Coping with Anxiety and Phobias
Harvard Health Publications
Harvard Medical School
Do you suffer from social anxiety?
It’s not unusual to feel nervous about meeting new people or attending parties. But some people may be inordinately uneasy and self-conscious in everyday social situations, and overly fearful of doing or saying something embarrassing and being negatively judged by others. If this sounds familiar, or if you are so anxious that you dread or avoid such situations, you may have social anxiety disorder, also called social phobia.
If you have social phobia, you might be terrified by just the thought of proposing a toast, or even making small talk. Even if you make yourself attend gatherings, you may feel miserable before, during, and afterward — worrying for days about people’s opinion of you. Avoiding these get-togethers is not the answer, of course; it can result in misunderstandings and other personal problems.
Studies have shown that certain medications and types of psychotherapy can help. Meanwhile, scientists have been investigating the roots of the disorder, as a step to discovering new therapies.
What does social phobia look like?
There are two types of social phobia. Specific social anxiety (also called performance anxiety) arises in limited situations. It’s a problem mainly for people whose work (for example, acting, music, or lecturing) requires them to perform in public.
Far more prevalent and disabling is generalized social anxiety. People with this disorder fear common social situations, such as eating or ordering food in public; asking questions or seeking help; meeting new people; speaking to strangers; and even using public facilities, such as restrooms. They may lose out on job opportunities because they’re afraid of interviews; they may forgo training and education because they fear being called on in class.
Symptoms include a racing heart, dry mouth, shaky voice, blushing, trembling, sweating, and nausea. In specific social anxiety, fear that people will notice these symptoms may impair performance, leading to a downward spiral in which worsening performance reinforces worsening anticipatory anxiety. Generalized social anxiety can produce a similar downward spiral: others feel ill at ease when they sense a person’s discomfort, and it’s natural to interpret that discomfort as rejection that justifies further social withdrawal.
Do you have social phobia?
If you answer yes to three or more of the following questions — and medications, substance abuse, a medical condition, or another emotional disorder isn’t the cause of your symptoms — you may have social phobia. If so, talk with a clinician or therapist about your concerns.
What to do
Certain types of psychotherapy and several medications can be helpful in treating and managing social phobia.
Psychotherapy. Cognitive behavioral therapy (CBT) has two parts. The cognitive therapy helps change habitual thoughts (“People will think what I say is stupid”) that prevent you from overcoming your fears. The behavioral element involves working to face those fears directly in anxiety-provoking situations.
The therapist typically begins by asking you to record your thoughts and level of anxiety in various situations. Then, you and the therapist discuss these thoughts, evaluate how realistic they are, and work together to substitute more productive thought patterns. The behavioral component involves a strategy called exposure, or desensitization, in which you face your fears — sometimes through role-play, sometimes by imagining and describing the situations that make you anxious.
Your therapist may also ask you to put yourself in a real-life situation (like a party) that sparks your worst fears, to let you practice recognizing negative thoughts and exchanging them for more realistic ones. With repeated exposure, you may eventually become desensitized to these fear-provoking situations. A related behavioral strategy teaches you coping skills for such situations. If parties are your worst nightmare, for example, you may work on conversational skills. CBT may also include learning relaxation techniques, such as deep breathing.
A therapist-guided variation of exposure therapy, called exposure and response prevention, aims to not only desensitize you to the feared situation but also prevent you from reacting with the usual avoidance behaviors.
Medications. As research uncovers the roots of anxiety in brain chemistry, anti-anxiety medications have become increasingly important, usually in combination with CBT. Typically, the first choice is a selective serotonin reuptake inhibitor (SSRI), often with a benzodiazepine tranquilizer added to quell symptoms for the four to six weeks until the SSRI kicks in. Some dual (norepinephrine and serotonin) reuptake inhibitor antidepressants are also effective. For people who have a lot of physical symptoms, such as heart pounding, a beta blocker may be prescribed.
For more about social anxiety disorder, Harvard Health Publications offers for sale a Special Health Report, titled Coping with Anxiety and Phobias, available at http://www.health.harvard.edu/AP.
Prepared by the editors of the Harvard Health Publications in conjunction with Michael Mufson, M.D., Assistant Professor of Psychiatry at Harvard Medical School. 49 pages. (2008)
Harvard Health Publications
Harvard Medical School
Do you suffer from social anxiety?
It’s not unusual to feel nervous about meeting new people or attending parties. But some people may be inordinately uneasy and self-conscious in everyday social situations, and overly fearful of doing or saying something embarrassing and being negatively judged by others. If this sounds familiar, or if you are so anxious that you dread or avoid such situations, you may have social anxiety disorder, also called social phobia.
