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Running Head: BEHAVIORS AND CHARACTERISTICS OF SOCIAL PHOBIA

Behaviors and Characteristics of

Social Phobia

Jolene M. Williams

Penn State University

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Abstract

The report is about shyness and social anxiety related behavior. Some aspects include characteristic behaviors, sociability, self-consciousness, and self-perceptions. The author has found that socially anxious people, as well as other people with anxiety disorders, are biased towards threatening and negative information. Socially anxious people also have an impaired positive inferential bias. These topics are discussed in more detail in the body of the report.

Other topics discussed in the report include the links between shy-sociable people and social anxiety disorder, physical symptoms and other secondary problems related to social phobia, and various treatment plans for social anxiety disorder. Overall, the report provides a basic understanding of social phobia, and it provides information about the most misunderstood and least known anxiety disorder.

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Behaviors and Characteristics of Social Phobia

Social phobia is also often called social anxiety disorder. A person with this disorder experiences overwhelming anxiety and self-consciousness in social situations. Another characteristic of social phobia is a persistent, intense, and chronic fear of being scrutinized by others and of being embarrassed or humiliated by their own actions. Many people experience some anxiety before a public appearance, but the anxiety in people with social phobia can become so great that they begin to avoid social situations. Many people with social phobia realize that their fears are excessive or unreasonable, but they are unable to overcome them. They may also worry about a dreaded situation for days or weeks in advance. ( NMHA, 2004 )

There are two types of social phobia, called generalized social phobia and specific or situational social phobia. Generalized social phobia, the most severe form, may be so broad that a person experiences phobic symptoms in any social setting. Specific social phobia is limited to one or a few situations, such as a fear of speaking in formal or informal situations, or eating, drinking, or writing in front of others. Very commonly feared situations include speeches and oral presentations, especially in front of a large audience. Social phobia can be very debilitating because people with this illness often avoid forming or maintaining close relationships or turn down opportunities for career advancement.

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These symptoms can become so severe that the person may become housebound. ( NMHA, 2004 )

Physical symptoms and other disorders often accompany social phobia. Physical symptoms include blushing, profuse sweating, trembling, and other symptoms of anxiety such as difficulty talking, nausea, and other stomach discomfort. Social phobia often runs in families and may be accompanied by depression, alcoholism, and other disorders. These will be discussed in more detail later in the paper. ( NMHA, 2004 )

Social anxiety disorder affects up to ten percent of the U.S. population. Many people with this disorder do not seek treatment. In addition, it is often misdiagnosed as another disorder, such as manic depression. Social phobia occurs in women twice as often as men, although a higher portion of men seek treatment. An interesting fact is that other anxiety disorders are also more common in women. In addition, these disorders also have higher lifelong prevalence rates among women. Social phobia typically develops in childhood or early adolescence. It rarely develops after age 25. ( Franklin, n.d.; NMHA, 2004; Allen, Gotlib, Lewinsohn, Lewinsohn, & Seeley, 1998)

Cognitive Aspects of Social Phobia

People with social phobia are very self-conscious. They are very vulnerable to what is called the “spotlight effect.”

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The spotlight effect is a tendency to exaggerate the degree to which other people are focused on the person with social phobia. People with social phobia also have distorted ideas of how they and their behaviors are being judged, how much people will remember their behavior, and how much people care about how well or badly the people with social phobia have performed. ( Bush, 2002 )

People with social phobia experience an elevated heart rate that cannot be explained by fitness differences. In social situations, they often believe that they are blushing because blushing is often accompanied by heart palpitations. The people with social phobia report more blushing than people who do not have social phobia, but they do not actually blush more than normal people. Another reason for this reporting is that people with social phobia focus more internally than externally. In addition, they are much more focused on their anxiety, reporting much more anxiety and embarrassment in social situations than people without the disorder. ( Gerlach, Gruber, Roth, & Wilhelm, 2001 )

People with social phobia have very poor attentional control in addition to higher levels of anxiety. People with high anxiety and low attention are particularly at risk to develop clinical disorders, such as anxiety disorders. People with social phobia generally feel more tense and inhibited in social situations, as well. Since shy-sociable people are particularly tense in social situations, social phobia is most likely more common in these individuals.

