Social anxiety disorder or social phobia (SD) is fear of social situations. Typically people are afraid they will be embarrassed or humiliated by showing signs of anxiety, saying or doing something which other people will react negatively to, or not knowing what to say or do.

    Common signs of anxiety are blushing, trembling or shaking, or losing track of conversation (feeling that your mind goes blank). People with social anxiety disorder often worry about social interactions and may go to considerable trouble to avoid them. Situations which are commonly feared include talking in a group, speaking in front of a large or small group, having a conversation (especially with someone who is not well known to them), meeting someone new, speaking to a person in authority, and dating situations. Some people experience difficulty using the telephone, eating or drinking when other people are watching, or participating in activities where there may be an audience such as sports, music, or acting.

    A person has social anxiety disorder when it interferes with the person's schooling, work, family functioning, or social life or if it causes significant distress. Some people may be described as very shy while others appear to be comfortable in social situations even though they feel very anxious.

    Social anxiety disorder is very common. Up to 7% of people have this problem and about half of these people have anxiety in more than one social situation. Some individuals report being very shy through their whole life, others say the problem developed in early adolescence or in adulthood. Problems with depression or abuse of alcohol or street drugs can also develop.

What causes Social Anxiety Disorder?

    Some individuals start life more prone to anxiety (an anxious temperament). As time goes on this may be influenced by stressful life situations (e.g., family problems). Some families and schools are better at developing social confidence and skilled social behavior.

Psychology can help!

    Cognitive behaviour therapy (CBT) helps people deal with anxious situations. It involves understanding the problem and developing coping strategies such as changing thinking patterns in social situations, learning to focus attention on effective social behaviours, using relaxation strategies, and learning to gradually face feared social situations in new ways.

    Special training is required to be skillful in helping people using cognitive behavior therapy. CBT is often part of the training of clinical psychologists. It may be provided individually or in small groups. Group treatment has the advantage of putting individuals in a social situation which is challenging to them and through which they can learn strategies to reduce anxiety, learn from others with similar problems and learn new coping strategies. Group treatments typically last from ten to fifteen weekly sessions. Individual treatments often require a similar number of sessions although the amount of time required varies depending on the extent of the problem.

    Antidepressant medications are the most widely used medication to treat social anxiety disorder. They tend to produce a similar degree of improvement to psychological treatment. Drug treatment usually continues for a considerable length of time (e.g., at least two years). Combined psychological and medication treatment is possible although it is not clear that combining the two improves on the results of either treatment alone. Some specialists suggest trying the preferred treatment first, then adding in the other treatment if necessary.

    Each treatment has advantages and disadvantages. Psychological treatment is usually less expensive in the medium to long term but requires more time and effort initially. Medication treatment requires less time and is more widely available but is often more costly in the long run. Some individuals have medication side effects and a significant proportion experience a return of symptoms in the months after medication treatment is discontinued. A family physician or pharmacist can provide more information about medication treatment.

How effective are psychological methods of treating social anxiety disorder?

    Recent research indicates that approximately 70% of people who complete a short term treatment program (10 to 15 sessions) are judged to be much or very much improved. The amount of improvement appears to be related to the amount of time and energy the person devotes to developing new coping strategies. Individuals who do not improve with short term treatment may require longer treatment or changes in the treatment approach. Persons who have improved need to continue applying their new coping strategies and may require booster sessions if they experience difficulties which cause a loss of some of their progress.

    Additional information on the psychological treatment of social anxiety disorder is available in: Dying of Embarrassment: Help for Social Anxiety & Phobia by Barbara Markway, Cheryl N. Carmin, C. Alec Pollard, and Teresa Flynn (1992). Oakland, CA: New Harbinger Publications.