Dealing With Social Phobia

Therapists can help people who have social phobia to develop coping skills to manage their anxiety. This involves understanding and adjusting thoughts and beliefs that help create the anxiety, learning and practicing social skills to increase confidence, and then slowly and gradually practicing these skills in real situations.

One element of the therapy might include learning relaxation techniques (such as breathing and muscle relaxation exercises). Behavioral rehearsal can be helpful as well, during which the therapist and the teen might role play certain situations, trying out new behaviors ahead of time. This can make it much easier and more automatic to put these behaviors into practice when the teen is faced with real situations.

Someone might also learn to correct self-talk that leads to anxiety by learning self-talk that is more positive and promotes self-confidence and builds coping skills. A teen may be guided by a therapist to tune into current thinking about particular situations and to modify certain thoughts, especially worry thoughts.

Understanding Worry Thoughts and Self-Talk

Worry thoughts have particular qualities. They often are in the form of a question that begins "what if . . ." and tend to be negative rather than positive. Examples of worry thoughts include, "What if there's no one to sit with at lunch?" and "What if I fail the test?" Worry thoughts also tend to get worse and worse, until the person having them expects not just bad things, but the worst possible outcome.

When someone with social phobia thinks about a teacher calling on him or her, chances are that thoughts run through that person's mind like, "What if I say the wrong thing?" or "What if I make a mistake?" or "What if they laugh at me?" There may also be thoughts like: "I can't do it. It's too hard and too scary. I'll mess up. I'll get it wrong." Usually the self-talk makes the anxiety worse and worse, and supports the person's pattern of avoiding the feared situations. The main messages people give themselves during this self-talk are "It's too scary" and "I'm not able to cope."

Therapists can help people identify and examine these thoughts. For example, students who worry about being called on in class might examine how likely it is that they'd actually give the wrong answer: If a student realizes he or she usually knows the right answer, then a mistake would be unlikely. Next the therapist can work on coping skills in case a student does make a mistake and how to replace worry thoughts with calm, reassuring ones when faced with stressful social situations. People might imagine what they'd say to a friend who needed reassurance, for example, and learn to think that way themselves.

For some teens, medications can be helpful as part of the treatment for social phobia. Certain medications that help to regulate the function of serotonin (a brain chemical that helps to transmit electrical messages having to do with mood) are sometimes used. Though medication doesn't solve the whole problem, it can reduce anxiety so a teen can put into practice some of the positive techniques described above.