Social Phobia or Social Anxiety Disorder is an anxiety disorder characterised by overwhelming anxiety and excessive self consciousness in everyday social situations. Most of us will feel some degree of anxiety when faced with a job interview, giving a presentation or meeting new people for the first time. We may worry about what we are going to say, or even wear in these situations. However these events often become easier with some experience. For people experiencing social phobia or social anxiety disorder these events and other social situations can be very frightening. A phobia can be described as a fear. We all have fears but for most of us they don’t really stop us from doing what we want to do. A fear becomes a phobia when it stops us from enjoying thing or doing them easily. If you have a social phobia you get very anxious when you are with other people, usually because you worry that they may be critical of you or you may do something embarrassing. This can be so bad that you get very anxious and cannot enjoy being with people or speaking in front of them and you avoid social situations altogether.

How does a person with social phobia feel?
Most people who have social phobia have a strong fear of being embarrassed in front of people. People who have social phobia feel as though everyone is watching them and will see them blush, sweat or otherwise show their fear and anxiety. They may feel inferior and think everyone around them is so much more confident and socially relaxed. People with social phobia usually know their fears are not completely rational, but they still find themselves dreading social situations. They may go out of their way to avoid some events. If people with social phobia do out to an event, they usually feel very nervous before the event and very uncomfortable during it.

Some main feelings include:

• Worrying a lot about making a fool of yourself in front of other people
  
• Feeling very anxious before going into any of the social situations you worry about
  
• Going through in great detail all the embarrassing things that could happen to you
  
• Unable to say, or do the thing you want to do
  
• After an event worrying about how you handled the situation. You may go over, again and again, how you might have behaved differently or said different things.

Symptoms
Social phobia can have emotional, behavioural and physical signs and symptoms.

Emotional and behavioural signs and symptoms of social phobia include:

• Intense fear of being in situation in which you don’t know people
  
• Fear of situations in which you are being judged
  
• Worrying about embarrassing or humiliating yourself
  
• Feel that others will notice that you look anxious
  
• Anxiety that disrupts your daily routine, work, school or other activities
  
• Avoiding doing things or speaking to people out of fear or embarrassment
  
• Avoiding situations where you might be the centre of attention.
  
• Drinking too much alcohol in order to try to reduce your anxiety.
  
• Taking drugs to hide your anxiety
  

Physical signs and symptoms of social phobia include:

• Blushing
  
• Profuse sweating
  
• Trembling or shaking
  
• Nausea
  
• Stomach upset
  
• Difficulty talking
  
• Shaky voice
  
• Muscle tension
  
• Confusion
  
• Palpitations
  
• Diarrhoea
  
• Cold, clammy hands
  
• Difficulty making eye contact.

You may also be affected by:

• Low self esteem
  
• Trouble being assertive
  
• Negative Self Talk
  
• Hypersensitivity to criticism
  
• Poor social skills

Situations that may cause you to fell anxious include:

• Any situation that requires you to interact with strangers
  
• Making eye contact
  
• Writing in front of strangers
  
• Returning items to a shop
  
• Entering a room where people are already seated
  
• Ordering feed in a restaurant
  
• Being introduced to strangers
  
• Initiating conversations
  
• Being teased or criticized
  
• Being watch or observed while doing something
  
• Making small talk
  
• Speaking up in a meeting or in class

Social phobia symptoms can change over time. They may flare up if you are facing a lot of stress or demands. Or if you completely avoid situations that would usually make you anxious, you may have no symptoms. Although avoidance may allow you to feel better in the short term, your anxiety is likely to persist over the long term if you do not confront the problem. Avoidance of situations may also mean that you miss out on otherwise great experiences and the opportunity to meet new friends and live life to the full.

Complications
There are some common problems associated with social phobia. Someone who is affected by social phobia may also be affected by:
Depression: You may be so upset by social phobia that you become depressed, to the extent that the depression becomes a problem in itself.
Agoraphobia: If you constantly avoid places where people meet, you may end up feeling afraid of those places even when there is nobody there. You may feel that leaving the house on your own become a major problem.
Drug and alcohol use: You may use alcohol and drugs to cope with your feelings. As your social phobia continues the reliance on alcohol and drugs may also increase.

