Social Phobia – Treatment
By: Beth McHugh 2006
Earlier we looked at the problem of social phobia from the viewpoint of a fictitious character named Jeff. Let’s now look at some methods Jeff can use to make life a little bit more bearable.
Not too many years ago, the prescribed treatment was to throw social phobics “in at the deep end” by advising them to join a speech-training organization like Toastmasters. This probably provided help for some sufferers, gradually allowing them to build enough confidence to cope better in their day-to-day lives. But for others, such a step was just too great, with each Toastmasters meeting becoming an exercise in terror management.
In more recent times, much better options have become available with the introduction of specialized support groups and training programs for social phobics. The latter often involves a combination of cognitive therapy and exposure-based rehearsal of situations that typically cause anxiety for the participants.
Cognitive therapy is used to enable the sufferers to uncover the thoughts that automatically flood their minds whenever they are in stressful situations. Upon careful examination, it is usually possible to identify a couple of key thoughts that are causing the over-the-top anxiety response. For example, Jeff may think that, if he attempts to tell his work colleagues a joke, he will probably mess up the punch line, or, even worse, that they won’t think the joke is funny. Social phobics also overestimate consequences. Jeff probably thinks that if he ruins the joke his colleagues will think he is an idiot and, therefore, not a wanted member of their social group.
After identifying the anxiety-causing thoughts, the second part of cognitive therapy tests the reality of the underlying thoughts by seeing if there is any evidence for these beliefs. Usually there isn’t. First, Jeff has probably successfully told jokes in the past, and, secondly, his friends have probably never ostracized a bad joke teller. With dedication this method can slowly chip away at damaging long-held beliefs.
Perhaps an even more important part of the modern treatment of social phobia is the rehearsal of stressful situations within a group situation. This role-playing method, in conjunction with the support provided by other group members, has been shown to be very effective at reducing the anxiety normally felt by social phobics. With practice, these gains will be carried over to the real world. Delivering a speech to an “audience” of supportive fellow-sufferers has thus proven to be a much better learning tool than delivering the same speech to a group of Toastmasters.
Various drugs have also been used to treat social phobia, with some degree of success. However, relapse is quite common when the medication is stopped. Therefore cognitive-behavioral therapy, as described above, is definitely the treatment of choice.