“Get a grip! It’s nothing!”
Many of Dr Peter Zwanzger’s patients hear remarks like this – before they decide to see him for psychotherapeutic counselling to treat their social anxiety. “That’s why I always give my patients words of encouragement in the initial interview, ” says Zwanzger, chief physician and medical director of general psychiatry and psychosomatics at kbo-Inn-Salzach Hospital in Germany, as well as chairman of the country’s Society for Anxiety Research (GAF).
Manifestations of social anxiety disorder, also known as social phobia, are often downplayed or not taken seriously by the general populace. One reason is that people may confuse the sufferer’s anxiety with shyness or introversion. It’s different, though.
“Social phobia is characterised by an intense fear of being judged negatively or criticised by others, ” explains Dr Ernst Dietrich Munz, president of the Berlin-based Federal Chamber of Psychotherapists.
Introversion is a character trait. Introverts are typically withdrawn and reserved towards others, but not out of fear.
“Shy people, on the other hand, are afraid of interpersonal contacts, particularly with unfamiliar people, ” Munz notes. “This is a learned behaviour that can be unlearned with training.”
Shyness can escalate into social phobia. “In social phobia, the fear of social gatherings, such as dinner with friends, is so intense that the person sometimes avoids them, ” according to Munz.
There are two kinds of social phobia: specific and generalised. An example of the former is the fear of public speaking only.
“We differentiate someone who ‘only’ has trouble speaking in front of groups from someone whose anxiety successively expands to multiple areas of life, ” Zwanzger says. In the latter case, the sufferer may also be afraid of knocking over a glass in a restaurant, for instance. Or that their boss will ask them a question they’re unable to answer. A self-reinforcing effect can take hold.
“It’s extremely embarrassing and unpleasant for these people to tremble or blush. Simply thinking about it can trigger a panic attack, and they develop a fear of becoming afraid. A veritable vicious circle begins, ” Munz says.
Social anxieties can seldom be overcome without help, and they can lead to depression and addictive disorders, says Munz, adding it’s therefore important that sufferers not hesitate to see a psychotherapist or physician. “As is the case with other mental illnesses, treatment is advisable if the fear is so strong and frequent that it makes normal life impossible, ” says Munz.
Cognitive behavioural therapy is the most effective way to treat anxiety disorders, according to Zwanzger. It includes a technique known as exposure therapy.
“The patient is gradually exposed to the feared or avoided situation – first notionally and then actually, ” Zwanzger explains. Role-play is often used to practise social skills, and after five to 20 sessions, the anxieties diminish and eventually disappear, he says.
Munz recommends that people with social anxieties immediately expose themselves to situations they fear – with therapeutic support.
“This first helps sufferers to better understand the fear, and then, step by step, to take on the fear-inducing situations, ” he says. “In so doing, they can find that their serious apprehensions – such as, ‘Everybody will notice that I go as red as a beetroot, ’ or, ‘I’ll be laughed at during my presentation’ – are usually unfounded.”
Using psychodynamic psychotherapy, an in-depth form of talk therapy based on psychoanalysis, an effort is then made to identify and resolve the conflicts that underlie the fears, Munz says.
“A repressed feeling of not being able to live up to excessive parental expectations may have carried over to other situations, for example, ” he says. – dpa
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