a heart medication used for high blood pressure, are prescribed to block the autonomic response (tremor, increased heart rate) in people with social phobia.

Unfortunately, due to the chronic condition of social phobia, the medication withdrawn is associated with high rates of relapse.

Psychotherapy
Medication can be combined with psychotherapy for a better outcome in people with social phobia. There are two types of therapy:

Behavioral Therapy: Behavioral therapy is a form of psychotherapy that focuses on modifying or "unlearning" those maladaptive behaviors that cause psychological discomfort. Behavioral therapy uses two major approaches: (1) various relaxation techniques to control the anxiety, and (2) exposure techniques that gradually expose the person to situations that cause anxiety by forcing the person to cope with the fear.

Cognitive-behavioral therapy: Cognitive-behavioral therapy is considered the most effective psychotherapy method to treat social phobia. This type of therapy considers that our thoughts and not the external situations, people or events, trigger the behavior and feelings. This form of therapy retrains the way a person thinks and reacts to different stimulus. Cognitive-behavioral therapy involves two components for a better outcome, cognitive component and behavioral component.

The cognitive component helps people change those dysfunctional thinking patterns that trigger and maintain the anxiety. This is achieved through a method called cognitive restructuring.

The behavioral component focuses on changing the person's reaction to feared situations. This is achieved through exposure therapy, when in a safe setting, individuals with social phobia gradually face their feared situations, initially using the imagination and later facing real social situations.

Hypnotherapy: Hypnotherapy is used to change peoples' behaviors, emotional content, and attitudes. This form of therapy uses deep relaxation and an altered state of consciousness to help people reprogram subconscious "programs" that can be part of the social phobia.

Related Information:

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Do you or someone you know suffer with social anxiety symptoms? Contact Tulsa Therapist Alina Morrow, LPC, today to make an appointment and get the help and relief you deserve. You can reach me by texting or calling 918-403-8873 or by Email.

Page Last Updated: October 30, 2016

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