A psychologist explains how to overcome social phobia

Social phobia is one of the psychological problems that most damage personal relationships.

Anxiety disorders are very frequent nowadays, and it is estimated, according to data from several researches, that 20% of the population will experience an anxiety crisis during their lifetime.

One of the best known anxiety disorders are phobias, among which we can highlight social phobia.. But, what is social phobia and what can we do to overcome it?

Interview to an expert psychologist in social phobia

In this article we talk to Sandra Isella Perotti, a psychologist with more than 20 years of clinical and psychotherapeutic experience, who works at Centro Psicológico Cepsim in Madrid, one of the most prestigious psychology clinics in our country, to help us understand the characteristics of this disorder.

Fear is an emotion that has played a fundamental role in the survival of human beings. But, when does it become a problem?

Yes, fear is fundamental in animals and humans for survival. It serves mainly to orient us about the dangers that may threaten us at a given moment, whether they are perceived in the external world or in the internal world. They activate in our organism the responses of flight or fight, according to what is more convenient.

It is very easy to see this in animals, for example, in a dog, when he is eating with great appetite and hears a noise unknown to him, he stops, raises his head, sniffs, looks, that is to say, he orients himself to see if the stimulus indicates that he has to go out and bark because someone is there, or run away to hide if he is very scared. In this orientation, the nervous system, in a state of alert, helps him to make these decisions. If, by orienting itself, it rules out that there is no danger for it, it will continue to eat calmly.

Fear in the human being is a kind of alarm that is turned on to warn us that something may put us at risk, ourselves, someone in our close environment or perhaps simply our esteem, our image or our feeling of security may be at risk.

The fear reaction originates in the oldest part of our brain, which is characterized by rapid activation, from 0 to 100, instantly. For example, if, when crossing a street, we see a car coming, fear activates our nervous system, first making us jump backwards, then giving us the sensation of startle and finally we may think "I could have been killed". We see there, how fear activates an immediate response to danger, even before we are aware of it, i.e. we can think about it.

Fear becomes a problem when it is activated in us so often or for such a long time that we no longer really discriminate risks and dangers, feeling frightened more or less constantly, for example in new situations, which do not in themselves represent a danger, but which are experienced in a threatening way.

And fear also becomes a problem when it arises associated with a stimulus, object or circumstance every time it appears or is contacted, and yet it does not in itself carry anything threatening or represent a real danger, but causes the person to constantly avoid them in order not to feel the discomfort that fear produces. This situation is what we call phobia.

It is like living in a permanent state of alert or alarm, which, being constantly on, not only warns about dangers, but also stops discriminating and therefore stops serving for orientation or for quick reactions in survival.

It thus becomes a very limiting problem that causes loss of freedom, excessive worry, anxiety, among other difficulties that have to do fundamentally with adaptation to the environment, to ourselves and to others.

So, what is a phobia? What are its symptoms?

A phobia is an irrational fear associated with certain external stimuli (phobia of flying, dogs, insects, heights, blood, needles) or with certain internal stimuli (phobia of intimacy, social contact, public speaking).

Its symptoms are varied and range from panic terror, with tachycardia, sweating, psychomotor agitation to paralysis, freezing, uncontrollable tremors.

Psychologically, these symptoms have to do with not feeling capable of facing something, with feeling overcome and not seeing oneself in a position to confront some object or situation, with a feeling of risk of life or death and above all, with the conviction of not being able to successfully go through certain circumstances related to that which causes the phobia, which leads the person to avoid everything that could mean an approach to the phobic object or situation.

What types of phobias are there?

Simple phobias, generally occur towards a single object. They have a source, from where they come from, generally in childhood, where as children we are frightened of certain things or situations. As adults and in similar scenarios, something acts as a trigger and makes us relive those terrifying sensations of the past, as if we were still small and defenseless, developing a phobia to something.

There are complex phobias, which are fears related and intermingled with personality and character traits. They generally appear in the course of development in childhood, or associated with various traumatic experiences in adolescence, which intensify already vulnerable aspects in the first years of life. They mainly hinder relationships with others, intimacy, commitment and aspects of self-concept, such as self-esteem. Social phobia is an example of complex phobias.

Differentiate complex phobias from simple phobias and talk about social phobia. What differentiates this type of phobia from shyness?

Shyness is a characteristic of introverted people, who are rather reserved, with a lot of inner life and who sometimes find it difficult to show themselves more socially, to appear, to have prominence and to perform socially with skills related to good conversation, to be entertaining or funny, to be the life of the party. They tend to be very reflective people with an intense emotional world that does not show outwardly.