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In Buss and Creek’s study, the shy-sociable subjects were the only ones that engaged in behaviors that are considered to be overt signs of anxiety about social interaction. In this study, it was concluded that shy-sociable subjects, strongly motivated to be with others, found themselves to be too fearful and inhibited to mix socially. ( Derryberry & Reed, 2002; Buss & Creek, 1981 )

People with social phobia perceive themselves very negatively and often have low levels of self-esteem. They assume that people will think of them as ugly, stupid, weak, awkward, unwelcome, worthless, or cursed with some other undesirable quality. Often, people with social phobia believe themselves to have these undesirable qualities. People with social phobia actually fear feeling embarrassed, ashamed, guilty, disgraced, rejected, or humiliated. People with social phobia often have these reactions even when no one is judging them negatively, and they expect to be judged and feel the negative emotions, even when it is objectively unlikely. They also assume that the experiences are unbearable, rather than experiences that they can cope with. ( Bush, 2002 )

People with social phobia predict that what will happen will be more extreme and negative than what actually happens. Things will usually be much better than they expect. They also have selective memory that is subject to many distortions. The brain constructs a scenario using incomplete and sometimes incorrect information, filling the gaps with what “must have happened”. What these people remember is a mixture of fact and fiction.

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In addition to the distortion of memories, people with social phobia often have a very unflattering and often inaccurate appraisal of their abilities and performance. They need to be particularly skeptical of their cognitions, especially because of these informational biases. ( Bush, 2002 )

People with social phobia do not learn threat-related information as well as normal people. This hampers their full recall of negative events. They have only partial memories and increased distress associated with these memories. Since this is the case, people with social phobia must reinterpret incomplete representations, and they often do so very negatively, especially in very emotional situations and circumstances. This is caused by a strategic avoidance of threat-related information. In addition, safety has a functional importance to anxious persons. They have a bias favoring safety. Socially anxious people also lack a positive on-line bias, which normal people do not lack. People with social phobia have an impaired positive inferential bias. This may explain why people with social phobia interpret things so negatively and predict that events will be much worse than they actually turn out. However, people with social phobia do not learn anxiety-relevant words any easier than words that are not relevant to their anxiety in social situations. The author was somewhat surprised by this particular result. ( Amir, Brigid, Coles, & Foa, 2001; Derryberry & Reed, 2002; Hirsch & Mathews, 2000; Andrich, Becker, Margraf, & Roth, 1999 )

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People, especially ones with social phobia, often have cognitive distortions. These include all-or-nothing thinking, over-generalization, mental filter, discounting the positives, jumping to conclusions, magnification or minimization, emotional reasoning, “should” statements, labeling, and personalization and blame. All-or-nothing thinking is when one looks at things in absolute, black-and-white categories. Overgeneralization is when one views a negative event as a never-ending pattern of defeat. Mental filter is when one dwells on the negatives and ignores the positives. Jumping to conclusions involves mind-reading, assuming people will react negatively when there is no evidence for this, or fortune-telling, arbitrarily predicting that things will turn out badly. Magnification is blowing things way out of proportion, and minimization is shrinking their importance inappropriately. Emotional reasoning is reasoning from how one feels, rather than logic. Should statements are when one believes that something should be a certain way and than an exception is not acceptable. Labeling is identifying with shortcomings. For example, when a person makes a mistake, they may label themselves as a “fool”. Lastly, people will blame themselves and other people as well as overlook how their attitudes and behaviors contribute to a problem. ( Bush, 2002 )

Behavior Aspects of Social Phobia

People with social phobia tend to under-participate in social situations.

