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Many people are concerned and slightly apprehensive when they are in social situations that may be unfamiliar to them or where they may need to perform in front of others. For some people, however, this concern and apprehension is of sufficient high intensity and severity and such individuals may be suffering with social phobia, also known as social anxiety disorder.
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Social Phobia
Social Phobia
What is social Phobia?
Importantly, the things that the person fears (e.g. “I’ll
say something stupid and others will laugh at me”)
Many people are concerned and slightly
may not happen, but the person worries excessively
apprehensive when they are in social situations
that they might happen or that they may have
that may be unfamiliar to them or where they
happened and they believe it to be true.
may need to perform in front of others. For some
people, however, this concern and apprehension
chris finds social situations stressful
is of sufficient high intensity and severity and such
individuals may be suffering with social phobia, also
Chris is a 29-year-old accountant who finds it an
known as social anxiety disorder.
effort to attend social functions as he worries
constantly that he will have nothing interesting
Social phobia is an anxiety disorder, where the
to say and that others will find him “dry” and
anxiety is triggered by thoughts and perceptions
“unintelligent”. Chris avoids these situations as
surrounding social and performance situations. The
much as possible, which has an impact on his work
person with social phobia worries excessively:
relationships, networking possibilities, and his social
life. He has never had many close friends and the
• that others may be scrutinising them for the
few close friends he has, have stopped phoning him
behaviours;
up to do things, as on 9/10 times he would make an
• about what others might think of them,
excuse to not go. He is saddened by this as, as he
still desperately wants to maintain friendships and
• about embarrassing themselves in front of
meet new people. If he does go out, Chris drinks
others, and/or
a number of beers before leaving the house and
• about being rejected, humiliated, or negatively
ensures that he has a drink in his hand at all times.
evaluated by others.
He chooses to stand on the edge of groups and if
he is asked a question, he will answer it as briefly as
The distressing factor for these individuals is that
possible, limit eye contact with the person, and not
they ‘crave’ and ‘desire’ social contact. Although they
ask a question in return.
may engage in social situations, they over-value
the opinions of others and, therefore, their fear of
After these situations, Chris spends days ruminating
humiliation and criticism often keeps them isolated.
about the situation, “I can’t believe I said that!”;
They fear being in situations where they may be
“Sam will probably think I’m too stupid to hold up
scrutinised by others and, when in these situations,
a conversation”; “I’m sure that they saw my shaking
are faced with ruminative and unhelpful self-talk
like a leaf! I bet that’s why they were laughing when I
(e.g. “I don’t want to make a fool of myself ”) and
walked up to the group.”
concern that such evaluation by others will be
negative. As a consequence, they also experience
high levels of physical distress.
sentiens brochures - social phobia

More resources at http://www.sentiens.com
At work, Chris spends most of his time in his
• Talking on the telephone; and
office. He eats privately, in his office, as he feels
• Speaking in formal social situations (e.g. work
excessively anxious and self-conscious in situations
meetings; university lectures; addressing an
where others may be watching him.
audience; making a speech at a wedding).
In summary, Chris’s extreme self-consciousness
Unhelpful thoughts (cognitive symptoms)
and his fear of being evaluated negatively by
others, results in him missing many opportunities
The main concerns lie in worries and fears that
to socialise with others. This results in him being
others will evaluate the person negatively or that
alone most of the time, even though he would like they may do something to be embarrassed by:
to be around others.
• “I’ll make a fool of myself!”
the cognitive-behavioural model of • People will laugh at me”
social Phobia
• “Ill have no idea what to say”
TRIGGER
• “I’ll be so nervous that I’ll mess food on my
Social situation/ Thoughts of an upcoming social situation
clothes and people will think I’m clumsy”
• “No one will find anything I have to say
interesting”
Unhelpful thoughts
e.g. “I’ll make a fool of myself,
• “I’ll blush/sweat/shake/stutter so much that
I hate being in these situations!”
people will know that I’m nervous!”