Causes of social phobia
It is difficult to pinpoint what causes social phobia. Experts in the field of social phobia have suggested that it is probably a combination of your genetic makeup and past experiences.

What adds to the problem?
Certain thoughts and behaviour seems to add to the problem of social anxiety. These include strict standards and behaviours that the person with social phobia imposes on themselves that adds to the anxiety. These include:

• Rules for themselves - e.g. ‘I need to look in control and happy’
  
• Beliefs about themselves: e.g. ‘I’ve nothing interesting or funny to say.’
  
• Prediction about the future - e.g. ‘if someone does talk to me they’ll realise just how stupid I am.’

These thoughts make you criticize yourself even more. Such thoughts can be so automatic that they feel true to you, although there is often no evidence for them at all. They can make you imagine that you appear to others in a certain, usually rather negative way. This is almost certainly very different from the way people actually see you.

We also do certain things to make yourself feel more in control in a social situation. They include:

• Drinking alcohol
  
• Avoiding eye contact
  
• Not saying anything personal about yourself
  
• Asking a lot of questions about the other person.

The problem with doing this is that it does not allow you to experience the fact that dreadful things do not happen if you stop trying to control your behaviour so much.

• Anticipation and post- mortems: Thinking over and over about a social situation, before or after, tends to make you focus on past ‘failures’. It strengthens your habit of over-scrutinising your behaviour and criticising yourself.

Getting help for social phobia
While it may feel like there is nothing you can do to overcome the symptoms of social phobia, in reality there are many things that can help. The best treatment approach for social phobia varies from person to person. You may find that self help strategies are not enough to ease your anxiety symptoms, or you may need professional help as well, such as therapy or medication. Whatever your approach, you can overcome your social phobia if you seek help and commit to the treatment option preferred by you and your G.P.

Lifestyle changes
While lifestyle changes alone are not enough to overcome social phobia, they can support your overall treatment progress. The following lifestyle tips will help you reduce your overall anxiety levels and enhance successful treatment:

• Avoid or limit caffeine. Coffee, tea, caffeinated soda, energy drinks and chocolate acts as stimulants that increase symptoms of anxiety.
  
• Drink only in moderation. You may be tempted to drink before a social event in order to calm your nerves, but alcohol increases your risk of having an anxiety attack. Alcohol can also make matters worse, if you drink too much and are drunk you may behave in a way that you later regret.
  
• Quit smoking. Nicotine is a powerful stimulant. Smoking leads to higher levels of anxiety.
  
• Sleep. When you are sleep deprived, you are more vulnerable to anxiety. Being well rested will help you stay relaxed in social situations.

Medication
Medication is sometimes used to relieve the symptoms of social phobia. They can be used most successfully in combination with therapy and other self help techniques that address the root cause of the social phobia.

Cognitive Behavioural Therapy
Cognitive behavioural therapy (CBT) is based on the premise that what you think affects how you feel, and your feelings affect your behaviour. So if you change the way you think about social situations that cause you to be anxious, you will feel and function better.

CBT for social phobia typically involves:

• Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises.
  
• Challenging negative, unhelpful thoughts that trigger and fuel social anxiety replacing them with more balanced views.
  
• Facing social situations you fear in a gradual, systematic way rather than avoiding them.

Other CBT based techniques for social phobia include role playing and social skills training often as part of a group. Group therapy for social anxiety disorder uses acting, videotaping and observing, mock interviews, and other exercises to work on situations that make you anxious in the real world. As you practice and prepare for situations you are afraid of, you will become more and more comfortable and confident in your social abilities, and your anxiety will lessen.

How can I reduce the impact of social phobia on my life?
The first thing that is required is a visit to your doctor so you can discuss symptoms, diagnosis and treatments options. We have also listed an example of tips below that you may find useful.