Social phobia, on the other hand, makes the person unable to go to meetings, events, sometimes to school or work, in the most severe cases the person remains confined at home or needs alcohol or drugs to establish a satisfactory interaction with others, since social contact is experienced as something very threatening and very frightening. Fear and shame are the prevailing affects.

How does social phobia affect the lives of people who suffer from it?

It is very limiting. It can reach the extreme that the person has to live confined to his house, avoiding contact with other people outside his family. Or it is also observed when the person finds it difficult to attend usual social activities (study, work, shows) or exceptional events (weddings, baptisms, graduations).

The fear of being evaluated or being exposed is the predominant affection that these people experience, in addition to having many difficulties to show themselves publicly, to be the center of attention of others or to stand out for any particular reason.

It is a very great suffering that they undergo, reaching the extreme of not feeling worthy of being loved by others or having the feeling that there is a flaw or defect in them that they do not want others to see.

In what context does social phobia affect more?

Social phobia affects more in contexts with low valuation of feelings, which are experienced as a sign of weakness, in environments of lack of affection, where children are not offered experiences of security within the family, so that they can later become successful children. Also in very overprotective and normative environments, where children do not develop self-affirming feelings of self-worth, where everything is given to them and they do not have to make an effort and use their own resources to get what they want.

They then develop a fear of going out into the world, of connecting with others as we are, with our faults and our strengths, of dealing with our limitations to overcome the obstacles that come our way. It may also happen that one of our childhood caregivers has this same problem and we somehow learn these or similar fears.

In any case, even if we have grown up in an adverse environment, as adults we can later acquire the security that we did not obtain in our upbringing, develop new resources and strengthen ourselves to make our way in the outside world. This sometimes occurs because there are more favorable contexts later in development (partner, educational or sports contexts, friends' relatives, university classmates' gangs, work team) or because people ask for specialized medical, psychiatric or psychological help to overcome these difficulties.

At Cepsim, what treatment do you provide to people suffering from this disorder?

At Cepsim, we first make a thorough diagnosis during the first sessions to assess the problem and the context in which it occurs, we also assess each person in particular and their way of being, case by case, in order to carry out the most appropriate treatment.

In our team, we are trained in different approaches and we know different therapeutic approaches that allow us to adapt the tools to each particular patient and not the other way around, as well as to combine different approaches to achieve recovery in the shortest possible time.

We use third generation therapies, such as Brain Integration Techniques, Sensorimotor or SomaticExperience therapy, Internal Family Model, Hypnosis, which are oriented to look for the scenario/s sources of the phobia in the past, to "deactivate it" so to speak, or process it, so that it stops turning on in the present every time a trigger recalls the emotion of fear experienced then. That in the case of simple phobias.

In the case of complex phobias, the treatments are longer because we work on aspects linked to the way of being and personality, focusing on the way of establishing affective bonds and managing the emotional world.

One of the most commonly used techniques for the treatment of phobias is systematic desensitization. What exactly does it consist of? Why is exposure to the phobic stimulus so useful?

Systematic desensitization consists of planning very gradual and progressive exposure to those stimuli that produce the phobia.

The person develops the possibility of approaching that which terrifies him/her with the support at first of the therapist, who sometimes acts as a counterphobic companion and through systematic repetitions, which increase the difficulty and time of exposure, the aim is precisely to desensitize, that is to say that the person no longer feels fear and that the object of the phobia becomes something that is not frightening for him/her.

Is it possible to overcome a phobia without applying exposure techniques?

Of course it is. The exposure technique has been developed by the Cognitive Behavioral approach and some patients do very well and solve their problem.

But we are very used to receiving people who, having experienced this type of punctual treatment on a phobia, based on exposure techniques, with the passage of time develop another similar one or the same one recrudesces, so it is necessary to apply here other types of treatments oriented to greater depth that allow to work the problem at its root, so that it does not reproduce itself again.

Can a person with social phobia recover completely?

A person with social phobia, or any other type of phobia, can recover. They can re-experience much of their functionality, they can develop roles and resources that allow them to go out into the world feeling safe and protected, safe and without fear, recovering a normal relationship with that which generated so much fear.

Many times our patients are surprised to discover that something they have suffered for so long can be remitted, giving rise to new experiences and expanding the possibilities of experiences that were not available before.