Behaviours
(things the person
Feelings (emotional symptoms)
Feelings
does to keep safe)
e.g., feeling anxious
e.g., avoid what makes
or fearful
• Intense anxiety – may escalate to panic
them anxious/fearful,
e.g. avoiding parties.
• Fear
Physical symptoms
Physical symptoms
e.g. feeling dizzy,
muscle tension,
heart pounding.
In threatening situations, the body becomes
prepared to fight or flee.
Each person with social phobia has a unique set
of social or performance situations that may lead
The bodily effects in social anxiety include:
to the experience of anxiety. The situations may
be few and specific (as in circumscribed social
• Increased heart rate and strength of beat
phobia) or more general (as in generalised social
• Increased rate and depth of breathing –
phobia). The may include:
leading to over breathing
• Any type of social situations, encounters, or
• Sweating
associations;
• Widening of the pupils
• Meeting people who hold positions of
authority (including employers and lecturers);
• Decreased activity of the digestive system –
person may feel nauseas
• Doing things in situations where others may
be able to observe the person (e.g. eating or
• Muscle tension
writing in public);
• Focused attention on surroundings to scan for
• Being introduced to others;
danger
• Being the centre of attention;
• Reduced ability to concentrate on ongoing
tasks.
• Initiating or maintaining conversation in social
or group situations (e.g. at parties or informal
• Shakiness
work functions);
• Dry mouth
• Arriving late for a meeting or lecture;
• Numbness or tingling sensations
• Participating in sporting activities;
• Light headedness

Behaviours that exacerbate the problem Safety behaviours
The way in which a person acts in response to
• Similar to avoidance behaviours, the person
their anxiety can exacerbate the anxiety. People
engages in behaviours that will prevent them
with social phobia often do things or avoid
from doing something embarrassing, thus
situations to avoid the feeling of anxiety or reduce
ensuring minimal focus of attention on them.
its intensity, but these usually serve as the driving
• For example, the person may constantly check
force behind the cycle and it continuing influence
that their zipper is done up; may speak softly
in the person’s life.
so to avoid people picking up on any mistakes
that they might make; carry water with them
Focus on internal sensations
in case they start to feel hot; only go out if a
friend accompanies them.
After a person experiences anxiety in certain
situations and is concerned about being anxious in • These behaviours are likely to draw more
those situations again (e.g. hot flushes or trembling
attention to the person (e.g. if someone asks
at a staff meeting), he/she can become very
them to speak louder), thus achieving the
focused on his/her internal physical sensations in
opposite of what they had hoped.
those or similar situations.
hoW is social Phobia different from
This can result in the person being very sensitive
normal shyness or “normal” social
and focused on their physical sensations (e.g.
increase in heart rate, or shortness of breath)
anxiety?
and may come to interpret any mild sensations as
indicating that something is wrong e.g. interpreting
Most people experience discomfort in social
a heart flutter as a heart attack, or dizziness as
situations at some point in their life (e.g. feeling
‘going crazy’.
shy). However, shyness is often manageable
and specific to the situation. Even the most
Hyper vigilant to possible threat
extroverted and confident people may experience
times of uncertainty, discomfort or doubt in social
situations. The apprehension for these people
As the person is already anxious in social
is often of a low intensity and the person can
situations, such situations are perceived as
use helpful coping techniques to reduce the
threatening, making them more likely to be on the
anxiety and/or use it productively to drive their
‘lookout’ for possible threats.
performance.
The person may be more attentive to others’
Social phobia is an extreme form of shyness and
facial expressions and body movements (e.g. “He
social anxiety and is associated with the activation
frowned. He must think I’m, a twit!”) or attentive
of the anxiety response and the associated
to their own bodily reactions – “I can feel my face
behaviours for reducing this anxiety. The anxiety
hotting up. I bet I’m red as a beetroot! Everyone
for people with social phobia is often debilitating
will laugh at me!”
and restrictive and severely affects day-to-day
living and opportunities.
