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Young Yet Sad: The Social Phobic

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

"I know how you feel too.  But at least you still have school and more chances. I’m 22 y.o..I finished school and all..so I don’t even have school to try to make friends with.  I don’t have the option of joining clubs anymore. I do have one friend left, but I feel as if she’s not really my friend anymore. I feel like I’m losing her and she’s not really talking to me anymore either. I don’t have any other friends and I don’t have a boyfriend either. I don’t even have a job. I have NOTHING! At least some other people who are alone have their boyfriends or husband at least. And I feel so alone and depressed all the time.  I’m even too shy to try to pick up the phone or go out to apply for a job. So what am I suppose to do."

This is one among many E. Mail responses sent in by young men and women about the dilemma of their social phobia. More of these and an article can be found by pressing on this link:

http://www.mentalhelp.net/poc/view_doc.php?type=advice&id=2574&at=7&cn=1&ad_7=1&submit=I+Agree#ad9195

The sample E. Mail quoted above is a perfect example of the kind of suffering our respondents experience in relation to social phobia. The overwhelming wish to avoid in response to deep seated fears and self doubts leaves most of these individuals isolated and feeling hopeless.

It is common for those with social phobia to have very low self esteem, little in the way of self confidence, poor body image. Social phobics are those who avoid social situations in order to reduce feelings of fear and experiences of rejection. The paradox of this behavior is that it results in the opposite of that which is desired by the individual. Instead of reducing anxiety, avoidance results in increased anxiety. What the social phobic needs more than anything is to acquire those social skills that will help him/her function at work, in groups and among friends. Yet, avoidance robs them of this opportunity. The failure of the strategy is something the phobic is well aware of. In fact, it is this awareness that causes increased depression. Self criticism for having practiced avoidance is what worsens their suffering.

Further confounding the paradoxical nature of avoidance is the fact that any social interaction that is perceived as rejecting becomes more fuel for self hatred. Ultimately the person with social phobia becomes isolated and that deepens the depression. The challenge for psychotherapists is how to help the patient end the vicious cycle of anxiety, avoidance and self hatred and isolation.

Actually, today the therapists has more tools than ever to help people reduce social fears so that they can fully participate in life with other people. This will be a brief summary of a few of the therapeutic techniques used by psychotherapists.

Therapeutic Techniques:

1. Systematic desensitization: The patient is trained in how to reduce tension and fear. Once relaxed and feeling stress free in the therapist office, they are asked to imagine themselves in social situations, ranging from the most benign for them and gradually, over a weeks and months of work, to the most threatening. The idea is to be able to imagine socializing while experiencing no sense of anxiety. The next step is to begin going into the real world and starting to experience this in the same gradual way as done in the office.

2. Cognitive Behavioral Therapy: The learns to identify those automatic thoughts that they commonly experience but that have no basis in the real world. Through cognitive restructuring they learn to think about their experiences in ways based on real evidence and not what they think. In other words, someone not returning their "good morning" greeting may not be a rejection but the fact that the individual did not hear them, was preoccupied, etc. They can ask that person why they did not say "hello" in return. So many times, the person with social phobia is ready to interpret the slightest error of proof that they are not liked. How many times have you failed to say "hello" completely unaware that the other person was near you? We can all be sensitive about these minor slights. For the social phobic, these slights are major rejections.

3. Along with psychotherapy self help is important. In fact, in CBT, there is usually homework to be done. That homework often involves not just thinking exercised but actions as well. In addition, there are many self help books on the market for this. Overcoming social phobia requires the learning of social skill so that a person can begin to feel more confident. Many times a patient has told me that what I wanted them to do seemed silly or unimportant but it was actually extremely important. What I am referring to is doing such things as rehearsing what to say when you see someone, learning to force yourself to make eye contact, learning to engage in small talk. I have rehearsed with patients how to talk about the weather, the economy and all the other minor things that are called "small talk." The fact is that the rehearsing really helps. The idea is to then rehearse with the neighbors, the grocery clerk, the supermarket cashier, etc. Everyone wants to feel acknowledged and it is a rare thing that people do not appreciate a smile and a hello.

4. Medication treatment: In the event that a psychotherapy patient fails to respond to the treatment, anti depressant medication is available. There are those cases where the use of medication is important as a way to reduce the emotional road block enough to get the process moving. What I mean is that medication is not the answer but a temporary tool to help make the psychotherapy work better. Many of the anti depressants have mild anti anxiety effects that work quite well with these types of fears. Medications that are strictly anti anxiety, like Valium, Zanax and other Benzodiazapines, carry with them the risk of addiction. Psychiatrists will sometimes use these only in the most severe cases and only on a limited time and dosage basis.

To all of those suffering from any type of social phobia or social anxiety, it is important for you to know that real help is available. Simply talking about anxiety is not enough. The anxiety disorders require action in the form of learning new behaviors before real change takes place.

Your comments and questions are welcome and encouraged.

Allan N. Schwartz, PhD.

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