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Shyness, Social Anxiety Disorder, and Social Phobia

Shyness is a problem that is well known to many people. It is that all-toofamiliar feeling of discomfort, tension, or anxiety that a person may experience when he or she has to interact with other people, or when he or she faces the prospect of doing something in front of others. Shyness can be troubling and very uncomfortable. Up to 80% of people report that they were shy at some time in their lives. Forty percent describe themselves as shy now. However, if you think of yourself as shy, it does not mean you have a problem that requires professional help. Most people feel some discomfort when thinking about social events (parties, for example), when preparing to take a social risk (asking someone for a first date), or when called upon to do something in front of others (public speaking). However, the typical shy person manages to get along reasonably well. These situations may not be comfortable and there may be great temptation to avoid them, but the shy person finds that he or she is still able to tolerate them and to get a great deal of satisfaction out of life.

However, these feelings can sometimes be severe. If they are sufficiently intense; if the person avoids doing things that are important to him or her because of these feelings; or if the person’s ability to function at home, at school, at work, or in his or her social circle is curtailed by these feelings, the label of shyness is no longer appropriate. Then mental health professionals call it social anxiety disorder (it is also known as social phobia).

Social anxiety disorder is the fear of being observed and evaluated by others. A person may experience this fear in a single situation or in any interaction with other persons. Individuals with social anxiety disorder are afraid that they will do something to humiliate or embarrass themselves in social situations. They are afraid that other people will judge them negatively (that is, wonder what is wrong with them). At the bottom of these concerns is the fear that other people will reject them or conclude that they are incompetent. These fears may easily interfere with a person’s ability to function in everyday life.

The Effects of Social Anxiety Disorder

Because of these concerns, individuals with social anxiety disorder may become extremely anxious in a number of situations or avoid them altogether. These situations may involve any or all of the following: public speaking; eating or drinking with others; writing, working, or playing while others are watching; initiating conversations with strangers; dating; parties; joining social groups; interacting with authority figures; or asserting oneself with others. The list of potential problem situations is long, because so much of what we do involves other people.

The effects of social anxiety disorder are varied, and many of the effects can be serious. Individuals with social anxiety disorder, often very bright, talented, and sensitive people, may find themselves socially isolated and lonely because it is just too frightening to approach others. They may compromise their educational goals because of the social demands of education or because their classes may require them to speak in front of others. They may find themselves in unfulfilling jobs because the exciting ones are also frightening. Importantly, individuals with social anxiety may be vulnerable to depression if their anxieties persist over time. Similarly, they may find relief from their anxiety in alcohol or tranquilizing medications, and these may create serious additional problems.

What Causes Social Anxiety Disorder?

Scientists do not agree on the causes of social anxiety disorder, which afflicts more than 12% of the general population at some point during their lives. It occurs a bit more frequently in women than men, although men are more likely to seek treatment for this problem. This is different from other anxiety disorders, such as agoraphobia or panic disorder, which occur much more frequently in women.

Social anxiety disorder appears to run in families, but it is the environment in which one grows up that may contribute the most to the development of social anxiety disorder. Individuals with social anxiety disorder often report that one of their parents had significant social anxiety, that their families did not socialize often with other families, that their parents did not encourage them to interact with other children when they were growing up, and that there was a great emphasis on the opinions of others in their families.

What Can Be Done to Help the Person With Social Anxiety Disorder?

A number of treatments are available for social anxiety disorder, and the chances that a person with social anxiety disorder may find relief are very good. These therapies attempt to teach clients cognitive (thinking) and/or behavioral skills for dealing with the situations they fear. These treatments may be combined with each other to fit the needs of specific clients and may be offered in either individual or group therapy settings. These treatments are described below.

Exposure Therapy

In Exposure Therapy, clients are asked to confront the situations they fear, starting with the least frightening situations, mastering them, moving to more difficult situations, mastering them, and so on until the most difficult situations no longer interfere with the client’s life.

Cognitive Behavioral Therapy

In CBT, clients are taught to examine their ways of thinking about feared situations. They do this by looking at whether their behavior is truly inadequate; looking at whether other people are really likely to evaluate them negatively, and, if they do, how important that is; and looking at their belief that feared negative consequences are likely to occur. Armed with new ways of thinking, they may act out these situations with their therapist or therapy assistants, or other group members. Thereafter, clients are encouraged to confront their real-life feared situations (just as in Exposure Therapy), using their new coping skills and relying on the successful experiences they have had in sessions.

Social Skills Training

Social Skills Training teaches new ways to act (like using eye contact and asking appropriate questions) in many different situations through practice and rehearsal.

Applied Relaxation Training

Applied Relaxation Training helps clients to learn to relax while in the situations they fear.

Several cognitive and behavioral therapies have effectively reduced the anxiety experienced by persons with social anxiety disorder, and these benefits have lasted for a number of years after treatment.

Medication Treatment

A number of medications have been scientifically studied; several classes of drugs have proven useful for social anxiety disorder. Consult your doctor about medication treatment for social anxiety disorder.

What is Cognitive Behavior Therapy?