Avoidance behaviours:
Unlike those who are shy and mildly anxious in
Since the person feels fearful or anxious in social
social situations, a person with social phobia:
situations, they see it as a realistic option to avoid
or prematurely leave these situations.
• Experiences excessive doubts, worries,
and fears in anticipation of the social or
The avoidance allows the person to temporality
performance event,, and afterwards;
avoid feelings of anxiety and, thus, reinforces their
need to avoid such circumstances by not allowing
• Does not experience a reduction of anxiety
the person to objectively test if the situation is
during the event because of the manner in
safe. Thus, thus they continue these avoidance
which the cycle is maintained; and
behaviours and the cycle is further maintained.
• Experiences anxiety that is disabling enough
More subtle avoidance behaviours include wearing
to limit their interactions and make it more
sunglasses to avoid eye contact with others or
likely that the interaction/performance is not
concentrating only on ‘safe’ topics of conversation.
successful.
sentiens brochures - social phobia

More resources at http://www.sentiens.com
What imPact can social Phobia have The causes
on a Person’s life?
No one single factor gives rise to anxiety
disorders such as social phobia, but rather various
The fears associated with social phobia can
factors coalesce in the onset of anxiety symptoms.
interfere with many areas of a person’s life and the
associated behaviours (e.g. avoidance) can result in: According to the American Psychiatric Association
• Isolation and feelings of loneliness;
(2002), social phobia can develop slowly over
time, or may develop suddenly after a humiliating
• Limited opportunities for establishing social
situation.
networks and developing and maintaining
platonic and intimate relationships; and
The causal factors include:
• Reduced opportunities for developing and
expanding ones potential (e.g. at work and
External factors
university).
Various factors in a person’s environment can
Social phobia is often associated with and
contribute to feelings of anxiety and worry.
accompanied by other difficulties, including:
Childhood experiences: A child observing an adult
• Being overly sensitive to criticism from others;
responding anxiously in certain social situations
• Difficulty asserting oneself;
may learn certain ways of thinking about and
acting in those situations.
• Low self-esteem;
• Poor social skills (associated with safety
Abuse and bullying in childhood may contribute to
behaviours e.g. poor eye-contact or low voice
the onset of anxiety in later life.
levels);
Negative experiences with social encounters or
• Depression and other anxiety disorders;
performance situations throughout ones youth.
• Bulimia nervosa; and
Internal factors:
• Use of alcohol, drugs and other medication
in an attempt to reduce the experience of
Person’s biological makeup (predisposition): Based
anxiety and manage situations that they may
on twin studies and family studies, there appears
perceive as threatening.
to be a biological component contributing to the
Who is affected by social phobia
onset of anxiety disorders like social phobia.
• Social phobia is the third most common
Personality and coping skills: Each person has a
psychiatric condition (Anxiety Disorders
different personality and an array of different
Alliance, 2003).
coping skills that determines how they deal
with various situations. These characteristics are
• It is estimated that 3%-13% of the population
partly inherited but are also shaped by ones life
will experience social phobia at some point in
experiences, particularly throughout childhood.
their lifetime (APA, 2002).
• Social phobia typically begins in mid-
Unhelpful thinking: Interpreting or perceiving
adolescence, with onset in early childhood for
situations to be threatening, thus triggering an
some (APA, 2002). Onset after 25 years of age associated stream of unhelpful and negative self-
is considered quite rare.
talk.
• Social phobia is equally prevalent in men and
women.
• Social phobia occurs in all cultures, but may
present differently across cultures, based on
culturally specific social codes of conduct.

How might social phobia change over
Specific components include:
time?
