Mr. S. is a middle level executive officer in the Indian government service. As part of his official duty, he has to attend official meetings once or twice a week. His boss often compels him to answer queries coming up in conferences. Talking in a conference is a dreadful thing for him. Whenever he tries to talk his mouth becomes dry. His hands and sometimes whole body becomes shaky. He fumbles for words and sometimes he is unable to utter a word. He explicitly told: “Doctor, I fear humiliation and embarrassment not only in official conferences, but also in all the social situations.” For these reasons he tries his best to abstain from conferences. This has affected his career and his promotion to the next level position has been kept in abeyance. Therefore he decided to seek the help of a psychiatrist to get rid of his malady.
A case of social anxiety disorder
Evidently Mr. S. is suffering from social anxiety disorder. Those who fear humiliation and embarrassment in social situations suffer from social anxiety disorder. This condition is also known as social phobia. It is characterized by intense fear in social situations.
The social anxiety disorder can be of a specific disorder (when only some particular situations are feared) or a generalized disorder. Generalized social anxiety disorder typically involves a persistent, intense, chronic fear of being judged by others and of being embarrassed or humiliated by one's own actions. These fears can be triggered by perceived or actual scrutiny from others. While the fear of social interaction may be recognized by the person as excessive or unreasonable, overcoming it can be quite difficult. Physical symptoms often accompanying social anxiety disorder include excessive blushing, sweating, trembling, sensation of heart thumping (palpitation), nausea, and stammering often accompanied with rapid speech. Attacks of extreme fear or panic also may occur under intense discomfort. A lesser form of social phobia is shyness in social situation.
Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is common for sufferers of social phobia to self-medicate and this can lead to alcoholism, drug addiction, eating disorders or other kinds of substance abuse.
Symptoms of social phobia
Social anxiety disorder is a persistent fear of one or more situations in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing. It exceeds normal "shyness" as it leads to excessive social avoidance and substantial social or occupational impairment. Feared activities may include almost any type of social interaction, especially small groups, dating, parties, talking to strangers, etc. Possible physical symptoms include "mind going blank", fast heartbeat, difficulty breathing, blushing, stomach ache or feeling of “butterflies in the stomach”, and nausea or vomiting sensation. Thoughts are often self-defeating and inaccurate.
Those who suffer from social anxiety disorder are afraid of being judged by others in society. People who suffer from this disorder may behave a certain way or say something and then feel embarrassed or humiliated after. Therefore, they chose to isolate themselves from society to avoid such situations. They may also feel uncomfortable meeting people they do not know and act distant when they are with large groups of people. In some cases they may show evidence of this disorder by not making eye contact or blushing when someone is talking to them. This is their way of showing discomfort.
Physiological aspects of social phobia
Physiological effects, similar to those in other anxiety disorders, are present in persons suffering from social phobia. In adults, it may be tears as well as experiencing excessive sweating, nausea, difficulty breathing, shaking, and palpitations as a result of the fight-or-flight response. Blushing is commonly exhibited by individuals suffering from social phobia. These visible symptoms further reinforce the anxiety in the presence of others. A study in 2006 found that the area of the brain called the amygdala, part of the limbic system, is hyperactive when patients are shown threatening faces or confronted with frightening situations. They found that patients with more severe social phobia showed increased response in the amygdala.
Cognitive model of social phobia
There are four essential elements in starting and maintaining social phobias. Understanding these elements is crucial in getting rid of the social anxiety disorder by self-help.
- Trigger. The social situation acts as trigger. (See the pictorial presentation of the cognitive model of social phobia) The trigger causes imagined social danger. At first the individual perceives a social danger. Typical assumptions and predictions of the socially anxious person are: “If I talk to them they will find me boring and reject me.”; “If I don’t get this just right, I will be humiliated.” Essentially these are fears centering on being negatively judged. The fears are not centered on the person’s ability to perform. This imagined danger acts as trigger.
- Focus of attention on the self. The social-anxiety cycle is maintained by intense self-awareness. This heightened self-awareness is distracting and disabling. It prevents the sufferer from reviewing the situations objectively. This leads to misinterpretation of reactions of other.
- Emotional thinking: Intense introspection about the sensations of anxiety renders the sufferer acutely aware of symptoms such as sweating, shaking and blushing. The sufferer assumes that others are also able to see his/her symptoms.
- Safety behaviour: The socially anxious person will attempt to avoid predicted humiliation or embarrassment by avoiding social contact. They usually avoid eye contact also. In doing so, the social fear is not addressed and remains intact.
Get rid of social phobia without medicines
- First step is re-focusing attention away from introspection. This helps the individual to reduce self-awareness.
- Develop an assertive inner voice to combat the harsh criticism expected imaginatively from others. The individual should suggest to himself/herself: “What I am presenting is correct and relevant. If anybody criticizes me I don’t care.”
- Re-evaluate the imagined social danger. Simultaneously one should review emotional reasoning. The individual should suggest to himself/herself: “I feel shaky because I am worried about the criticism from others; I should not bother myself with it. I need not give much attention to my sweating etc.” If possible the person can view videoed session which allows the individual to evaluate objectively the severity of his/her overt anxiety symptoms.
Along with these cognitive measures the individual should do relaxation and deep breathing for 10 – 15 minutes every day. This will help the individual to refocus attention away from introspection and to reduce self-awareness.