Social Phobia
> 2/17/2006 2:14:05 PM

Social phobia is characterized by a marked and persistent fear of social or performance situations in which embarrassment may occur.  In the feared situations, socially phobic individuals experience concerns about embarrassment and are afraid that others will judge them to be anxious, weak, “crazy,” or stupid.  This leads to the avoidance of the feared situations, or, less commonly, endurance of the social or performance situation with a state of intense anxiety. 


The fear or avoidance must interfere significantly with the person's normal routine, occupational or academic functioning, or social activities or relationships, or the person must experience marked distress about having the phobia.  Social phobia can be characterized as being generalized when the fears are related to most social situations, usually fearing both public performance situations and social interactional situations.


Cognitive behavioral therapies, such as social skills training (SST), exposure (EXP), or cognitive strategies, are commonly used to treat social phobia. Social skills training involves modeling, behavioral rehearsal, corrective feedback, social reinforcement, and homework assignments to teach effective social behavior. 


Exposure therapy involves the participant confronting the feared situation or stimuli through prolonged exposure.  When exposure treatment is used, the expectation is that over time the participant will habituate to stimuli that previously elicited an emotional reaction.  Imaginal exposure involves presenting the participant with feared situations or stimuli using the process of imagery.  The construction of imaginal scenes requires the inclusion of all relevant variables of importance, especially those features that serve to instigate and maintain the anxiety and fear.


Exposure conducted in vivo involves exposing the individual to the feared situation or stimuli in real life.  In vivo exposure can be carried out in an intensive fashion, or it can be implemented gradually.  It is conducted in the same manner as imaginal exposure, with the issue of identifying and addressing the relevant variables is essential here as well. 

In exposure therapy, there may be differences in the amount of therapist involvement, the amount of time devoted to EXP per session and in total, the spacing of the sessions, and whether participants are expected to remain in the situation until anxiety is substantially reduced. 


Cognitive strategies attempt to restructure the maladaptive beliefs about social situations and the opinions of others.  Such treatments include Rational Emotive Behavior Therapy (REBT), also known as Rational Emotive Therapy (RET), which focuses on disputing irrational beliefs commonly held by socially phobic individuals.  Self-Instructional Training (SIT) is a modified version of Meichenbaum’s stress-inoculation training, in which the negative thoughts and feelings that occur in social situations are identified, and coping thoughts and phrases are developed to be repeated in anticipation of and during stressful social situations.


Multicomponent behavioral interventions integrate successful treatment methods within the framework of a single treatment strategy in order to address the multiple aspects of the social phobia syndrome, and with the belief that a combination of treatments would be more effective than any given treatment alone. 


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