Social phobia

When is it called a social phobia?

Those affected have a great fear of being the center of attention or behaving embarrassingly and making a fool of themselves. Although they know that their fears are exaggerated and unfounded, they cannot control them. Social situations represent a major burden and trigger strong anxiety reactions. These also manifest in physical symptoms such as blushing, nausea, gagging, trembling, sweating, or the urge to urinate or defecate – accompanied by thoughts like "what will others think of me?", "they think I'm stupid and can't get anything done". The fear of being negatively noticed continues to increase as a result and can escalate into a panic attack. The feared situations are increasingly avoided by those affected. Consequently, professional and private limitations arise, leading to a very high level of suffering.

In some affected individuals, social anxiety only occurs in performance situations (speaking in public, giving a presentation, taking an oral exam, performing athletic feats, etc.). In the past, these individuals have usually had repeated negative experiences, such as being laughed at for stuttering during a presentation. This specific social phobia (performance type) often begins around the age of 17.

If the anxieties do not only occur in performance situations but in many different social situations (e.g., making contact with strangers), it is referred to as a generalized social phobia (generalized type). The anxieties can be traced back to a general lack of self-confidence and/or a lack of social skills. The onset of symptoms is usually before the age of 15.

Please contact JUVENIS by phone at +43 1 236 3020, by e-mail at empfang@juvenismed.at or via the contact form, to arrange a consultation or treatment appointment.

How do social anxieties develop?

It can be observed that the parents of some affected individuals often suffer from social anxiety themselves or exhibit a lack of social competence. In these cases, the children did not have the opportunity to learn from their parents' example and could not develop many skills. Furthermore, the history of socially phobic people often shows negative interpersonal experiences, such as being mocked by peers or laughed at for mistakes in performance situations. Many affected individuals were already shy, introverted, avoidant, or anxious in childhood.

On one hand, this involves innate temperament, but on the other hand, it is also shaped by the parental upbringing style. Social phobia is often triggered by stressful events or life changes in general that place increased demands on a person's social competence. For example: changing schools, starting university, a new job with numerous team meetings, etc.

Behaviors with negative effects on the course of the illness

To better endure or master social situations, some affected individuals resort to sedatives or alcohol. In the short term, they experience relief, but in the long term, the social phobia remains or even worsens. Additionally, there is a risk of developing an addiction. Apart from substance abuse, many affected individuals tend to use the following safety behaviors: avoiding questions, speaking quickly, quietly, or mumbling, covering their mouth with their hand, lowered gaze, checking what was said afterwards, not eating or drinking, mentally rehearsing everything beforehand, and much more. Affected individuals tend to think about everything they did poorly or wrongly after an interpersonal interaction. This pronounced self-criticism strengthens anticipatory anxiety and worsens the symptoms in the long term.

Anxiety-inducing situations are increasingly avoided, which means that those affected cannot experience that their fears are unfounded, and the symptoms persist or worsen. To avoid mistakes in social interactions, those affected also tend to increase self-observation. This impairs spontaneity and focus on the interaction partner, which is subjectively perceived as a concentration disorder. Fears of failing again (anticipatory anxiety) as well as unfavorable thought patterns ("I am boring", "I must not show my fears", "the others see my nervousness") also have negative effects on the course of the illness.

If left untreated, other mental illnesses can occur, such as alcohol and medication abuse or depression.

How does psychotherapy (behavioral therapy) help with social phobia?

Every treatment is preceded by precise diagnostics. An individual explanatory model is created, which offers insight into the development of the disorder. This takes into account pre-existing risk factors (e.g., parental upbringing behavior) as well as triggers (e.g., changing schools) and maintaining factors (safety behaviors) of the illness. These factors are given special consideration during treatment.

The patient receives information about the course of anxiety, the significance of anticipatory anxiety and safety behaviors, etc. In addition, an individual vicious cycle of anxiety is created with the patient. The patient should thus gain a better understanding of the illness.

For many patients, the first contact with the therapist is already a major challenge and confrontation. The therapeutic relationship offers the first important learning experiences in the treatment of social anxiety and represents an important active factor in therapy.

If social competence deficits are at the forefront for a patient, the treatment focus lies on improving social skills. Within the framework of psychotherapy, the patient should learn to make demands (e.g., complaining, protesting against injustice), refuse others' requests or say "no", pay attention to their own needs, express them openly and assert them appropriately, express and accept criticism, start, maintain, and end conversations, give praise, allow themselves to make mistakes, etc. The various areas are worked out together and practiced, for example, in the form of role-playing. Patients are encouraged to practice these skills in everyday life and to discuss their experiences in therapy. Social skills training can be carried out in individual or group therapy.

Please contact JUVENIS by phone at +43 1 236 3020, by e-mail at empfang@juvenismed.at or via the contact form, to arrange a consultation or treatment appointment.

Other patients have good social skills but show (phobic) fear of contact, judgment, or attention from other people. In this case, confrontation is the method of choice. This means the patient is encouraged to increasingly face the anxiety-inducing situations in order to experience that the feared consequence does not occur ("I will not be laughed at", "the others won't do anything to me"). At the beginning of therapy, one chooses a situation that triggers relatively little anxiety. The situations are discussed in detail with the patient before and after. Examples: getting advice in a shop without buying anything, complaining about purchased goods, or buying a small item and having it gift-wrapped, and much more.

By training social perception, those affected learn to better assess the reactions of other people.

In the treatment of all social anxieties, cognitive therapy plays an important role. Unfavorable thought patterns are identified, questioned, and changed. For example: "I must avoid criticism", "I want to be liked by everyone", "it is terrible to be rejected".

It is also important to address individual background problems, such as a pronounced self-esteem issue. Building activities (leisure activities, social contacts) also represents an important aspect of therapy.

In behavioral therapy, a frequency of 1 session per week is usual.

A partial reimbursement of costs through your health insurance fund is possible if a clinically significant mental disorder is present. Some private supplementary insurances often cover part of the costs – however, this should be clarified by the patient with their supplementary insurance.

There is also the possibility of deducting clinical-psychological treatment as an extraordinary expense on your taxes.

We have answered the most frequently asked questions on the topic of Social phobia answered. If you have any further questions, please feel free to contact us via empfang@juvenismed.at or at +43 1 236 3020.

Responsible for the content of this page: Mag. Hilde Winkler & Mag. Dorothea Bertram