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Social phobia treatment plan example


Social anxiety disorder (social phobia) - Diagnosis and treatment

Diagnosis

Your health care provider will want to determine whether other conditions may be causing your anxiety or if you have social anxiety disorder along with another physical or mental health disorder.

Your health care provider may determine a diagnosis based on:

  • Physical exam to help assess whether any medical condition or medication may trigger symptoms of anxiety
  • Discussion of your symptoms, how often they occur and in what situations
  • Review of a list of situations to see if they make you anxious
  • Self-report questionnaires about symptoms of social anxiety
  • Criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

DSM-5 criteria for social anxiety disorder include:

  • Persistent, intense fear or anxiety about specific social situations because you believe you may be judged negatively, embarrassed or humiliated
  • Avoidance of anxiety-producing social situations or enduring them with intense fear or anxiety
  • Excessive anxiety that's out of proportion to the situation
  • Anxiety or distress that interferes with your daily living
  • Fear or anxiety that is not better explained by a medical condition, medication or substance abuse

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Treatment

Treatment depends on how much social anxiety disorder affects your ability to function in daily life. The most common treatment for social anxiety disorder includes psychotherapy (also called psychological counseling or talk therapy) or medications or both.

Psychotherapy

Psychotherapy improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations.

Cognitive behavioral therapy (CBT) is the most effective type of psychotherapy for anxiety, and it can be equally effective when conducted individually or in groups.

In exposure-based CBT, you gradually work up to facing the situations you fear most. This can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others. Practicing exposures to social situations is particularly helpful to challenge your worries.

First choices in medications

Though several types of medications are available, selective serotonin reuptake inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social anxiety. Your health care provider may prescribe paroxetine (Paxil) or sertraline (Zoloft).

The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder.

To reduce the risk of side effects, your health care provider may start you at a low dose of medication and gradually increase your prescription to a full dose. It may take several weeks to several months of treatment for your symptoms to noticeably improve.

Other medications

Your health care provider may also prescribe other medications for symptoms of social anxiety, such as:

  • Other antidepressants. You may have to try several different antidepressants to find the one that's most effective for you with the fewest side effects.
  • Anti-anxiety medications. Benzodiazepines (ben-zoe-die-AZ-uh-peens) may reduce your level of anxiety. Although they often work quickly, they can be habit-forming and sedating, so they're typically prescribed for only short-term use.
  • Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs. Because of that, they may work best when used infrequently to control symptoms for a particular situation, such as giving a speech. They're not recommended for general treatment of social anxiety disorder.

Stick with it

Don't give up if treatment doesn't work quickly. You can continue to make strides in psychotherapy over several weeks or months. Learning new skills to help manage your anxiety takes time. And finding the right medication for your situation can take some trial and error.

For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse.

To make the most of treatment, keep your medical or therapy appointments, challenge yourself by setting goals to approach social situations that cause you anxiety, take medications as directed, and talk to your health care provider about any changes in your condition.

Alternative medicine

Several herbal remedies have been studied as treatments for anxiety, but results are mixed. Before taking any herbal remedies or supplements, talk with your health care team to make sure they're safe and won't interact with any medications you take.

More Information

  • Social anxiety disorder (social phobia) care at Mayo Clinic
  • Cognitive behavioral therapy
  • Psychotherapy

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Lifestyle and home remedies

Although social anxiety disorder generally requires help from a medical expert or qualified psychotherapist, you can try some of these techniques to handle situations that are likely to trigger symptoms:

  • Learn stress-reduction skills.
  • Get physical exercise or be physically active on a regular basis.
  • Get enough sleep.
  • Eat a healthy, well-balanced diet.
  • Avoid alcohol.
  • Limit or avoid caffeine.
  • Participate in social situations by reaching out to people with whom you feel comfortable.
Practice in small steps

First, consider your fears to identify what situations cause the most anxiety. Then gradually practice these activities until they cause you less anxiety. Begin with small steps by setting daily or weekly goals in situations that aren't overwhelming. The more you practice, the less anxious you'll feel.