If you have social phobia, you might be terrified by just the thought of proposing a toast, or even making small talk. Even if you make yourself attend gatherings, you may feel miserable before, during, and afterward — worrying for days about people’s opinion of you. Avoiding these get-togethers is not the answer, of course; it can result in misunderstandings and other personal problems.
Studies have shown that certain medications and types of psychotherapy can help. Meanwhile, scientists have been investigating the roots of the disorder, as a step to discovering new therapies.
What does social phobia look like?
There are two types of social phobia. Specific social anxiety (also called performance anxiety) arises in limited situations. It’s a problem mainly for people whose work (for example, acting, music, or lecturing) requires them to perform in public.
Far more prevalent and disabling is generalized social anxiety. People with this disorder fear common social situations, such as eating or ordering food in public; asking questions or seeking help; meeting new people; speaking to strangers; and even using public facilities, such as restrooms. They may lose out on job opportunities because they’re afraid of interviews; they may forgo training and education because they fear being called on in class.
Symptoms include a racing heart, dry mouth, shaky voice, blushing, trembling, sweating, and nausea. In specific social anxiety, fear that people will notice these symptoms may impair performance, leading to a downward spiral in which worsening performance reinforces worsening anticipatory anxiety. Generalized social anxiety can produce a similar downward spiral: others feel ill at ease when they sense a person’s discomfort, and it’s natural to interpret that discomfort as rejection that justifies further social withdrawal.
Do you have social phobia?
If you answer yes to three or more of the following questions — and medications, substance abuse, a medical condition, or another emotional disorder isn’t the cause of your symptoms — you may have social phobia. If so, talk with a clinician or therapist about your concerns.
- Do you fear being in certain situations — for example, performing or socializing with people you don’t know well — because you’re afraid you’ll do or say something embarrassing?
- In these situations, do you experience symptoms of anxiety, such as palpitations, sweating, diarrhea, confusion, or (in severe cases) panic?
- Do you believe that your fear of these situations is unreasonable or excessive?
- Do you avoid social or performance situations whenever possible?
- When you can’t avoid them, do you endure them with intense distress?
- Does the problem seriously interfere with your daily routine, work, or social life, or do you feel distressed about having the problem?
What to do
Certain types of psychotherapy and several medications can be helpful in treating and managing social phobia.
Psychotherapy. Cognitive behavioral therapy (CBT) has two parts. The cognitive therapy helps change habitual thoughts (“People will think what I say is stupid”) that prevent you from overcoming your fears. The behavioral element involves working to face those fears directly in anxiety-provoking situations.
The therapist typically begins by asking you to record your thoughts and level of anxiety in various situations. Then, you and the therapist discuss these thoughts, evaluate how realistic they are, and work together to substitute more productive thought patterns. The behavioral component involves a strategy called exposure, or desensitization, in which you face your fears — sometimes through role-play, sometimes by imagining and describing the situations that make you anxious.
Your therapist may also ask you to put yourself in a real-life situation (like a party) that sparks your worst fears, to let you practice recognizing negative thoughts and exchanging them for more realistic ones. With repeated exposure, you may eventually become desensitized to these fear-provoking situations. A related behavioral strategy teaches you coping skills for such situations. If parties are your worst nightmare, for example, you may work on conversational skills. CBT may also include learning relaxation techniques, such as deep breathing.
A therapist-guided variation of exposure therapy, called exposure and response prevention, aims to not only desensitize you to the feared situation but also prevent you from reacting with the usual avoidance behaviors.
Medications. As research uncovers the roots of anxiety in brain chemistry, anti-anxiety medications have become increasingly important, usually in combination with CBT. Typically, the first choice is a selective serotonin reuptake inhibitor (SSRI), often with a benzodiazepine tranquilizer added to quell symptoms for the four to six weeks until the SSRI kicks in. Some dual (norepinephrine and serotonin) reuptake inhibitor antidepressants are also effective. For people who have a lot of physical symptoms, such as heart pounding, a beta blocker may be prescribed.
For more about social anxiety disorder, Harvard Health Publications offers for sale a Special Health Report, titled Coping with Anxiety and Phobias, available at http://www.health.harvard.edu/AP.
Prepared by the editors of the Harvard Health Publications in conjunction with Michael Mufson, M.D., Assistant Professor of Psychiatry at Harvard Medical School. 49 pages. (2008)
