Social phobia is an anxiety disorder characterized by a pronounced fear of social situations. In such situations, people with a social phobia are afraid of being judged by other people and of embarrassing themselves. Social phobia is treated with psychotherapy, in particular cognitive behavioral therapy, and medication.
Here you will find further information as well as selected specialists and centers for people with social phobia.
Social phobia is one of the so-called anxiety disorders. It is a pronounced fear of social situations.
Those affected are afraid of behaving embarrassingly or shamefully when they are the center of attention. They are afraid of being judged by other people.
Social phobia is one of the most common mental disorders. According to recent surveys, it ranks third in frequency after alcohol addiction and depression.
The incidence of the disease in Germany over the course of a year is just under 8 percent of the total population. Around one in nine people will suffer from social phobia at some point in their lives. Women are affected around 1.5 times more frequently than men.
The causes of social phobia are varied. A family predisposition is conspicuous. Relatives of people with social phobia have a three times higher risk of developing the disease than people from unaffected families.
In addition to a biologically based susceptibility to the disorder, learning processes play an important role. The theory of avoidance learning by the American psychologist Mowrer is of particular importance here.
This theory states that the affected person first learns a fear response to certain stimuli. For example, a boy stutters when answering a teacher's question and the other pupils laugh. This can link social situations in which the pupil feels judged with fear and shame.
In the next step, the pupil will try to avoid such situations. For example, he skips school and avoids contact with classmates. As a result, he feels less fear and shame. The reduction in anxiety acts internally as a reward for avoiding social situations. As a result, this behavior increases in frequency.
This example illustrates the importance of learning processes with regard to a social phobia. Those affected learn that avoidance leads to less anxiety. Conversely, this behavior can also be unlearned.
The fear of being judged by other people and embarrassing oneself in front of them characterizes a social phobia © Feodora | AdobeStock
Social phobia is characterized by a specific fear of being judged or devalued by other people. Due to a negative self-assessment, those affected are convinced that they cannot meet other people's expectations of themselves. They are therefore afraid of embarrassing themselves.
People with social phobia tend to feel a strong sense of shame. "I could sink to the ground with shame". This saying succinctly summarizes the feeling that those affected fear when in contact with other people.
Situations in which judgment seems more likely are particularly feared. This includes, for example, speaking in the presence of other people
In these situations, those affected often suffer from clear physical symptoms of anxiety or shame, such as
They are particularly afraid that outsiders might notice their own insecurity: This insecurity could serve as an indication of their own supposed inability.
The fear of social situations can become so great that they completely avoid such situations. As a result, those affected are often severely restricted in many areas of their lives, e.g. in
They withdraw even though they would like to have contact with others.
Social anxiety during puberty is relatively common. They must be distinguished from social phobias, which usually develop before the age of 25.
People with social phobia often have little or no sexual contact. Experiences with partnerships are also not very pronounced.
Depression or alcohol dependency often develops as a concomitant disease of social phobia. Suicidal thoughts and attempts also occur with pronounced social phobia. This is also related to the increasing isolation of patients.
Social phobia can be treated with medication and psychotherapy. A combination of both measures is often recommended.
The drugs recommended and effective in the treatment of social phobia come from the group of antidepressants. These are drugs that are often also used to treat depression. They also have an effect on anxiety.
Selective serotonin reuptake inhibitors in particular have proven effective in the treatment of social phobia. These include active substances such as
Other antidepressants are also effective (e.g. venlafaxine). The drugs cause a change in the concentration of neurotransmitters, i.e. neurotransmitters between nerve cells. They are not addictive. It is necessary to take the medication regularly, as this is the only way to achieve an effective blood level.
Caution is advised when treating social phobia with direct anxiolytic drugs such as benzodiazepines. Well-known active ingredients include lorazepam or diazepam (the suffix "-am" indicates the corresponding substance group). These drugs are extremely effective in the short term because they directly relieve anxiety. However, they have a high potential for addiction.
If taken regularly over several weeks, a drug dependency develops. It must be treated in the long term as part of inpatient addiction therapy. Although the long-term use of sedative medication ends the social phobia, it causes drug addiction.
This danger does not exist when treating social phobia with antidepressants!
Caution: Alcohol also has a short-term anxiety-relieving effect. This is why sufferers of social phobia often drink alcohol to treat themselves. This can lead to the development of alcohol dependence.
In addition to medication, psychotherapy is an important element in the treatment of social phobia. As a rule, those affected undergo psychotherapy and take medication at the same time. However, an attempt at treatment with psychotherapy alone is also possible. The treating doctor decides which treatment is appropriate in each individual case.
Various methods can be used as part of psychotherapy. The treatment of social phobia can take place as individual or group therapy.
Cognitive behavioral therapy, in which the patient talks about their thoughts and fears, is very helpful. This makes them aware of the irrationality of their thoughts.
For example, many sufferers fear that a catastrophe will happen if other people realize that they are anxious or insecure, sweating, shaking and blushing. The therapist discusses with the patient that these fears are unfounded. On this basis, they are instructed to calm themselves down, i.e. to counter the catastrophizing thoughts with calming thoughts.
As the therapy progresses, the patients are then exposed to the anxiety-inducing situations in the practice. There they learn to use the strategies they have learned.
In this way, the social phobia is reduced through training. Gradually, the patient also eliminates their avoidance behavior. They can then enter more and more previously anxious social situations.
Other psychotherapy methods such as
can also be helpful for social phobia.
Attending a self-help group has a good effect, especially because of the social contact.
Cognitive behavioral therapy achieves good results in terms of improving social phobia and reducing avoidance behavior. More than 50 percent of those affected are said to experience an improvement in symptoms.
However, a long duration of illness and concomitant illnesses are rather unfavorable for the healing process of social phobia.
A 20-year-old man moves from his parental home in a village in the Eifel to Aachen at the beginning of his studies. At the instigation of his family doctor, he consults a psychiatrist.
The patient reports that he is in his first semester at university. He has felt very uncomfortable in lectures, practicals and seminars from the very beginning. Initially, he still went to the relevant events. However, he always had the feeling that other students did not take him seriously and laughed at him.
He describes one particular situation in particular. When answering a question from the professor, he blushed and stuttered. Other students laughed at this.
Since then, he has stopped going to lectures and mainly stays at home. He had recently been drinking more alcohol because he felt his anxiety less strongly. He has no relationship and no close friends. He goes to his parents at the weekend, where he feels a little better. He was considering dropping out of university.
In the further description of his biography, it becomes clear that the patient grew up in a very strict parental home. He often felt like a failure there.
The patient receives medication with an antidepressant that is also effective for anxiety disorders and has no dependency potential. He should take it for the next 6 months.
In addition, he is referred to an outpatient psychotherapist with a focus on behavioral therapy. There, the patient learns about the connection between his current social phobia and his life history.
In particular, the therapist makes it clear to him that his fears will only improve if he confronts himself with fear-inducing situations. If the patient repeatedly experiences that the feared catastrophes do not occur, a habituation effect will occur.
The patient is instructed to seek out and endure embarrassing social situations. For example, he should
He learns to calm himself down in anxious situations.
The social phobia improves during 50 hours of behavioral therapy once a week. The student is able to continue his studies. After completing the therapy, the patient is largely free of symptoms.
