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Depression: Depression & Related Conditions

Treatment for Specific Phobias and Treatment for Social Anxiety Disorder (Social Phobia)

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.

Treatment for Specific Phobias

We previously described this disorder and reviewed its diagnostic criteria.

public speaking word collageCognitive-behavioral therapy for specific phobias is typically a straightforward and systematic approach. Behavioral exposure therapy consists of gradual exposure to the feared object or situation either in vivo (live), in imagination, or a combination of both. Therapy participants may begin by exposure to photographs of the feared object before facing the real object or situation. Cognitive therapy can be utilized to address cognitive distortions related to over-estimation of risk or harm associated with the feared object. For example, a person who has developed a fear of snakes may be misinformed and believe that snakes are aggressive and predatory, when in reality their tendency is to hide and avoid human contact.

Treatment for Social Anxiety Disorder (Social Phobia)

We previously described this disorder and reviewed its diagnostic criteria.

Social Phobia responds quite well to standard cognitive-behavioral therapy. Studies demonstrate the positive effect of treatment remains after treatment ends (Taylor, 1996). There is evidence that exposure therapy alone may be as effective as a combination of cognitive and behavioral therapies (Feske & Chamblass, 1995). Behavioral techniques for social phobia consist of exposing the therapy participant to feared interpersonal situations. Common examples are interacting with strangers or peers, inconveniencing others, and eating in public.

Cognitive therapy frequently focuses on decreasing the excessive concern regarding the opinion of others. Furthermore, it is necessary to correct the inaccurate belief that inept, social behavior will result in becoming a social outcast. People with social anxiety also display a tendency toward excessive self-monitoring, or self-observation in social situations. This excessive self-focus increases their distress by creating more uncomfortable physical sensations (such as blushing). This in turn increases the person's worry that others will notice, and judge them in a negative way. Self-focus can also interfere with a person's ability to fully participate in conversations. This further solidifies the belief they are socially incompetent.

Often, social skills training can be an important part of treatment for social anxiety. Social skills are skills acquired over time through participation in social gatherings and social discourse. Unfortunately, people with social anxiety have avoided social gatherings for much of their life. Therefore, these skills are often lacking or rudimentary at best. Most of us take for granted social skills. However, imagine what kind of experiences you would have if you didn't know how to "read" the social cues that someone wishes to disengage from a conversation. Or, suppose you didn't understand the give-and-take of social dialogs and simply talked about yourself non-stop. From these examples, you can see the importance of social skills. Lacking these skills, a person is likely to have many unpleasant social interactions without understanding why. Lacking this understanding, people erroneously conclude they are somehow defective and incompetent. Thus, avoidance of social situations is perpetuated since most of us naturally prefer to avoid unpleasant situations. This avoidance creates a cycle whereby there are no opportunities to learn social skills. A social skills training group address this problem in a safe and comfortable manner.

Social skills training is usually delivered in a group therapy format. This is because a therapy group provides an ideal social environment in which to practice these skills.

A high percentage of people with Social Phobia use alcohol to self-medicate before attending social events. Treatment may need to specifically address excessive alcohol use/abuse.