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Social Phobia: Symptoms & Treatment

Dbt

Do you frequently avoid social situations and have fears about how others will see? When you are in social situations do you have a fast heart rate and sweat profusely? If so you could have a condition called, Social Phobia. To help understand what the symptoms of Social Phobia is and what type of help is available for someone with Social Phobia, I have interviewed therapist Tezlyn “Sam” Clark, M.Ed, LPC.

“I am a Licensed Professional Counselor, currently working in private practice in Anchorage, Alaska. I work with adolescents and adults, specializing in treating PTSD / abuse / trauma, anxiety disorders, addictions, codependency, anger management, and depression. I utilize a self-created skill based 3-part modality based therapy model that combines Cognitive Behavioral Therapy (CBT), emotion regulation / Dialectic Behavioral Therapy (DBT), and boundary / interpersonal skills. I also utilize EMDR (a therapy used for abuse and trauma). I am a fourth generation Alaskan, whose great-grandparents came over from Norway for the Gold Rush days in the late 1800’s. I have worked extensively with the Alaskan Native Culture (with whom, I have to add, I just adore), including spending two years in a remote bush village as a counselor at one of Alaska’s boarding schools. This remote area, unfortunately, has one of the highest suicide rates in the nation, as well as some of the highest addiction and abuse statistics. During this two-year time period, I worked extensively collaborating with the schools, community, and families in the prevention of addictions, trauma, and suicide.”

“Having worked in the counseling field since 1988, I have seen some heart-wrenching cases, but, more importantly, I have also seen some of the most amazing strength and resiliency the human spirit is truly extraordinary! I am reminded of a quote by Jean-Paul Sartre, “Freedom is what you do with what has been done to you.” We all have had things done to us, but these things do not define us – the key is what we do with them afterward. This is the philosophy I come from in my work with my clients. Social Phobia can stem from these things that have happened to us, from past conditioning; the good news is if they are learned responses, they can be unlearned.”

What are the signs and symptoms of social phobia?
“The signs of social phobia can include excessive worrying (sometimes for days, weeks, or months) about attending an upcoming social function. It may start as thoughts of just preparing for the event, but then can turn into intense ruminating thoughts and anticipation of how the event will go and what could unfold i.e., intense fear of being judged; extensive fear of being embarrassed or humiliated in public; panic attacks; and avoidance of social events.”

Some symptoms include dry mouth, sweating, rapid or shallow breathing, rapid or pounding heartbeat, tight chest, dizziness, upset stomach, blushing, trembling or shaking, clammy hands, or difficulty talking.

What type of impact does social phobia have on a person’s life?
“It’s normal and common for most people to have some kind of fear or worry about an important upcoming social event, but for people with Social Phobia these upcoming social events can be their very thought and focus for days, weeks, and sometimes even months. For some their disorder can be so debilitating that they cannot attend any social event or even go out into public. In addition, it doesn’t just affect their social lives and relationships, but their health as well. This constant worrying puts one’s body in “fight or flight” mode. This raises our cortisol levels (our stress hormone), which has been shown to have a wide range of effects on the body, including thyroid function; blood sugar imbalances; high blood pressure; lowered immunity; increased inflammation; and especially our hippocampus, the area of our brains associated with memory and learning.

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What type of help is available for someone who has social phobia?
“Help can include medications, therapy, or a combination of both. The most common, and effective treatment for Social Phobia has been shown to be Cognitive Behavioral Therapy (CBT). This therapy is based on the premise that how you think affects how you feel, and consists of teaching skills to help the client identify their thought patterns that may be unproductive and help the client change or modify those thoughts to more effective patterns, which would then, in turn, help the client feel better. For example, the thoughts of a person with Social Phobia may include, I can’t do this, I’m too anxious,What if I trip and fall on my face, then everyone’s going to laugh and I’ll look so stupid,” and/or “They think I’m an idiot who can’t talk in public . . . I am an idiot who can’t talk in public.” These thoughts just continue to reinforce the phobia. The goal then is to learn to identify these thoughts and change them to more beneficial and helpful ones . . . because if you sit and think about a funeral all day long, how are you going to feel?”