Lifestyles and home remedies
Although social phobia generally requires help from a medical expert or qualified psychotherapist, you can try some self-help techniques to handle situations likely to trigger social anxiety disorder symptoms.

First, assess your fears to identify what situations cause the most anxiety. Then gradually practice these activities until they cause you less anxiety. You may need to begin with small steps in situations that are not overwhelming.

Situations to practice may include:

• Eating with a close relative, friend or acquaintance in a public setting.
  
• Making eye contact and returning greetings from others, or being the first to say hello.
  
• Giving someone a compliment.
  
• Asking a shop assistant to help you find an item.
  
• Getting directions from a stranger.
  
• Showing an interest in others. Ask about their friends, hobbies etc
  
• Calling a friend to make plans.
  

At first being social when you are feeling anxious is challenging. As difficult or painful as it may seem initially, do not avoid situations that trigger your symptoms. By regularly facing these kinds of situations, you will continue to build and reinforce your coping skills.

The following techniques can help you begin to face situations that make you nervous. Practicing these techniques regularly can help you manage or reduce your anxiety.

• Prepare for conversation. For instance, read the newspaper to identify an interesting story you can talk about.
  
• Focus on personal qualities you like about yourself.
  
• Practice relaxation exercises.
  
• Adopt stress management techniques.
  
• Set realistic goals.
  
• Pay attention to how often the embarrassing situations you are afraid of actually take place. You may notice that the scenarios you fear usually do not come to pass.
  
• When embarrassing situations do happen, remind yourself that your feelings will pass, and you can handle them until they do.
  

In addition, be sure to keep your medical or therapy appointments, take medications as directed, and talk to your doctor about any changes in your condition

Techniques for reducing the physical symptoms of anxiety
Many changes happen in your body when you become anxious. One of the first changes is that you begin to breathe quickly. Over breathing throws off the balance of oxygen and carbon dioxide in your body — triggering additional physical anxiety symptoms such as dizziness, a feeling of suffocation, increased heart rate, and muscle tension. Learning to slow your breathing down can help you bring your physical symptoms of anxiety back under control.

Practicing the following breathing exercise will help you decrease the physical symptoms of anxiety and stay calm:

• Sit comfortably with your back straight and your shoulders relaxed. Put one hand on your chest and the other on your stomach.
  
• Inhale slowly and deeply through your nose for 4 seconds. The hand on your stomach should rise, while the hand on your chest should move very little.
  
• Hold the breath for 2 seconds.
  
• Exhale slowly through your mouth for 6 seconds, pushing out as much air as you can. The hand on your stomach should move in as you exhale, but your other hand should move very little.
  
• Continue to breathe in through your nose and out through your mouth. Focus on keeping a slow and steady breathing pattern of 4-in, 2-hold, and 6-out.
  

Challenging negative thoughts
Social anxiety sufferers have negative thoughts and beliefs that contribute to their anxiety. If you have social phobia, you may find yourself overwhelmed by thoughts like:

• “I know I’ll end up looking like a fool.”
  
• “My voice will start shaking and I’ll humiliate myself.
• ” “People will think I’m stupid.”
  
• “I won’t have anything to say. I'll seem boring.”

Challenging these negative thoughts, either through therapy or on your own, is one effective way to reduce the symptoms of social anxiety disorder.

The first step is to identify the automatic negative thoughts that underlie your fear of social situations. For example, if you‘re worried about an upcoming work presentation, the underlying negative thought might be: “I’m going to blow it. Everyone will think I’m completely incompetent.”

The next step is to analyse and challenge them. It helps to ask yourself questions about the negative thoughts: “Do I know for sure that I’m going to blow the presentation?” or “Even if I’m nervous, will people necessarily think I’m incompetent?” Through this logical evaluation of your negative thoughts, you can gradually replace them with more realistic and positive ways of looking at social situations that trigger your anxiety.

Unhelpful thinking styles involved in social phobia
In particular, ask yourself if you’re engaging in any of the following unhelpful thinking styles:

• Mind reading – Assuming you know what other people are thinking, and that they see you in the same negative way that you see yourself.
  
