Prof. Dr. Kemal Arıkan
Psikiyatrist

Social Phobia and Cognitive-Behavioral Thereapy

Social anxiety disorder, which is also known as “social phobia” in daily life, is a disorder included in the group of anxiety disorders, namely the psychological disorders with the main symptoms of anxiety, fear and anxiety.

Social phobia is a problem that can cause significant disorders in the social functions and life quality of the individual.  Social phobia generally appears during childhood and adolescence and, if not treated, can become chronic and turn into a serious disorder that can disturb the individual for his/her entire life.

According to the “DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) issued by the American Psychiatric Association, the criteria for the clinical diagnosis of social phobia are as follows:

  1. To feel like being judged in social environments and to be afraid of displaying embarrassing, shameful or belittling behaviors in social environments.
  2. To frequently have intense anxiety, or even panic attacks in such frightening social environments and situations.
  3. To be aware of the fact that this increased state of social phobia is irrational and excessive.
  4. To avoid fearful social environments and situations.
  5. Other significant fields of life, such as work and school, being negatively affected by the apprehension concerning social environments and situations.
  6. A continuity of minimum 6 months for this situation.
  7. Or this situation not being associated with any substance use or other medical disorders.

Social phobia is an anxiety disorder that particularly manifests itself in social environments such as workplaces, schools, public transportation vehicles, malls, meetings, parties, restaurants, etc. where individuals have to be present in the same place with other people and interact with them.   By its shortest definition, social phobia is sort of a disease of being stuck into the idea of “what would others say about me?”.   Social phobia is also a “stage fright”.

Social phobia can also manifest itself in various forms such as being unable to talk in front of an audience, having extreme difficulties in establishing relationships with the opposite sex, being frightened of presenting one’s own wishes, needs and opinions to others.   The individual feels like she/he is being constantly scrutinized, criticized and judged by the people in the social environments she/he enters.   That’s why the individual may gradually start to display behaviors of avoiding social environments, such as keeping away from crowded environments, not attending the meetings, coming together with family members and friends less frequently.   In some untreated social phobia patients, the avoidance of social environments may even reach to the extent where the individual does not even leave his/her house anymore.

According to the scientific researches carried out, social phobia is a disorder, the causes (etiology) of which are associated with “biopsychosocial” factors, namely both biological/genetic factors and the individual’s psychological condition and his/her social circle.   While medications in social phobia have the purpose of enabling a relief in the person by targeting the biological factors, psychotherapy, particularly Cognitive-Behavioral Therapy (CBT), aim to diminish social phobia by elaborately taking both psychological and social factors into consideration.   The fastest, most effective and permanent social phobia treatment is possible the use of medication and the CBT together.

According to the CBT models, psychological disorders like social phobia are based on the cognitive mistakes unintentionally made by the individuals while interpreting themselves, their surroundings and the events in their lives.  The failure to see and interpret things as they are (for instance, perceiving a normally curious and exciting look or a word as hostile or criticizing) causes problematic behaviors (such as avoiding social environments, etc.) and due to the fact that these behaviors give the person a short-term emotional relief (for instance, preventing anxiety and calming down by not going out to the public) they get consolidated in time and continue. According to the CBT model, while interpreting their own feelings, thoughts and the events in their lives, patients see them worse and riskier than they actually are, and they frequently deviate from principles like reality, objectivity (neutrality) and rationality.

The CBT model considers the human mind as a computer constantly processing the information and events around it, and it claims that the current operating system and codes it has (namely how the person is raised, his/her character, culture, his/her beliefs about himself/herself and others, his/her world view, standards of judgment, main thoughts) determine the manner this computer processes and interprets the information.   In disorders like social phobia, according to CBT, brain distorts the world around it based on unhealthy and false beliefs of the individuals about themselves and others and shows it as it were worse or more dangerous than it actually is, rather than showing it objectively, realistically and in a rational manner.   Thus, in the CBT, the realism, objectivity and rationality of the beliefs and main thoughts behind the social anxiety of the person are inquired through an analysis made on them.   Concrete evidences are searched regarding the person being really judged by others in social environments, etc.   Mostly, it is determined that this anxiety of judgment is irrational and baseless, that the person himself/herself created them through the misinterpretation of the results of various bad incidents since his/her childhood.   Furthermore, in the case that there is actually a social judgment, then the thing what makes it this worse is looked for.

This intense and elaborate attempt to restructure the mind and thoughts during the CBT process is accompanied by the behavioral experiments and assignments to be given by the therapist from time to time.   The purpose of these behavioral experiments and assignments is to enable the person to actively implement the new and healthier information and methods, which he learned during the therapy, on his/her own life in the real world.   The behavioral aspect, which accompanies the cognitive restructuring process of the CBT and teaches the individuals to implement their new social and cognitive skills virtually “on the field” by making them try, enables the individuals to gradually cope with their fears and social phobia safely and in a manner they deem the most suitable.   As the person pushes towards her/his fears, she/he gradually sees that the bad events she/he is worried about do not actually happen, and she/he recovers by developing methods of interpreting the worrisome environments and events in a healthy and positive manner after witnessing that her/his social phobia is actually meaningless.

During the treatment of social phobia with the CBT, various basic social skills are also taught to the people.  Breathing through diaphragm to cope with stress and for emotional control and relaxation, muscle relaxing and even mindfulness meditation are also taught.   Beyond diminishing the social phobia, the purpose is to enable the individuals to have a more positive and realistic view of life in general, to establish healthier relationships, to effectively cope with stress and to offer more creative and rational solutions to all kinds of problems they might encounter.

Senior Clinical Psychologist Barlas Günay, MSc

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