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Previously known as Social Phobia

Many of us get a bit anxious or shy before new situations, eg meeting new people, but we find that once we are there we can cope and enjoy the opportunity. However, some of us become very anxious about these situations. At best we don’t enjoy them and, at worst, we may have to leave, or avoid them altogether.

This is what doctors/psychologists call Social Anxiety Disorder – one of the group of anxiety disorders that affect up to 25% of the population.

Social Anxiety Disorder is generally excessive fear(s) and avoidance of being judged/criticised and/or embarrassing oneself in public.

Some Social Anxiety Disorder patients specifically fear and avoid situations in which they believe they may be watched while performing, eg public speaking, writing, questioning, confronting, queuing, eating, using public toilets etc.

Social Anxiety Disorder affects 12% of women and 11% of men.

If not treated, Social Anxiety Disorder may hinder a person’s functioning throughout the rest of his/her life. Complications (comorbidity) include: depression, suicide, panic, agoraphobia, drug or alcohol misuse, eating disorders etc.

Social Anxiety Disorder is a medical condition and can respond to psychological treatments or medications. These can be used either separately or, preferably, together.

Generalised Type

Symptoms/Problems may include:
· Extreme shyness
· Worry about becoming the centre of attention
· Avoiding social situations
· Feeling uncomfortable around other people
· Worry that everybody is looking at you
· Fear of being introduced to other people
· Worry about eating or drinking in public
· Difficulty going to shops or restaurants
· Embarrassment at undressing in public (eg beach)
· Difficulty confronting your boss or colleagues
· Queuing, especially at supermarkets

Specific Type

Symptoms/Problems may include:
· Being the focus of attention because of a person’s life/work/sport.
· Difficulty speaking in public, asking a question, performing, writing etc. This can also occur when meeting people in authority, or the opposite sex.

Anxiety Symptoms

You may feel or experience:
· Blushing or blanching, feeling hot, sweating, tense, shaking, trembling
· Palpitations (rapid or irregular heart rate)
· Dry mouth/difficulty swallowing
· Panting – over-breathing
· Frequency in wanting to urinate/move bowels
· Thinking processes not working properly
· Light-headedness/confusion
· Fear of losing control (nerves, mind or body)
· Pins and needles or strange sensations

You may see yourself as:
· Incompetent – not fitting in – a failure.
· Going through in detail all the embarrassing things that could happen to you.
· Unable to say or do what you want in company.
· Over sensitive – taking offence easily.
· Afraid of criticism – assuming people are getting at you.
· Demoralised as you struggle to do things others find easy.
· Reluctant to approach other people.
· Depressed and unhappy.
· Thinking too self-critically after events.

Consequences of Social Anxiety Disorder

Social Anxiety Disorder is a disabling disorder.
Social Anxiety Disorder sufferers are more likely than others to:
· Be single or have relationship failures.
· Be socially isolated/impaired social support.
· Be of lower socio-economic class.
· Be less educated – less likely to be promoted.
· Be financially less well off.
· Have an unstable employment record/performance.

Treatment Strategies

Multimodal – May need several treatments, eg medical, talking treatments, skills training.

Multiphasic – Treatment varies with progress, eg initial medication may have done its job; or another may be required for short or long term.

Treatment Focus/Double Diagnosis

If Social Anxiety Disorder appears in association with other disorders it is important to recognize both, but not to allow one condition to take precedence over the other, eg depression, alcohol/drug. These may need to be treated initially, then increasingly the Social Anxiety Disorder will need to be the main focus.

Self Help

· Accept you have an illness.
· Face it – don’t bottle it up.
· Float – don’t fight it all the time.
· Take time – improvements take months.
· Resist the temptation to drown your sorrows.
· Attend a support group.
· Talking to people, friends, family, workmates etc, who you feel have empathy, intelligence, experience and time to listen to you.

When in therapy work together for wellness

Psychological Treatments

Anxiety, fears, Social Anxiety Disorder, panic attacks can be treated by various types of talking or “psychotherapy” which may include individual or group therapy.

Cognitive Therapy helps people to understand the irrational basis of the fears and adopt a more rational approach.

Behavioural Therapy involves gradual exposure to the feared situation(s) which helps reduce anxiety and fear and therefore helps people to be more outgoing and confident.

Group Therapy can help some people confront and overcome their fears by practising their skills in a social setting. It is supportive and assists in relating, understanding and the building of confidence.

Social Skills training helps to achieve social skills and encourages relaxation and confidence.

Medication

Social Anxiety Disorder may be associated with an imbalance of brain chemicals. Some medications can restore the normal balance/functioning.

Many medications are useful, relieving or preventing symptoms and sometimes curative of the “illness”. Often they don’t achieve more than 30% of the work required to attend complete “wellness”.

There are two main approaches –

· Short Term
Performance anxiety reducing, to cope with specific events (e.g. public speaking):
Beta Blockers: Propranolol (intermittently)
“Tranquilizers”: Diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)
Clonazepam (Rivotril)
(Used long-term these can be habit-forming or addictive.)

· Long Term
Beta blockers (Nadolol and Atenolol)
Buspirone
Citalopram
Moclobemide
Dothiepin
Doxepin
Venlafaxine
Mirtazapine

These are safe to use long term; dependency is infrequent and, if it occurs, is relatively easy to resolve.

Self-Medicating?

If can be tempting to use drugs or alcohol to help yourself cope, eg drinking before going out so that you can loosen up and relax enough to actually enjoy it – this could lead to dependency!

Is therapy worth the effort and fees?

Most patients keep this condition a secret. They are scared to inform others because of shame and stigma. Most cope by avoidance, continuing to fail to reach their potential and dreams.

Therapy can reduce illness and problem patterns of thinking and behaviour, and improve self-acceptance, self-confidence, empowerment, ability to relate and a growing wellness in relationships and employment.

I am confident I can help if you want to improve and are willing to work at therapy. The choice must be yours – it can’t just be given to you. If will not be easy, but will be worth the struggle and can be cost effective for self-worth and relationships, and improved productivity.

“Life can be a dance when you take the steps”
“Therapy can be an adventure”

Dr Harvey Williams
M.B., Ch.B, DPM (Lond), F.R.A.N.Z.C.P

Medical Specialist (Psychiatrist)

Medical Director and Founder
of Caledonian Clinic (1986)

Caledonian Clinic
304 Papanui Road, Christchurch

Ph: 03 355 0336
Fax: 03 355 0337
Cell phone: 0274 58 78 28

E-mail: harvey@caledonianclinic.co.nz

Contact us for Treatment Advice
We would like to be of service.

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