More than Just Shyness...
We have all had a time in our life where a simple task felt insurmountable because we worried whether people would evaluate us or judge us negatively. For instance, the fear of speaking in front of a crowded audience- even if we know the topic well. Typical associated thoughts may be: what will they think of me? What if my mind goes blank? What if people don't laugh at my jokes? But somehow, for most of us, we manage to pull through the event relatively unscathed, and we can go on to do it again and again.
However, for people with clinically defined social phobia, a specific form of anxiety, the sheer embarrassment or fear of performing particular, often simple, tasks in front of other people is more than overwhelming, and the individual is always aware that the fear is unjustified in terms of the stress and anxiety potential of the event. Furthermore, in some cases, the worry can occur even days or weeks before the feared event or task; and it is accompanied by an anxious state often resulting in physical symptoms which all gradually impede social or occupational functioning. This is what differentiates social phobia from shyness or an avoidant like personality. For example, a barrage of fearful thoughts can lead to an overall anxious and hypervigilant mood which signals to the brain that there is a 'problem'. So what does the brain do? It tried to protect us by getting into fight or flight mode- so we can literally 'fight' or 'flee' from the situation. Therefore, even the mere thought of doing something that could be judged unfavourably, or which could lead to embarrassment, is enough for our body to start trembling, our heart to race a million miles an hour, our palms to go sweaty, and our cheeks to go fire engine red. And more often than not, these people will try to 'flee' any time this particular threat comes their way. The typical response to this pattern of fear needs to continue for approximately 6 months for social phobia to be diagnosed; and it often starts in the teenage years with approximately 40% of cases occurring before 10 years of age, and 95% of cases occurring before the age of 20. Research is still undecided on how much of social phobia is due to nature (brain chemical) or nuture (learned behaviour).
One example of social phobia is a client who experienced fear to such an extent that she was gradually finding it more and more difficult to go to work. There was undue pressure on her because of group meetings that were called for spontaneously by her manager. This meant that at any given moment, she would have to go to a meeting and be accountable for the issue at hand. Ironically, she knew she excelled in her field, and therefore she knew her worries were irrational- typical in social phobia- but she was unable to control her feelings. She was also continually plagued with doubt about her performance or about an error that she 'might' have made, and primarily, the reactions of others to her 'errors' and how they would judge her associated physical reactions (sweating, quivering voice, and red blotching around her neck)- which unfortunately only reinforced her beliefs that this was a potentially scary or 'dangerous' event. She was also scared when meetings were organized simply because they were out of her control- she felt could not prepare herself in time. She often made excuses not to go to the meetings which became difficult in and of itself. As a result, when she was initially given a reprieve from some of the meetings, it actually made future meetings an even worse experience, and she became even more self conscious in front of her co-workers. Therefore, her fears became more generalized to the entire realm of her work environment, not just the meetings alone. For other people with social phobia, their fear may remain more specific, and therefore may simply be limited to the embarrassment of signing a cheque in front of a bank teller, eating and drinking in front of others, using the telephone, or being watched performing a task.
Unfortunately, given the nature of everyday life, we need to be able to say and do things that we are not always comfortable with. We have to accept at a certain level that a mistake may be made, that people may not like us or that they will scrutinize us at some level. But this is not always something we are taught to deal with as children. Furthermore, for people who are perfectionists or who spend a lot of their time seeking out social approval to feel better about themselves, the recovery process may take a little longer.
Although research shows that a combination of medication and psychological therapy can be the most beneficial in treating social phobia and preventing relapse, the first step is for people to actually seek help from a sensitive professional who will not make them feel like they are being judged, and the decision about whether or not medication is truly necessary would be assessed. Then, the trick is to cognitively ease up on yourself- challenging the true reality of your thoughts- and to start de-sensitizing yourself to the worst possible outcome that may be envisioned. This is best done with the help of a mental health professional who is trained in cognitive behavioural therapy and systematic desensitization techniques. You will also need to be educated about the nature of anxiety and why you feel such fear in particular situations. This means that you will be able to start confronting the feared situations in small chunks, and the ramifications of your fear will gradually have less impact on your social and occupational quality of life.
General health and lifestyle techniques are also beneficial in addressing the physiological component of anxiety, so make sure that in addition to receiving psychological help, you have a balanced lifestyle- plenty of exercise, correct breathing and relaxation techniques, time out from stressful situations, an appropriate diet with minimal stimulants, and training in assertiveness and self esteem. Remember, as soon as you have the courage to ask for help, you can start to truly make the most of your life- a life without fear.