PRESCRIPTIONS
Behavior therapy, drugs combat social phobia
By Landis Lum
Q. I'm so shy I can't go to lunch with my co-workers. They think I'm a snob, but I wouldn't know what to say during conversation. I can't even ask for help from sales clerks or use public restrooms! And now my son is exhibiting similar behavior. What can I do?
A. While 25 percent of adults are shy, 5 percent to 10 percent have social phobia, and have such intense anxiety before and during social interactions or doing something in front of others that it interferes seriously with work, school and relationships. This fear of negative judgment from others often begins during the early teens, and may lead to depression and substance abuse. Social phobia is the third most common psychiatric disorder after depression and alcoholism.
But don't despair, because there are effective treatments. Find a therapist who knows how to do cognitive behavior therapy. This uses exposure therapy, which helps you become more comfortable with frightening situations, from the imaginary to the real.
According to Kaiser psychologist Greg Browne, the first step involves introducing you or your son to the feared situation.
The second stage is to increase the risk for disapproval in that situation to build confidence that you can handle rejection or criticism. The third stage involves teaching you techniques to cope with disapproval. You imagine your worst fear and develop constructive responses to whatever happens — even disapproval.
Social phobics tend to amplify their minor mistakes, and need reassurance that making an error doesn't signify global failure and won't make others reject them.
CBT may also include anxiety management training such as deep breathing and meditation techniques to reduce anxiety. Groups and family therapy to educate others about the disorder are also helpful. Social phobics may also benefit from social skills training.
Dr. Garry Roy, a psychiatrist at Wahiawa Family Practice Clinic, agrees, adding that certain nonaddicting drugs such as Celexa, fluvoxamine, Paxil, Prozac or Zoloft can be a godsend if CBT fails. Great books on the topic are "Shyness: A Bold New Approach" by Bernardo Carducci, "Painfully Shy" by Barbara & Gregory Markway, and "The Shy Child" by Ward Swallow. Here's what one reader from Amazon.com said about "The Shyness & Social Anxiety Workbook" by Martin Antony and R. Swinson:
"I had been a social phobic for many years and read a lot of material about this subject. This book is the BEST I ever read — buy it! buy it! buy it!!"
As Roy says, "Exposure therapy is kind of the certification exam for the whole process."
The Amazon.com reader underscored this point, saying "As a person with social anxiety I can tell you exposure treatment is a frightening prospect but it does work."
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine.
Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.
