Social phobia: what it is and how to overcome it

Introduction

Imagine the first day of a new course. Since you don't know anyone, you choose a seat at the back so as not to draw attention. Five minutes in, the teacher asks everyone to stand up and introduce themselves to the group. Your face flushes, your body trembles, your voice breaks and, when it's over, a hard-to-describe embarrassment sets in.

Almost all of us recognize a scene like that. The difference lies in the intensity. When that distress is so great that it pushes you to avoid entire areas of life, we're no longer talking about shyness, but about social phobia. The good news is that treatments exist that have proven effective within about 12 weeks.

Social phobia is the intense, irrational fear of being judged, humiliated or rejected by others, especially by strangers. It generates strong anticipatory anxiety: it appears merely from imagining the situation.

It differs from shyness in two ways. The first is the degree of avoidance: a shy person has a hard time, but shows up; a person with social phobia looks for excuses not to expose themselves. The second is the physical symptoms — sweaty palms, flushing, racing heart, dry mouth, trembling — that ordinary shyness doesn't usually produce. Two types are distinguished: the specific kind, tied to one concrete situation (almost always public speaking), and the generalized kind, which covers most social contexts.

It isn't a rare problem. According to large epidemiological studies such as the National Comorbidity Survey led by Ronald Kessler and his team, social anxiety is one of the most frequent mental disorders, and around 12% of people experience it at some point in their lives.

Why it's so hard to overcome

Whoever suffers from it already knows their fear is irrational, but knowing something isn't the same as feeling it. What's more, two mechanisms keep it going:

The brain tends to assume it's being watched. Research on gaze perception, such as that of Colin Clifford and his team (2013), shows that, when in doubt, our brain assumes by default that others are looking at us.
Neutral faces are interpreted as negative. People with social anxiety tend to read someone else's neutral expression as disapproval. That is, they not only believe they're being watched, but that it's being done "with a disapproving face".

Its origin usually lies in childhood or adolescence, sometimes after a humiliating experience or in a hostile emotional environment, and it frequently coexists with low self-esteem and perfectionism.

The two strategies with the best scientific backing are cognitive-behavioral therapy (changing what you think in order to change your behavior) and acceptance and commitment therapy (accepting what you think in order to change your behavior). Various trials have found that, for many people, they're as effective as or more effective than medication in the long run, because they teach the brain to respond differently. As a general rule, the cognitive-behavioral approach fits mild or moderate phobias better, and the acceptance approach fits generalized ones where depressive symptoms are also present.

Although professional support is always recommended, these are the basic guidelines for both.

Option A: change what you think

Social phobia is a snake eating its own tail: you feel anxiety, you avoid the situation, the anxiety drops and your brain learns that avoidance "works". That's how it perpetuates itself. To break that circle, thoughts are worked on in three steps:

1. Identify them. When you notice anxiety rising, write down what you were thinking just before. In a week you'll have your list. They usually take recognizable forms: mind reading (assuming what people think of you without evidence), fortune-telling (predicting something bad), catastrophizing (always imagining the worst) and personalization (believing all attention is on you). 2. Challenge them. Question the evidence with questions like: am I 100% sure it will happen? how many times has it happened before? how will I feel in six months? what would I say to a friend who thought this? 3. Replace them with rational interpretations based on facts. Repetition over about three months turns that new way of thinking into a habit.

To this is added gradual exposure: facing what you fear little by little, without the usual "crutches" (always going with someone, staying in the background, keeping quiet for fear of a mistake). Break the situation into about 10 stages ordered from least to most anxiety-provoking and set yourself a measurable objective at each one — for example, making three comments in a group conversation — regardless of other people's reactions. If you stay in the situation long enough, the anxiety comes down on its own.

Option B: accept what you think

Acceptance and commitment therapy starts from a different idea: thought and behavior can coexist independently. There's no need to wait until you stop feeling fear before acting. (Do you stop going to work on the days your boss intimidates you?) Its elements are:

Cognitive defusion: observing thoughts as what they are — words — and not as realities. Visualizing the phrase "I'm boring" floating in different colors gradually strips it of its charge.
Acceptance: observing the physical sensations of fear with a scientist's curiosity — where is that knot, what shape does it have — instead of fighting them.
Contact with the present (mindfulness): training attention in the here and now, so you can focus on the conversation rather than on your own thoughts.
Values and commitment: defining what kind of person you want to be (connecting with others, living freely) and committing to concrete objectives that bring you closer to those values. The key question is: is it worth feeling some anxiety in order to live according to what genuinely matters to me? The answer is usually yes.

Since someone with social phobia exposes themselves little, they often haven't been able to train their social skills either, and that lack of resources feeds more insecurity. That's why it's worth learning, in parallel, to communicate better: asking open questions to put the focus on the other person or opening up emotionally (it has been observed that the more you do so, the more people open up with you) are very useful resources.

Conclusion

With either the cognitive-behavioral strategy or the acceptance and commitment one, most people manage to overcome social phobia. One or the other will work better for each person, but the essential thing is not to start either without being able to commit to it. With consistency and effort it's achieved. Don't let fear decide for you what you can offer the world.

References

Kessler, R. C., et al. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders. Archives of General Psychiatry, 62(6).
Hofmann, S. G., et al. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5).
Mareschal, I., Calder, A. J., & Clifford, C. W. G. (2013). Humans have an expectation that gaze is directed toward them. Current Biology, 23(8).
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy. Guilford Press.

Social phobia: what it is and how to overcome it