• Fortune telling – Predicting the future, usually while assuming the worst will happen. You just “know” that things will go horribly, so you’re already anxious before you are even in the situation.
  
• Catastrophising – Blowing things out of proportion. If people notice that you are nervous, it will be “awful,” “terrible,” or “disastrous.”
  
• Personalising – Assuming that people are focusing on you in a negative way or that what’s going on with other people has to do with you.
  

How can I stop thinking that everyone is looking at me?
In order to reduce self-focus, pay attention to what is happening around you, rather than monitoring yourself or focusing on symptoms of anxiety in your body:

• Look at other people and the surroundings.
  
• Really listen to what is being said (not to your own negative thoughts).
  
• Do not take all the responsibility for keeping conversations going – silence is OK, other people will contribute.
  

How to gradually face my fears
One of the most helpful things you can do to overcome social phobia, is to face the social situations you fear rather than avoid them. Avoidance keeps social phobia going. It prevents you from becoming more comfortable in social situations and learning how to cope. In fact, the more you avoid a feared social situation, the more frightening it becomes.

While it may seem impossible to overcome a feared social situation, you can do it by taking it one small step at a time. The key is to start with a situation that you can handle and gradually work your way up to more challenging situations, building your confidence and coping skills as you move up the “anxiety ladder.”

For example, if socialising with strangers makes you anxious, you might start by accompanying an outgoing friend to a party. Once you are comfortable with that step, you might try introducing yourself to one new person, and so on.

• Do not try to face your biggest fear right away. It is never a good idea to move too fast, take on too much, or force things. This will backfire and reinforce your anxiety.
  
• Be patient. Overcoming social anxiety takes time and practice. It is a gradual step-by-step progress.
  
• Use the skills you have learned to stay calm, such as focusing on your breathing and challenging negative assumptions.
  

Beating social phobia by building better relationships
Actively seeking out and joining supportive social environments is another effective way of tackling and overcoming social phobia. The following suggestions are good ways to start interacting with others in positive ways:

• Take a social skills class or an assertiveness training class. These classes are often offered at local adult education centers or community colleges.
  
• Volunteer to do something you enjoy, such as walking dogs in a shelter, helping out with a local community group— anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people.

Coping and Support
Coping with social phobia can be challenging. Having social phobia can make it difficult for you to go to work or school, to interact with other people, or even to visit the doctor.
Over time, treatment can help you feel more comfortable, relaxed and confident in the presence of others. In the meantime, try not to use alcohol or illicit drugs to try to get through an event or situation that makes you anxious.
Some positive coping methods include:

• Reaching out to people with whom you feel comfortable
  
• Joining a support group
  
• Engaging in pleasurable activities, such as exercise or hobbies, when you feel anxious
  
• Getting enough sleep
  
• Eating a well-balanced diet
  

Over time, doing this can help control your symptoms and prevent a relapse. Remind yourself that you can get through anxious moments, that your anxiety is short-lived, and that the negative consequences you worry about so much rarely come to pass.

How can I support a friend who has a social phobia?
In order to support someone who has a social phobia, learn as much as you can about the condition. Speak to the person directly about how the social phobia makes them feel.

Having someone to talk to about their anxiety is a very helpful step towards coping with the situation. Actively encourage your friend to come out with you. Just go out as a pair to begin with. Once out, remember what your friend has told you. If you know somewhere is getting too crowded or there are too many new people around, suggest a different venue that your friend might feel more comfortable. Discretely ask your friend how s/he is doing throughout the night.

Where can I go for additional help and advice?
Social Anxiety Ireland is a group operating from the Mater Hospital in Dublin but with additional groups in Louth and Waterford. www.socialanxietyireland.com for more details.

OANDA – The Out and About Association.
OANDA offers practical help and self-help support groups for people suffering from agoraphobia and social anxiety disorder. Group meetings are held in Dublin, Cork, Limerick and Drogheda to allow sufferers to have personal contact with other sufferers and to educate relatives regarding their role in helping recovery.
Tel: 01 - 833 8252