Consider practicing these situations:

  • Eat with a close relative, friend or acquaintance in a public setting.
  • Purposefully make eye contact and return greetings from others, or be the first to say hello.
  • Give someone a compliment.
  • Ask a retail clerk to help you find an item.
  • Get directions from a stranger.
  • Show an interest in others — ask about their homes, children, grandchildren, hobbies or travels, for instance.
  • Call a friend to make plans.
Prepare for social situations

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

These strategies can help you begin to face situations that make you nervous:

  • Prepare for conversation, for example, by reading about current events to identify interesting stories you can talk about.
  • Focus on personal qualities you like about yourself.
  • Practice relaxation exercises.
  • Learn stress management techniques.
  • Set realistic social goals.
  • Pay attention to how often the embarrassing situations you're afraid of actually take place. You may notice that the scenarios you fear usually don't come to pass.
  • When embarrassing situations do happen, remind yourself that your feelings will pass and you can handle them until they do. Most people around you either don't notice or don't care as much as you think, or they're more forgiving than you assume.

Avoid using alcohol to calm your nerves. It may seem like it helps temporarily, but in the long term it can make you feel even more anxious.

Coping and support

These coping methods may help ease your anxiety:

  • Routinely reach out to friends and family members.
  • Join a local or reputable internet-based support group.
  • Join a group that offers opportunities to improve communication and public speaking skills, such as Toastmasters International.
  • Do pleasurable or relaxing activities, such as hobbies, when you feel anxious.

Over time, these coping methods 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.

Preparing for your appointment

You may see your primary care provider, or your provider may refer you to a mental health professional. Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

  • Situations you've been avoiding, especially those that are important to your functioning
  • Any symptoms you've been experiencing, and for how long, including any symptoms that may seem unrelated to the reason for your appointment
  • Key personal information, especially any significant events or changes in your life shortly before your symptoms appeared
  • Medical information, including other physical or mental health conditions with which you've been diagnosed
  • Any medications, vitamins, herbs or other supplements you're taking, including dosages
  • Questions to ask your health care provider or a mental health professional

You may want to ask a trusted family member or friend to go with you to your appointment, if possible, to help you remember key information.

Some questions to ask your health care provider may include:

  • What do you believe is causing my symptoms?
  • Are there any other possible causes?
  • How will you determine my diagnosis?
  • Should I see a mental health specialist?
  • Is my condition likely temporary or chronic?
  • Are effective treatments available for this condition?
  • With treatment, could I eventually be comfortable in the situations that make me so anxious now?
  • Am I at increased risk of other mental health problems?
  • Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your health care provider

Your health care provider or a mental health professional will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your health care provider may ask:

  • Does fear of embarrassment cause you to avoid doing certain activities or speaking to people?
  • Do you avoid activities in which you're the center of attention?
  • Would you say that being embarrassed or looking stupid is among your worst fears?
  • When did you first notice these symptoms?
  • When are your symptoms most likely to occur?
  • Does anything seem to make your symptoms better or worse?
  • How are your symptoms affecting your life, including work and personal relationships?
  • Do you ever have symptoms when you're not being observed by others?
  • Have any of your close relatives had similar symptoms?
  • Have you been diagnosed with any medical conditions?
  • Have you been treated for mental health symptoms or mental illness in the past? If yes, what type of therapy was most beneficial?
  • Have you ever thought about harming yourself or others?
  • Do you drink alcohol or use recreational drugs? If so, how often?

By Mayo Clinic Staff

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CBT Treatment for Social Anxiety Disorder and Social Phobia

Eng, W. , Roth, D.A., & Heimberg, R.G. (2001). Journal of Cognitive Psychotherapy

Having anxiety in social situations or situations that involve other people is very common in the United States. The lifetime incidence of social anxiety disorder (aka social phobia), the most severe form of social anxiety, is over 12%. Approximately 7% of adults meet criteria for social anxiety disorder at any time. Oftentimes, when this disorder is left untreated, it can result in severe functional impairment. Studies have found untreated social anxiety disorder to be associated with much higher rates of depression, substance abuse, and other anxiety disorders. Fortunately, there is a cure for social anxiety disorder: Cognitive behavioral therapy (CBT).

Numerous research studies have found CBT to be the treatment of choice for social anxiety, significantly more effective than medication or traditional talk-therapy. Follow this link to a chart comparing the effectiveness of CBT to other treatments for social anxiety disorder.  Through CBT for social anxiety, people learn different ways of reacting to thoughts and feelings, and they learn to engage in different behaviors that result in decreased fear. CBT also helps people learn and practice social skills when there is a deficit. Unlike traditional talk-therapy, CBT for social anxiety is an active, brief treatment, involving use of skills training and behavioral homework assignments. Through learning and practice of CBT skills, people learn to become their own therapists, which is why CBT for social anxiety lasts signficantly less time than traditional therapy. Click here to learn more about what CBT is.

