Social phobia

When do we speak of social phobia

Those affected are very afraid of being the center of attention or behaving embarrassingly, of making a fool of themselves. Although they know that their fears are exaggerated and unfounded, they are unable to control them. Social situations are very stressful and trigger strong anxiety reactions. These also manifest themselves in physical symptoms such as blushing, nausea, nausea, trembling, sweating, urge to urinate or defecate - accompanied by thoughts such as "what will others think of me?", "they think I'm stupid and won't get anything done". The fear of attracting negative attention continues to increase and can escalate into a panic attack. The feared situations are increasingly avoided by those affected. This results in professional and private restrictions and a very high level of suffering.

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

If the fears occur not only in performance situations, but in many different social situations (e.g. making contact with strangers), this is referred to as a generalized social phobia(generalized type). The fears can be traced back to a general insecurity 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 3020by e-mail to empfang@juvenismed.at or via the contact formto make an appointment for a consultation or treatment.

How social anxiety arises

It can be observed that the parents of some of those affected often suffer from social anxiety themselves or have a lack of social skills. In these cases, the children did not have the opportunity to learn from their parents' example and were unable to develop many skills. Social phobics also often have a history of negative interpersonal experiences, such as being ridiculed by peers or being laughed at when they make mistakes in performance situations. Many of those affected were already shy, introverted, avoidant or anxious as children.

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

Behaviors with negative effects on the course of the disease

In order to better tolerate or cope with social situations, some sufferers turn to tranquilizers or alcohol. This provides short-term relief, but in the long term the social phobia persists or even worsens. There is also a risk of developing an addiction. Apart from substance abuse, many sufferers tend to adopt the following safety behaviors: Avoiding questions, speaking quickly, quietly or mumbling, hand over mouth, lowered gaze, checking what has been said afterwards, not eating or drinking anything, thinking everything through internally beforehand and much more. After an interpersonal interaction, those affected tend to think about everything they have done badly and wrong. This pronounced self-criticism increases the fear of expectations and worsens the symptoms in the long term.

Anxiety-inducing situations are increasingly avoided, which prevents sufferers from experiencing that their fears are unfounded and the symptoms persist or worsen. In order to avoid making mistakes in social interactions, those affected also tend to increase their self-observation. This impairs spontaneity and attention to the interaction partner, which is subjectively perceived as a lack of concentration. Fears of failing again (fear of expectations) as well as unfavorable thought patterns ("I am boring", "I must not show my fears", "the others see my excitement") also have a negative impact on the course of the illness.

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

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

Every treatment is preceded by a precise diagnosis. An individual explanatory model is created which provides insight into the development of the disorder. This takes into account pre-existing risk factors (e.g. parental parenting behavior) as well as triggers (e.g. change of school) and maintaining factors (safety behaviors) of the disorder. These factors are given special consideration as part of the treatment.

The patient receives information about the course of anxiety, the significance of fears of expectation and safety behaviors, etc. In addition, an individualized vicious circle 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 is an important factor in the effectiveness of the therapy.

If a patient's social skills deficits are in the foreground, the focus of treatment is on improving social skills. As part of psychotherapy, the patient should learn to make demands (e.g. complain, protest against injustice), refuse requests from others 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 developed together and practiced, e.g. in the form of role plays. Patients are also encouraged to practise these skills in everyday life and to discuss their experiences in therapy. Social skills training can be carried out as part of individual or group therapy.

Please contact JUVENIS by phone at +43 1 236 3020by e-mail to empfang@juvenismed.at or via the contact formto make an appointment for a consultation or treatment.

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 that the patient is asked to increasingly confront the fearful situations in order to experience that the feared consequence does not occur ("I won't be laughed at", "the others won't hurt me"). At the beginning of therapy, a situation is chosen that triggers relatively little anxiety. The situations are discussed in detail with the patient beforehand and afterwards. Examples: Getting advice in a store without buying anything, making a complaint about purchased goods, or buying a little something and having it wrapped as a gift, etc.

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

Cognitive therapy plays an important role in the treatment of all social anxiety. Unfavorable thought patterns are identified, questioned and changed. For example: "I have to avoid criticism", "I want to be popular with everyone", "it's terrible to be rejected".

It is also important to work on individual background problems, such as pronounced self-esteem issues. The development of activities (leisure activities, social contacts) is also an important aspect of the therapy.

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

A partial refund of the costs via your health insurance is possible if you have a mental disorder that qualifies as an illness. Some private supplementary insurance policies often cover part of the costs—however, patients should check with their supplementary insurance provider.

It is also possible to deduct clinical-psychological treatment from tax as an extraordinary burden.

We’ve answered the most common questions about social anxiety here. If you have any further questions, please feel free to contact us atempfang@juvenismed.at or by phone at +43 1 236 3020.

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