First, people who have social phobias should speak about their symptoms with their family doctors. The doctor should do an exam to make sure that another physical problem isn’t causing the symptoms. The doctor may refer them to a mental health specialist. Social phobia is generally treated with medication, cognitive-behavioural therapy or both.
Medication
The most commonly prescribed medications for social phobia are anti-anxiety medications and antidepressants. Anti-anxiety medications (such as Valium) are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.
Antidepressants (such as Zoloft) are used to treat depression, but they are also helpful for social phobia. They are probably more commonly prescribed for social phobia than anti-anxiety medications. Antidepressants may take several weeks to start working. Some may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to the doctor about any side-effects. A type of antidepressant called monoamine oxidase inhibitors (MAOIs) are especially effective in treating social phobia. However, they are rarely used as a first line of treatment because when MAOIs are combined with certain foods or other medicines, dangerous side effects can occur. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.
Another type of medication called beta-blockers can help control some of the physical symptoms of social phobia such as excessive sweating, shaking, or a racing heart. They are most commonly prescribed when the symptoms of social phobia occur in specific situations, such as “stage fright”.
Some people do better with medication, while others do better with cognitive behavior therapy. Still others do best with a combination of the two. Talk with a family doctor about the best treatment.
Cognitive-Behavioural Therapy treatment of Social Phobia
Research has shown that CBT is one of the few forms of therapy that reliably helps in overcoming social phobia.
One of the central goals of CBT is to identify irrational beliefs and thought patterns and replace them with more realistic views. As part of the therapy process, patients will work on a number of problem areas including: misperceptions they may have about their abilities and self-worth, guilt, embarrassment, or anger over past social situations, how to be more assertive, tackling overly strict personal standards and being more realistic dealing with procrastination related to social anxiety
CBT therapy sessions for social phobia may feel somewhat like a student-teacher relationship. The therapist may take the role of a teacher, outlining concepts and helping patients on a path of self-discovery and change. Patients will also be assigned homework assignments that are key to making progress
CBT for social phobia includes of a number of techniques, many of which focus on problematic thinking. Cognitive (i.e., thought) methods help lessen anxiety in interpersonal relationships and groups, and give the person with social phobia a feeling of control over their anxiety in social situations. The ultimate goal of CBT is to change people’s underlying core beliefs (also known as “schemas”) which influence how we interpret our environment and relationships. A change in our core beliefs will lead to long-lasting improvement of social anxiety symptoms.
One of the central problems targeted by CBT are automatic negative thoughts, also known as cognitive distortions. People with social phobia may have developed automatic negative ways of thinking that are misaligned with reality, increase anxiety, and lessen their ability to cope. These thoughts occur instantly when they think about an anxiety-provoking situation. For example, if they have a fear of public speaking, just thinking about the situation will elicit thoughts of embarrassment and fear of failure. The goal of CBT is to replace these cognitive distortions with more realistic views.
People with SAD, at some point in their lives, have probably been told to just “think positively”. Unfortunately, the problem is not that simple to solve –- if it were, they likely would have overcome their anxiety long ago. Because their brain has become hardwired over time to think negatively and have anxious thoughts, it needs to be gradually trained to think in a new way. Just telling themselves “I will be less anxious next time” doesn’t work because this is also an irrational statement, given their current way of thinking.
Changing negative automatic thinking in the long term requires practice and repetition, every day for several months. At first they might be asked by their therapist to simply to catch negative automatic thoughts and make them rationally neutral. As this becomes easier, they work their way up to thoughts that are more realistic. Only then does it become automatic and habitual.
Over time, their memory processes will be affected and the neural pathways in their brains will be altered. They will begin to think, act and feel differently, but it will take persistence, practice, and patience for progress to be made. At first, this is a conscious process but as it is practiced and repeated it becomes automatic.
One of the most commonly used CBT techniques to treat social phobia is “exposure” training, also known as “systematic desensitization.” Exposure training involves, with the therapist’s help, gradually exposing the affected person to anxiety-provoking situations so that over time they elicit less fear.
Research has shown that there are several keys for success when it comes to CBT and social phobia. The likelihood that CBT will help depends largely on the patient’s expectations about success, their willingness to complete homework assignments, and their tolerance for confronting uncomfortable thoughts. People who are willing to work hard and believe that CBT will help them are more likely to improve. Although this form of therapy is intensive and requires active participation by the person with SAD, the improvement shown tends to be long-lasting and well worth the effort invested.
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