Social phobias are highly treatable

October 10, 2005|by Dr. Matthew Wagner

Many people have a significant fear of social situations or of performing in public. Exposure to a social or performance situation brings on an immediate feeling of anxiety. This feeling is very intense, and is often accompanied by physical symptoms of pounding heart, shortness of breath, sweating, trembling and the like.

Persons with social phobia know that their fear is excessive or unreasonable, but they are unable to control it. They fear embarrassing themselves and so may avoid public speaking or social events. They may spend days worrying about an upcoming event.

Most of us have feared being embarrassed in certain situations. However, for a diagnosis of social phobia, the fear must interfere with normal functioning or relationships.

Social phobia usually emerges in the teenage years, often in youngsters who were quite shy as children. Without treatment, it might be a lifelong problem. The good news is that people can learn to overcome their fears and tackle situations that they previously avoided.


Therapists help people learn relaxation techniques that counteract many of the symptoms they feel in social situations. At the same time, they learn to challenge beliefs that lead to anxiety, such as the belief that everyone is looking at them or judging them.

For more severe problems, medications often are helpful. Heart medicines known as beta blockers are often enough to block the trembling, shaking feeling that impairs performance. These medicines are often used by musicians or public speakers. In other situations an anti-anxiety medicine may be needed.

Obsessive compulsive disorder (OCD) causes repetitive thoughts or images and repetitive behaviors. The thoughts are experienced as intrusive and odd. They take the forms of doubts: doubts that one might have unintentionally harmed someone or left something important undone. The images might be violent or sexual.

Again, the person with OCD knows that the obsessions are excessive or unreasonable.

Compulsive behaviors often take the form of excessive hand-washing, checking and rechecking, counting and keeping objects in a particular order. Resisting the compulsive behaviors produces painful anxiety.

This illness often is called the doubting disease.

Research has identified a specific circuit in the brain that functions differently in OCD sufferers. Treating OCD with therapy and appropriate medication helps to bring that circuit back to normal. Therapy teaches how to better resist compulsive behavior and ignore intrusive thoughts. Medication is almost always needed for success in treating this condition. There is no cure.

Many people who experience traumatic events develop posttraumatic stress disorder, or PTSD. Military combat, sexual assault, robbery and auto accidents are common examples. Almost everyone in such a situation goes through a painful psychological reaction. This usually subsides with time. For reasons which still are unclear, some people continue to have a high level of anxiety and fear over months or years. They re-experience the trauma in intrusive memories or dreams. They avoid anything that may remind them of the event. Often PTSD sufferers feel detached from others and distanced from their emotions. They have trouble sleeping or concentrating. They are irritable and startle easily.

PTSD is a challenge to treat. Those who suffer with PTSD need support and understanding. One effective technique involves a repeated re-telling of the traumatic experience in therapy, to slowly rob the memory of its power to terrorize. Anti-anxiety and antidepressant medicines can be helpful.

Anxiety disorders cause suffering, but professionals are getting better at helping people with these conditions. Misunderstanding and prejudice are barriers which prevent people from coming forward for help. Advocacy groups, doctors and therapists are working to increase awareness and understanding of these problems.

Dr. Matthew Wagner is a staff psychiatrist with Behavioral Health Services of Washington County Health System.

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