What is social anxiety disorder (or social phobia)?

This disorder consists of intense fear or anxiety in social situations in which the person perform in front of others (for example, speaking in public, carrying the voice of everyone in a meeting, dancing in front of others, participating in a work of theater or musical presentation, etc.) or in those where the person interact with others (for example, having to start or maintain a conversation, talk to a superior, tell another person you like them, asking in a store, saying that something bothers you, etc.).

In these situations the person is exposed to the observation by others, to a possible evaluation on their part or to become the center of attention, and their greatest fears are related to making mistakes, saying something embarrassing, appearing incompetent, being ignored or criticized or that others realize that they are nervous.

What characterizes social anxiety disorder (or social phobia)?

A person with this disorder shows typical symptoms of anxiety or fear (such as blushing, feeling the heart racing, breathing faster and shallowly, sweating, stomach or gastrointestinal discomfort, such as cramps or a pinch in the stomach, muscle tension, for instance in the neck and back, etc.) to be in the feared social situation or even to anticipate that he must face it or imagine that he is in it.

These people tend to be very inhibited in situations of social interaction or acting in front of others and usually are less skilled in them. That is why it is common to observe that they conduct escape or avoidance behaviors of such situations.

Their thoughts, ideas, interpretations and beliefs usually refer to a negative evaluation of themselves (for example, being uninteresting, boring, inadequate, etc.) and the fear they experience of rejection or criticism by others.

What impact does social anxiety disorder (or social phobia) have on the patient?

Depending on the degree of generalization of social fears, it will also impact the person’s life. The greater the variety of social fears, the greater the negative consequences it will have on their life.

Thus, a person can suffer more and have a worse quality of life if he expresses fear in different social dimensions, such as interaction with strangers, interaction with people of the opposite sex, interaction with people of authority or speaking / performing in public, when faced with situations that demand the use of assertiveness (knowing what to say in a social situation, expressing feelings, defending one’s rights and points of view without attacking or harming others), feeling embarrassed etc., as opposed to someone whose fears are more focused on one or two types of social dimensions.

The emotional state and health can be affected in someone with SAD (they may feel depressed and abuse alcohol), their interpersonal relationships (it is hard for them to get friends, partners), their work or school performance (people can see them as “loners”, it is hard for him to work in a group, he does not receive recognition for his work), and/or their economy (he may not achieve good economic conditions when leaving school or work).

What other mental disorders can occur at the same time as social anxiety disorder (or social phobia)?

Social anxiety disorder often occurs together with other anxiety disorders, such as major depressive disorder and disorders related to alcohol or other toxic substances. SAD frequently precedes all these disorders.

What are the causes of social anxiety disorder (or social phobia)?

To date there is no established cause for this disorder. However, being an anxiety response, one of the explanatory models suggests that it was possibly caused by the association of an alarm reaction (all typical fear responses) with one or several social situations and that association was maintained because the person began to perform escape or avoidance behavior of these situations, reducing the anxiety response or preventing them from going further. These avoidance behaviors (of the anxiety caused in social situations) are what make the disorder continue.

In any case, it is known that not all those who suffer criticism, rejection or are observed by others develop a social anxiety disorder. This means that there will be preconditions (biological and in personal history) that increase the vulnerability of those who do suffer from the disorder (for example, having a behaviorally inhibited temperament, hypersensitivity to their own physical symptoms, overprotective or anxiety disorders parents, having received reinforcement for submission behaviors, having had negative and stressful experiences such as abuse and harassment during childhood), as well as current conditions (for example, a very peculiar way of interpreting the elements of social situations as threats, having someone to serve as a guide when faced with feared situations, have few social skills, etc.)

What could a person with a social anxiety disorder (or social phobia) do?

Without doubt, a person with SAD requires psychological help, since this disorder does not disappear over time. It is true that when you reach adulthood it seems not to be so problematic, perhaps because the demands disappear or a desired status has been reached, but that does not mean that the psychological problem has been resolved. For example, interaction with people for whom you are attracted is no longer a matter of concern if the person gets a partner. However, this same problem could come alive again if it were to break up with this couple.

Cognitive behavioral therapy has the greatest scientific support for the treatment of ASD. The cognitive behavioral psychologist will make a complete evaluation that includes conducting a clinical interview (using even structured formats) to help you determine whether or not you have an ASD and other possible psychological problems that occur together, and will pass some questionnaires to better identify the most affected areas, the type of social situations you fear and the level of severity of the disorder. Likewise, it could use some system to record the ways of reacting and acting in everyday social situations. Subsequently, he will trace the therapeutic objectives together with the patient and design the treatment plan.

What treatments are there for social anxiety disorder (or social phobia)?

Cognitive behavioral therapy includes an explanation of what happens to the patient (psychoeducation) in combination with procedures and techniques aimed at exposing oneself to the feared social situations. It is about the person staying in it, tolerating anxiety and using their skills so that it decreases to the point that it does not interfere with their social skills. All of this will therefore require training in these skills. For the latter, for example, breathing or relaxation and cognitive techniques are used that allow you to focus on the important aspects of the situation as well as to identify and change those (catastrophic) thoughts or ways of interpreting reality that increase and maintain the discomfort experienced in social situations and that are related to the fear of rejection and negative evaluation by others. Cognitive behavioral therapy usually includes homework, so that the patient practices what they learned during the session.

These treatments can be performed individually or in groups and at FUNVECA Clinical Psychology Center we have both modalities. Recently we have also developed a treatment program for social anxiety called the MISA program (“Multidimensional intervention for social anxiety”), which we apply in our center in group format. Every October/November we start these social anxiety treatment groups that can be targeted by anyone who is suffering from this type of problem. At this time, participation in these treatment groups is free as it is supported by a research project granted by the Ministry of Science, Innovation and Universities.

More information about the MISA program, what it is and how to sign up can be found in the section of the website dedicated to this program.

As for pharmacological treatment, it is important to know that its use is not recommended before having tried cognitive behavioral therapy. The drugs are used together to help control anxiety symptoms only in severe cases of SAD. This situation should be assessed by the health professional.