Difficulty in Talking In Public--Social Phobia

Social Phobia

A phobia is basically a fear. We all have fears about things such as heights and spiders but, for most of us, they do not interfere with the way we lead our lives. These fears are only called phobias when they interfere with things we would otherwise enjoy or do easily.

Many of us get worried before meeting new people, but we find that once we are with them, we can cope and even enjoy the situation. However, some of us become very anxious about these situations. At best, we cannot enjoy them and, at worst, we may have to avoid them altogether. This is what doctors and psychologists call social phobia.

This leaflet describes what it feels like to have a social phobia, how you can help yourself, and what other kinds of help are available.

There are two main sorts of social phobia.
General social phobia
If you suffer with a general social phobia, you will tend to worry about becoming the centre of attention anywhere you find yourself with other people. You will find yourself worrying that everybody is looking at you and noticing what you are doing. You may fear being introduced to other people and may even worry about eating or drinking in public. It may be difficult for you to go into shops or restaurants. You may feel so embarrassed about undressing in public that you can't face going to the beach. It may also be difficult for you to confront your boss or colleagues, even when you really ought to.

Parties are likely to be particularly difficult. Many of us will hesitate slightly before going into a room full of people. If you have a social phobia, you may tend to hover around the entrance or outer rooms - some people believe they are claustrophobic because of these feelings. When you finally get into the room with other people, it may feel as though everybody is looking at you. It can be tempting to use alcohol to help yourself cope, starting to drink before going to a pub or party, so that you can loosen up and relax enough to actually enjoy it.
Specific social phobia
This is a particular phobia that affects people who have to be the centre of attention as part of their way of life. It may affect anybody who has to perform or speak in front of other people. Salesmen, actors, musicians, teachers, or union representatives may all suffer from it. In spite of this, it doesn't seem to cause problems for them in ordinary social situations. If you do suffer from social phobia, you may find that you can mix and socialise with other people without any problems. However, when you have to get up and talk or perform in front of others, you become very anxious, perhaps stammering or even 'drying up' completely. It can affect even people who are experienced at speaking in public and do it regularly. At its worst, it can make it impossible for the sufferer to speak in public at all, even to ask a question.
What does it feel like?
If you have a social phobia you will probably find yourself worrying a lot about making a fool of yourself in front of other people, and you will feel very anxious before going into any of the social situations that worry you. You may find yourself going through, in great detail, all the embarrassing things that could happen to you. When you are actually with people, you will feel even more anxious, and may be unable to say, or do, what you want. In a way, it is a self-fulfilling prophecy. You worry so much about looking worried that you actually do look worried. Your worry is your worst enemy.

Once it is all over, you find yourself worrying about how you handled the situation. You may go over, again and again, how you might have behaved or talked differently.

People experiencing both of these types of social phobia have many of the same physical symptoms. You may get a very dry mouth, sweat a lot, experience palpitations (the feeling that the heart is beating very fast and / or irregularly) and want to pass water or open your bowels. Other people may be able to see some of the signs of this anxiety, such as blushing, stammering, shaking and trembling. Sometimes, you may breathe too fast, which can give you feelings of numbness or pins and needles in the fingers and toes. This can, in itself, be quite alarming and can make the anxiety even worse.
Panic attacks
At their worst, these feelings of fear and bodily symptoms can end in a panic attack. This is a short period, usually lasting only a few minutes, during which people feel overwhelmingly anxious, terrified of losing control, and may feel they are going mad or dying. These feelings tend to reach a peak and then pass off rapidly, leaving the person feeling weak and exhausted. Although these attacks are very alarming, they eventually stop on their own and cannot harm you physically.

Does it affect the way you think about yourself?
It can be very demoralising to suffer from a social phobia, because other people seem to do so easily many things you find impossible. You may think that you are rather boring and may worry that others will think so too. It may make you over-sensitive and reluctant to bother other people, even when you should. It's easy to see how this can make you feel depressed and unhappy. This can make the social phobia even worse.
How can it affect people's lives?
Many sufferers cope by arranging their lives around their symptoms. This means that they (and their families) have to miss out on many things they might otherwise enjoy. They can't visit their children's school, can't do the shopping or go to the dentist. They may even actively avoid promotion at work, even though they are quite capable of doing a more demanding and more financially rewarding job. About half of those with a severe phobia, particularly men, will have difficulty in making long-term relationships.
How common is it?
About one to two in a hundred men and two to three in a hundred women will suffer from a social phobia.
Are there any complications?
Some people are so upset by their social phobia that they develop a depressive illness. This may need treatment in its own right, quite apart from the social phobia. If somebody constantly avoids places where people meet, they may in the end develop a fear of those places even when there is nobody there. They may then find themselves unable to go out - this is called agoraphobia. Others may use alcohol, drugs or tranquillisers prescribed by doctors to cope with their symptoms and may become addicted to them. However, in spite of their anxiety and panic attacks, people with social phobia don't seem to have more heart attacks than anybody else.
What cause social phobia?
We really don't know. Some experts think that it might be due to people getting stuck at the normal stage of shyness that all children go through between the ages of three and seven.
Can it be helped?
There are several different ways of helping people with social phobia. These may be used on their own or together, depending on the individual's needs.
Self-help
If you are naturally shy, you may find it helpful to join a self-confidence or assertive course at an Adult Education Centre. Relaxation exercises may help you feel generally less anxious - you can get details of these from many GP surgeries.
Psychological treatments
Social Skills Training: This helps to make people feel more relaxed and confident in company. It does this by teaching some of the simple social skills that we tend to take for granted, like how to start a conversation with a stranger. There is a lot of practice with other people and so-called 'feedback' - people watch themselves practising on video to get an idea of what they are doing and how they appear to other people.

Exposure Therapy:This involves helping a person to relax while in the situation that they find frightening. It can be done in stages, each time making the situation a little more intense and frightening. Another way is called 'flooding'. The patient is first taught how to relax in a frightening situation and is then put into a situation that would normally worry them, such as a crowded room. They are then helped to relax and wait for their anxiety to disappear, which it does after a while.

Cognitive Behavioural Therapy: We can often make ourselves anxious by the way that we think about things. This treatment helps people change the way that they think about themselves and other people. Take the situation when a conversation dries up. Someone with a social phobia will tend to think that it is their fault, and so will start to feel anxious. In Cognitive Behavioural Therapy, the therapist will remind them that it is just as likely that the other person has run out of things to say, a much more realistic and less worrying way of thinking about the situation.

Drug treatments
Beta-Blockers: These drugs are usually used to treat high blood pressure. In low doses, they control the physical shaking of anxiety - which can be a symptom of the social phobia - and can be taken shortly before meeting people or before speaking in public.

Anti-depressants:
More recently developed anti-depressants (known as SSRIs - Selective Serotonin Re-uptake Inhibitors) have been found to be helpful in social phobia, but may sometimes cause headaches and dizziness in the first few weeks. You can eat what you like if you are taking these drugs.

Tranquillisers: Drugs like Valium were used in the past to treat all sorts of anxiety. We now know that they are addictive and that they do not help in the long run. They should usually not be used to treat people with a social phobia

Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com