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Chapter 23. Anxiety > Social Phobia

Social Phobia

People with social phobia experience marked and persistent fear in a social or performance situation in which they may be under scrutiny or exposed to new people. Typical examples include giving a talk, performing at a music recital, or meeting new people. They generally try and avoid such situations.

Social Phobia

Erin was capable at her job. She was neither a star nor a dunce. Each month, however, she would dread the cross-departmental meetings. One hundred people were present, and every now and then she was called on to make a comment, never with forewarning. She feared she would not know the answer or would say something stupid and that her boss would forever hold it against her. She was especially worried because her boss chaired the meetings.

Under pressure from a friend, Erin talked to an executive coach. He taught Erin relaxation techniques and talked with her about the times she felt anxious. The coach suggested that Erin speak with her boss a few days prior to the meetings, tell him she wanted to be sure to give good answers, and would like to know in advance if he was going to ask her a question. Her boss agreed, and meetings ceased to be so terrifying.

Although the most anxiety-provoking situation was now under control, her difficulty speaking in public was still a problem. She tried a course of CBT. She and her psychiatrist looked at the things she said to herself about speaking in public. They looked at her fears of being embarrassed and her expectations that people would look disparagingly at her and that she would say something inappropriate. This helped, but not as much as she needed it to.

Before Erin could complete the course of therapy, she had an opportunity to give a talk that could be very good for her career. Her doctor gave her a beta blocker. This class of medication is primarily used to treat high blood pressure. It prevented her from having the physical aspects of anxiety and thereby prevented her from getting into an escalating cycle of feeling anxious, becoming tense, and becoming more anxious as she sensed her body’s tension. Many people use beta blockers prior to giving talks or musical performances. Erin’s speech went well. She saw how valuable public speaking would be to her career. Rather than chronically using beta blockers, she decided to continue therapy.

Her psychiatrist taught her progressive relaxation techniques. After relaxing herself, Erin imagined scenes of progressively more stressful speaking opportunities. Each week, she used her relaxation exercises to be able to imagine the stressful scene but stay relaxed. Her ability to perform in public without high levels of anxiety continued to improve.



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