“However, one of the things to reiterate here is the fact that these thoughts are not only unhelpful, but they tend to reinforce feelings of guilt and shame, which just helps to perpetuate a shame-based cycle where one feels bad about one’s self so they beat themselves up verbally (and sometimes physically as well, with drugs, alcohol, cutting, etc.) This just then leads to more shame and bad feelings, which cause the cycle to start all over again. We see this cycle in many more areas that just Social Phobia addictions, trauma survivors, depression, anger issues, etc.; they just have a different face.”

“Another treatment technique that is gaining popularity and is also quite effective, especially coupled with CBT, is Mindfulness. Mindfulness is a technique whose premise is twofold. The first premise is based on the fact that all we have is just this moment right now there is no future because it has not happened yet, so teaching clients techniques to stay in the moment helps to alleviate fear and anxiety because the majority of thoughts associated with Social Phobia are based on fear and anxiety about the future. Thus, if one learns to practice “staying in the now,” these feelings can be greatly reduced.”

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“The second premise is based on noticing one’s thoughts and feelings in the moment with no judgment, no labeling, and no criticism just notice them and let them pass through. This is also beneficial to help address and reduce the guilt / shame piece that affects a person with Social Phobia.”

What advice would you like to leave for someone who has social phobia?
“A very important piece I would like add here is a concept that I like to call “The Mentality Shift.” It’s not really anything new, but just seems to be lost and not taught as much as it was in the past. Without going into it too deep, “The Mentality Shift” is basically a technique that teaches a person to take a look at any situation and list what is their “stuff” in it, what is the other person’s “stuff, and then list out what they have control over and what they don’t have control over. Much of our country seems to come from the mentality that “I’m responsible for you and you’re responsible for me;” from the mentality that “You can make me mad.” Can someone actually make you mad? Are there knobs inside you that they can reach in and turn or change? No, they don’t make you mad, you choose to get angry based on your thoughts and beliefs about what that person did to you, but that person did not make you mad you chose to be mad. No one has control over your feelings, but you. I know to some this may sound like a foreign language . . . but think about this how liberating would it be to know no one could make you mad ever again. It is truly a wonderful, most liberating experience.”

“Taking this one step further, what if someone came up to you and hit you. First, would that person be the one that made you mad, or would it be you who had the choice to decide how you feel about this person hitting you? Some people might react to that person, hit them back, start yelling and screaming, etc., but some may just look at that person and think “Wow, how sad it is that this person feels they have to walk around hitting people.” It’s like if someone were to write anger on a cup, and when they began yelling and screaming at you, it would basically be like they are trying to give you THEIR cup THEIR anger, it’s not yours. If you react, yell, scream, etc. back at them; you have just taken THEIR cup / owned THEIR anger. I know some people might be saying here, yes, but I have a right not to be hit by that person. Yes, you are absolutely right you do have a right not to be hit by that person . . . but that doesn’t mean that that person doesn’t has the free will to hit you, right? Can we make a person not hit us? No. Can we make a person do anything? No. I mean we can certainly try (usually through manipulation), but can we actually MAKE them do something they don’t want to do? No. Yet, there are so many of those who try over and over again to change another person; If he would just . . ., If I could just get her to . . . , ” “That person better stop disrespecting me!” I don’t even think that we realize we do it most of the time.”

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“So what does all this have to do with Social Phobia, you ask? Well, we have already established that the thoughts of a person with Social Phobia often include feeling judged by another person. And, as we have just discussed, this anxiety is based on something we have no control over another person’s feelings or thoughts. This is the where “The Mentality Shift” comes in ‘” because when a person can truly come to the realization that they don’t have control over another person’s feelings AND learn how to not own that other person’s feelings, it can help to release a significant portion of that anxiety and help them get to a place where they can work on the other issues surrounding their Social Phobia.”

“Finally, I would like to tell those who may be struggling with Social Phobia, or any of these related issues, to not give up hope, and to encourage them to seek therapy if they have not already done so. Psychology Today is a popular site and has a great web page where you can put in your zip code and look for specialty therapists in your area the website is www.psychologytoday.com, then click on “Find a Therapist” and type in your zip code. There are numerous effective treatments and therapists that can help with Social Phobia ‘” try a couple of therapists out and see which one fits best for you. Best wishes to all.”

Thank you Tezlyn for doing the interview on social phobia. For more information about Tezlyn Clark or her work you can check out her website on www.tezlynclark.com.

Recommended Readings:
Phobias: Questions and Answers
Panic Attack with Agoraphobia
Do You Have Panic Attacks? Try Stress Management

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