• Education about social phobia: similar to that
presented in this brochure, and as specific to
Some people may experience the abrupt onset of
the person.
social phobia after a situation that they perceive
as stressful, critical, or degrading, whereas others
• Breathing and relaxation exercises: help the
may develop the disorder over time. Without
person experience a relaxed state, allowing
treatment, social phobia may continue without
the person to be able to better assess the
end, whereas some people may experience
situation in a calm and objective manner.
a reduction in its severity or cessation of the
• Challenging unhelpful thinking: targets the
symptoms as adults (APA, 2002).
thinking patterns of people with social phobia,
which are most often peppered with negative
A person may set up their life in such a way
evaluations.
that the full impact of social phobia is not always
apparent. However, the impact may become
• Graded exposure tasks (and response
apparent when the person’s life situation changes
prevention): Avoidance behaviours are one of
or if the person faces increased life demands, for
the strongest maintaining factors of the social
example:
anxiety, and an important part of the cycle
that need to be addressed and broken. This
• a person who has a fear of public speaking
part of treatment involves setting up tasks that
may continue through much of life without
place the person in the feared and avoided
many difficulties. However, a promotion at
situation and allows them to test out within
work may involve the need for presentations,
the situation the very thing that they worry
thus triggering the person’s fears.
will happen.
• a recently divorced person (who has avoided
• Social skills training: the person is provided
much social contact while married), may face
with an opportunity to learn and practice
again the fears of social dating (including eating
specific social skills, such as assertive
and drinking in front of others), which may re-
communication, appropriate levels of eye
trigger previously held anxieties.
contact and addressing people within various
situations.
What does treatment involve?
• The process of treatment is graded and gentle
Cognitive Behaviour Therapy
and ensures that the person feels comfortable
with each step that they complete, making
it more likely that they will continue with
Cognitive Behaviour Therapy (CBT) is an
treatment.
approach that helps to break the cycle of anxiety
and reduce the experience of anxiety by focusing
• Treatment continues for approximately 16-24
on the way that a person thinks, feels, and behaves.
weeks
Research has shown the use of CBT in a group
format to be highly effective in the treatment of
social phobia (Barlow, 2002).
CBT for social phobia incorporates a package of
techniques aimed at targeting the person’s:
• unhelpful thinking styles;
• emotional and bodily reactions experienced
in social situations (or when thinking of the
situations), and
• behaviours in response to these situations (e.g.
avoidance).
sentiens brochures - social phobia

More resources at http://www.sentiens.com
Medications
What can i do to helP myself?
Medications may be helpful in reducing the levels
If you have read this brochure and feel that the
of anxiety that a person might feel in or leading up information in it is relevant to you, then it is
to a social situation.
important that you seek the appropriate help. This
can be done by:
Effective medications include:
• Arranging to see a Clinical Psychologist at
• Monoamine oxidase inhibitors (MAOI’s):
Sentiens for individual counselling, where a
phenelzine (Nardil)
thorough assessment can then be conducted
• Selective Serotonin Reuptake Inhibitors
and an individual treatment plan developed.
(SSRI’s): paroxetine (Aropax); fluvoxamine
• Talking to one of the Mental Health
(Luvox), and sertraline (Zoloft).
Professionals at Sentiens about Sentiens group
• Benzodiazepines: clonazepam (Klonopin) and
programs that may be most suitable for you.
alprazolam (Xanax).
• Organising a consultation with your doctor or
• Anxiolytic: buspirone (BuSpar).
psychiatrist.
It is important that a person consult with their
If you are currently taking medication it is
doctor before taking any such medication(s), so
important that you continue to take the
as to enure that the most suitable medication is
prescribed dose at the appropriate times, on those
prescribed and that the levels and possible side-
days when things may feel challenging, as well as
effects are monitored and managed as needed.
on days when you are feeling good. This will help
you to prevent future episodes and relapse.
exPectations for the future
If you are concerned about medication side effects
and wish to change or stop taking you medication
Although people who do not receive treatment
it is important that you discuss this with your
may experience life long suffering from the
doctor before taking any action. This is important
disorder, research trials report relapse rates of
as some medications must be stopped gradually in
between 0-17% for people undertaking CBT for
order to protect the person from dangerous side
social phobia and 50% for those who are treated
effects.
with medications. (cf. Bruce & Saeed). Research
also indicates that CBT involving exposure tasks
Family and friends can offer great support during
and thought restructuring may be effective in 75%
challenging times. Also, local support groups
of people with social phobia (cf. Bruce & Saeed,
running in your community may be a place where
1999). Such research supports CBT as the first
you can meet other people experiencing similar
line treatment of choice for social phobia.
difficulties.
