When you're more than shy

What is social phobia?

People who suffer from social phobia, also called sociophobia, have a strong fear of drawing unpleasant attention, either through their behaviour or through the symptoms of their anxiety. They fear being observed, belittled or ridiculed by others, and contact with people becomes a stressful challenge. This fear is often particularly pronounced in interactions with the opposite sex.

The anxiety can be accompanied by physical symptoms such as blushing, trembling or a racing heart. Social phobias go beyond normal shyness and have serious consequences for social life.

Social phobia goes beyond normal shyness and has more serious effects on social life. It is important to know whether this insecurity occurs only in certain situations, such as a job interview, and then subsides, or whether it spreads into daily life so that certain activities are avoided or even given up entirely. If someone withdraws increasingly while their life circumstances remain unchanged, this can indicate a negative development and that professional help may be necessary.

What behaviours are typical for people with social phobia?

Affected individuals tend to hide their symptoms, often suffer in silence and hesitate to seek professional help in the form of psychotherapy. Without appropriate therapy, social anxiety disorder often becomes chronic and can lead to social isolation and loneliness through strong avoidance behaviour.

Social phobics avoid interpersonal contacts. Even making small talk or going to a restaurant can be uncomfortable for them because they fear being judged negatively or observed. Some people with social anxiety also avoid eating, drinking or writing in public for fear of trembling.

In addition, affected people often avoid calling authorities, returning goods or asking strangers for information, e.g. for directions. People with social phobia fear reading aloud in social situations, approaching strangers or encounters with people of the opposite sex. They fear criticism, rejection and eye contact. Low self‑esteem, feelings of shame and panic attacks may also occur.

People with social anxiety may fear specific situations or suffer from a general fear of all social situations. Affected individuals tend to avoid performance‑related situations. They often worry that their behaviour may be embarrassing or that they may appear incompetent. These fears lead to a withdrawn and anxious demeanour.

People with social phobia often worry excessively about how they are perceived by others. They feel constantly observed and assume that others judge them negatively. They tend to be very self‑critical, set high standards for themselves and think: “Others see me as clumsy and stupid.”

What causes contribute to the development of social phobia?

The development of social anxieties does not have a single cause. Rather, different factors interact and can contribute to the development of social phobia, although not necessarily. Research suggests that genetic predisposition may play a role. Children of parents who suffer from social phobia have an increased risk of developing social anxieties themselves. Personality also has an influence. People who are naturally more inhibited and shy tend to show these traits especially in new situations or when meeting strangers.

Upbringing also plays a role. Children who are constantly criticised, feel little loved or feel troubled may develop low self‑esteem. This can lead to insecurity that affects other areas of life. On the other hand, children of overprotective parents may not learn how to cope with negative experiences and mistakes. Parents who place great importance on the opinions of others can also have an influence.

Often distressing experiences in childhood or adolescence play a role, such as being teased, rejected or feeling you said something wrong at school. Children who have been teased for years because of their appearance may still feel inferior as adults and fear contact with other people. Fears may also be triggered by divorce, family conflicts or a parent's mental illness.

What other mental disorders can occur alongside it?

People with social phobia are often affected by other mental disorders such as anxiety disorders, eating disorders, depression or addiction. They tend to remain unmarried, and the phobia significantly impairs both work and private relationships. The high level of distress can even lead to suicidal thoughts.

What to do when social anxiety is present: proven techniques

• An affected person may need support to decide to start therapy. With a pronounced social phobia, it is likely that personal initiative alone will not be sufficient.
• At certain stages of life, medication can help meet demands successfully and thus pave the way for further steps. These are usually antidepressants that must be taken regularly over a longer period. These medications are intended to help the affected person have positive experiences in situations that previously triggered anxiety. This should enable them later to cope successfully with such anxiety‑provoking situations without medication.
• To treat social phobia, doctors also use selective serotonin or noradrenaline reuptake inhibitors. These drugs prevent the rapid removal of the neurotransmitters serotonin or noradrenaline from their site of action. However, it takes about two to four weeks for an effect to occur. Once symptoms of the social anxiety disorder have improved, the doctor continues the medication for a few more weeks to prevent relapse.
• Cognitive behavioural therapy is the most thoroughly researched psychotherapeutic approach for anxiety disorders in general and for social anxiety disorder in particular. The aim of this therapy is to gain new positive learning experiences by actively seeking out anxiety‑provoking situations.
• The next step in therapy for social phobia is cognitive restructuring, where maladaptive thoughts are examined and changed. Many patients have automatic negative thoughts that are not conscious. The therapist helps to identify these thoughts and encourages the patient to develop more realistic and less threatening thinking patterns.
• Later in therapy the focus is on role‑plays in which the patient confronts their fears. These exercises recreate real situations, for example giving a speech in front of other participants. This helps the patient acquire skills that can strengthen their confidence in social interactions.
• The following step is so‑called exposure therapy. Patients first create a list of situations that particularly frighten them. They then practise dealing with these situations together with the therapist. Patients gradually place themselves in uncomfortable and embarrassing public situations. The difficulty is increased step by step. Through exposure, patients often find that the feared reactions do not occur: other people respond neutrally or even positively.
• Unresolved conflicts that may have contributed to the development of social phobia are addressed in psychodynamic psychotherapy. Here relationship conflicts play a major role. Despite the desire for recognition, a strong fear of rejection and humiliation prevents normal social contact from being resumed. Relationships are often broken off for fear of revealing one's own insecurity through blushing or trembling. In psychodynamic therapy the therapist and patient explore together how this maladaptive relationship pattern developed and what function it serves.
• Relaxation techniques can help people with social phobia reduce their chronic tension. A commonly recommended method is Jacobson's progressive muscle relaxation. This method uses breathing exercises and tensing and relaxing the muscles to produce an active relaxation of the whole body.
• When dealing with persistent stress, affected people can also draw on natural supports. Chamomile, with its essential oils, helps calm the nervous system and relieve both physical and emotional tension. Traditionally chamomile is used to promote a sense of inner peace and calm through relaxation and soothing of the whole body. Lavender, with its specific essential oils, has a profound effect on the central nervous system and is used as a classic calming agent by inhalation and massage. Peppermint has a calming and relaxing effect, mainly due to the menthol it contains. Valerian tea is a popular remedy to relieve stress and anxiety.
• In addition to the therapeutic approaches mentioned for social phobias, methods such as mindfulness training, expressive therapy, biofeedback, neurofeedback, participation in depression‑management groups and sport‑ and movement‑therapy offers can be used as supportive measures.
• A comprehensive therapy often also takes into account comorbid mental disorders such as depression. In such cases a holistic approach is important to effectively treat both the social phobia and the other mental disorders.

With a well‑considered mix of therapy, medication and supportive measures, improvements can emerge. The central insight: help is within reach and people with social phobias have the chance, with professional support, to overcome their fears and lead a more fulfilled life.