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They avoid social situations, rushing through them, cutting them short, or being physically present but thinking and acting in ways that insulate the person emotionally from normal social interaction. Examples of the last form of under-participation include substance abuse, daydreaming, and deliberately ignoring social situations. People with social phobia also get absorbed in and carried away by emotion-steeped thoughts, memories, and fantasies. They also do what may seem like the opposite, but actually has the same effect, such as trying to force the thoughts out of their minds. Either way, the person is emotionally engaged with the thoughts. ( Bush, 2002 )

Other Aspects of Social Phobia

Physical symptoms often accompany social phobia. These visible symptoms heighten the fear of disapproval in social situations, and the symptoms themselves can become and additional focus of fear. The fear of symptoms can cause a vicious cycle; as people with social phobia worry about experiencing the symptoms, the greater their chances of developing the symptoms. ( NMHA, 2004 )

Social phobia can cause lowered self-esteem, depression, and in extreme situations, suicide attempts. People with social phobia also may use alcohol or other drugs to alleviate anxiety, which can lead to addiction. They may also develop other anxiety disorders. People with social phobia may become so anxious that they experience panic attacks when in dreaded social situations. Social Phobia 10

They may take extreme measures to avoid situations in which they fear another panic attack may occur or in which help may not be immediately available. The avoidance may develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. ( NMHA, 2004 )

Possible causes of social phobia are being investigated. Some investigators suggest that people with social phobia have hypersensitive amygdalas. The amygdala is believed to be a central site in the brain that controls fear responses. If this is the case, the amygdala will send a false alarm of great danger, triggered by the sight or sound of other people, or even by remembering or imagining oneself in the presence or thoughts of other people. Social phobia may also be inherited. Researchers supported by the National Institute of Mental Health recently identified the site of a gene in mice that affects learned fearfulness. Another line of research suggests that heightened sensitivity to the disorder may be physiologically or hormonally based. Other researchers believe that the environment influences social phobia. People with social phobia may acquire their fear from observing the behavior and consequences of others, a process called observational learning or social modeling. ( NMHA, 2004; Bush, 2002 )

Treatment and Recovery Options

There are various treatment and recovery options available for social phobia.

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These include medications and cognitive behavior therapy, as well as other options.

Various medications are used to treat social phobia. These include SSRIs, an SNRI, an MAOI, an anticonvulsant, and a benzodiazepine. The SRI medications are Paxil, Zoloft, and Effexor XR. The medications of other types are Nardil, Neurontin, and Klonopin. The most effective drugs, when used alone, are Nardil and Klonopin. SRIs are not nearly as effective, but are prescribed more often. Most of the time, two or more drugs are used in combination, however. ( Socialfear.com, 2004 )

Cognitive behavior therapy is another treatment option for those suffering with social anxiety disorder. It combines two very effectives kinds of psychotherapy. These are cognitive therapy and behavior therapy. Cognitive behavior therapy helps the patient weaken the connections between troublesome situations and habitual reactions as well as teaches the patient how certain thinking patterns are causing the symptoms. In cognitive behavior therapy, the therapist takes an active part in helping the patient solve problems as well as provides a custom treatment plan for the patient. CBT also provides clear structure and focus to treatment. It is focused on what needs to be changed and what doesn’t. CBT emphasizes the present and future much more than traditional therapies.

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It focuses on achieving beneficial change rather than explanation or insight and is the therapy with by far the most research support. CBT is usually tried alone, without drugs, and it usually is brief. ( Bush, 2003 )

Other therapies are not quite as common and usually accompany the other types of treatment. These include anxiety management training, supportive therapy, relaxation therapy, systematic desensitation, as well as immersion therapy. ( NMHA, 2004; Franklin, n.d. )

Conclusion

The report defined social phobia and gave a basic description as well as providing some basic statistics about it. Next, the cognitive aspects of the disorder were discussed. These included self-consciousness, self-perceptions, informational biases, and cognitive distortions. Then, the behavior aspects were discussed, including common avoidance behaviors. Next, other aspects of the disorder were discussed, such as physical symptoms, secondary disorders, and possible causes. Finally, treatment and recovery options were discussed. These included medications, cognitive behavior therapy, and other options.

The author found the subject matter to be very interesting and informative. The author learned much about the disorder, as well as a few surprising items, such as how ineffective SRIs are for treating the disorder. The author enjoyed reading about the disorder as well as learning so much new information about it.

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The author hopes that social phobia will be more well-known and recognized in the near future.

References

Socialfear.com. (2004, April). SSRI Failure in the Treatment of Social Anxiety Disorder (Social Phobia). Retrieved April 19, 2004, from http://www.socialfear.com/ssri_failure_in_sp.html