Progress through treatment, and after, is not a
Some people find self-help books to be a valuable
smooth process. The person may experience days
resource. Self help books can be used in isolation
where it is difficult to manage their symptoms,
or in combination with another form of treatment.
particularly at times of severe stress, where the
Some self-help resources that are relevant for
person’s lowered stress tolerance may make it
people with social phobia are listed below.
more difficult to manage anxious thoughts and
feelings. However as treatment continues, and
as the person incorporates self-management
strategies in to their everyday life, these tough
times may be more easily managed.
If a person struggles to manage the symptoms of
anxiety following treatment, it is best for them to
contact their CBT clinician and ask for ‘booster
sessions’. These will provide them with the needed
support to refresh the steps learnt in treatment.


further reading
Bruce, T. J. & Saeed, S.A (1999). Social Anxiety
Disorder: A Common, Underrecognized Mental
There have been some good texts written
Disorder. American Family Physician. Retrieved,
primarily for clients experiencing social phobia
18 January 2005, from http://www.aafp.org.
related symptoms. Some suggested readings
afp/991115ap/2311.html
include:
Hofmann, S.G. & Barlow, D. (2002). Social
Books:
Phobia (Social Anxiety Disorder). In D.H. Barlow
(Ed.), Anxiety and its disorders: The nature and
Berent, J. (1993). Beyond Shyness - How To
treatment of anxiety and panic (2nd ed), pp. 454 –
Conquer Social Anxieties. New York: Fireside.
476. New York: The Guilford Press.
Anthony, M. & Swinson, R. (2002). The Shyness
Kingsep, P. & Nathan, P. (2001). Social anxiety in
and Social Anxiety Workbook. Oakland, CA: New
schizophrenia: A cognitive behavioural group
Harbinger.
therapy programme therapist manual. Perth:
Riobay Enterprises.
Rapee, R.M. (1998). Overcoming Shyness and
Social Phobia: A Step-by-Step Guide. Northvale,
Norcross, J. C., Santrock, J. W., Campbell, L. F.,
NJ: Jason Aronson.
Smith, T. P., Sommer, R., & Zuckermam, E. L. (2003).
Authoritative Guide to Self-Help Resources in
Websites:
Mental Health. New York: The Guilford Press.
http://www.anxdepaust.com - Anxiety and
Social Phobia/ Social Anxiety Association. What
Depression Support Groups Australia
is Social Anxiety? Retrieved, 28 December 2005,
from http://www.socialphobia.org/whatis.html
http://www.healthinsite.gov.au (with links to
relevant social phobia sites)
http://www.ada.mentalhealth.asn.au - Anxiety
Disorders Alliance
references
American Psychiatric Association. (2002).
Diagnostic and Statistical Manual of Mental
Disorders (4th ed.). Washington: American
Psychiatric Association.
Andrews, G., Crino, R., Hunt, C., Lampe, L., & Page,
A. (1994). The treatment of anxiety disorders:
Clinician’s guide and patient manuals. Melbourne:
Cambridge University Press.
Antony, M. M. & Barlow, D. H. (2002). Handbook
of assessment and treatment planning for
psychological disorders. New York: Guildford
Publications.
Anxiety Disorders Alliance (2003). Social Phobia.
Retrieved, 28 December 2005, from http://ada.
mentalhealth.asn.au/social.html
Bennet-Levy, Butler, Fennell, Hackamn, Mueller
& Westbrook (Eds). (2004). Oxford Guide to
Behavioural Experiments in Cognitive Therapy.
Oxford: Oxford University Press.
sentiens brochures - social phobia

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