There are two main strategies used to overcome social anxiety disorder (sometimes called “social phobia”). The first is medication and the second is behavioral therapy. They actually work in tandem, and here’s why.

Social anxiety is viewed as a type of phobia – an unreasonable or irrational fear of something that normally doesn’t cause a fear response. It’s very similar to the anxiety most people get when faced with the challenge of giving a speech. They worry about being judged by their audience and about the intense focus on them – all those eyes, all that evaluation. And while this type is very common, the true phobic experiences much the same in “regular” social situations, all the way from a party situation through to being unable to get the mail until the postman has left. “If I go out now, I might have to talk to him!”

The physical side and the anxiety symptoms generate a fear response – an adrenaline rush, a sense of danger and an overwhelming urge to flee. That response becomes self-reinforcing so that patients become “fearful of fear” – they know they are going to get that response and avoid situations where it might happen. The cycle needs to be broken before they can move on and learn to deal with the problem. This is where medication can help.

Medications are used to blunt the physical process and allow a graduated, stepwise approach toward retraining the mind so that the fears do not arise. With time and training, the medications are no longer needed – and that’s the goal here.

The behavioral training used is through exposure to stronger and stronger stimuli. Patients first identify and rank those scenarios where they are fearful and which produces the most and the least anxiety. Starting with the least anxiety-producing, they move through stages, overcoming each step in turn until the most imaginably fearful situation can be overcome. A gradual progression should keep them moving forward while not giving them a full blown anxiety attack. This is done through a variety of techniques, using imagination, scripting, and practice. Some scenarios may be:

Eating in public with someone you trust

Looking people in the face while talking to them

Calling an acquaintance to make plans

Learning about an acquaintance – their likes, dislikes, and opinions

Getting help from a store clerk to find an item

Asking a stranger for directions or the time

All of these can seem minor to someone not affected by the condition, but any could produce real fear in a patient. Other scenarios will be developed with the therapist and customized to a specific patient’s needs.

In general, suffers of social anxiety can teach themselves to use the tricks that work best for them. Some common techniques are:

Preparation and rehearsal. Planning out a conversation or having something interesting to say at the ready.

Not giving up when things don’t go well and focusing on the successes rather than the missteps.

Tracking those situations that really do produce fear and recognizing those that do not – there are usually many more of the latter, but they go unnoticed.

Emphasize that most feared outcomes simply don’t happen.

Relaxation and stress management training will be beneficial and can be directed by a therapist.

Shift the focus from “what are they thinking about me” to positive things you already know about yourself.

Learn to handle embarrassment and understand that most people feel that way sometimes.

The real goal is not necessarily to lose all anxiety or become an armored shell of a person. A win is when the anxiety is noted and set aside without driving the situation, and to do this while medication-free.

Photo: Pixabay