Treatment for social anxiety disorder generally includes the following interventions:

  • Assessment: Learning to analyze and identify what it is about specific situations that triggers anxiety

  • Cognitive restructuring: Learning to identify thoughts responsible for undue anxiety, and take a scientific approach to examining their veracity, subjecting them to rigorous tests of logic.

  • Mindfulness training: learning to attend to the present rather than getting caught up in one’s negative interpretations about the future.

  • Systematic exposure: Learning to reduce anxiety by putting yourself in anxiety-provoking situations while using mindfulness and cognitive skills. In systematic exposure, you begin with situations that trigger the least amount of anxiety. Once you master these situations, you work your way into increasingly anxiety-provoking situations until you master them as well. In this way, you can work at your own pace without feeling overwhelmed.

If you would like to learn more about CBT for social anxiety disorder, or would like a consultation to determine whether CBT for social anxiety is right for you, visit Cognitive Behavioral Therapy Los Angeles for more information.

What you need to know about social phobia?

Are you very afraid that you will be judged? Are you shy in everyday social surroundings? Are you afraid to meet new people?

If you have been experiencing this feeling for six months and these feelings interfere with your daily activities such as talking at work, meeting new people, you may have social anxiety disorder.

Social anxiety disorder is a long-term and overwhelming fear of social situations. This fear can affect work, school, and other daily activities, or make it difficult to make new acquaintances. But social phobia should not prevent you from reaching your potential.

In fact, this disorder is very common in society. Women usually suffer from this more than men. In the early 1960s, the term "social phobia" appeared. At that time, scientists believed that this disorder was very rare. However, the National Institute of Mental Health reports that 12.1% of people in the US experience anxiety at some point in their lives.

It usually starts during adolescence. Some people get better as they get older. For many, this does not go away on its own.

Callback

Symptoms of social phobia:

  • blush;
  • sweat;
  • trembling;
  • palpitations;
  • feeling of nausea.

You may experience social phobia if:

  • worry about everyday activities: meeting strangers, starting a conversation, working or shopping;
  • avoid or worry a lot about activities: parties, dinner with company;
  • always worry about things that you find unpleasant, such as blushing, sweating, or appearing incompetent;
  • it's hard to do things when others are watching: You may feel like you're being watched and judged all the time;
  • afraid of criticism: avoid eye contact.

If you see that your friend has these symptoms, then the best way to help him is to support, not condemn him.

Examples

The types of situations that trigger anxiety can vary greatly from person to person. Here are some examples of what social anxiety might look like:

  • You walk into a cafe and see your friends whispering and laughing. You are afraid that they will laugh at you. Even when they claim it isn't, you continue to worry.
  • You want to ask the teacher a question, but you can't because you're afraid it will sound stupid.
  • You are afraid to read aloud because you might mispronounce something or miss a word.

What do you feel and what do others see

If you have social anxiety then you probably think that your anxiety is obvious to everyone. But in fact, looking anxious is another thing people with social anxiety fear. But others may not know this. This is because many anxiety symptoms appear below the surface.

You may have panicky thoughts and some physical symptoms of anxiety, such as heart palpitations or indigestion, but other people probably won't notice. More noticeable signs such as redness.

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Why Worry Avoidance Doesn't Work

One of the things people learn to do when they're worried is to avoid things that worry them. Skip parties, school, social events. Although it may help calm your anxiety in the short term.

But experts warn that hiding from your anxiety really only makes it worse.

Another dangerous thing about fear avoidance is that it can become a habit and you may find yourself moving further and further away. This will make your anxiety worse and other people will not understand why you are leaving. This may make you feel even more alone.

Social phobia is a fear reaction to something that is not really dangerous, although the body and mind react as if the danger is real. This means that people with this disorder do experience physical sensations of fear, such as rapid heart rate and rapid breathing. They are more sensitive to the fear that they will be embarrassed, look stupid, make a mistake, or be judged, criticized or laughed at. This makes them avoid such situations.

Why it's so important to seek help

Social anxiety can prevent you from doing what you want and cut you off from the people you want to be friends with. It can also increase the likelihood of depression. Asking for help can be hard, but it's really important.

Social phobia should not control your life. Fortunately, this disorder is treatable. Therapists/psychotherapists can correctly create a treatment plan to help people deal with this. Treatment can help you overcome your symptoms.

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