Social Phobias: Causes, Symptoms And Treatment

Among the people who suffer Anxiety disorders, “Social Phobia” is one of the most frequent conditions, as well as dangerous: because it is almost always (80%) accompanied by another condition; such as Alcoholism – Drug addiction – Depression – Agoraphobia, and others. For example: It is common for many people to choose to drink alcohol to face some fear. This is seen very frequently among adolescents. In this PsychologyFor article we are going to discover the Causes, symptoms and treatment of social phobias so you know how to deal with this condition.

Anxiety disorders and social phobia

Now, let’s remember: what does it mean to “suffer from an Anxiety Disorder?” People who suffer from Anxiety Disorders present an exaggerated anxiety response to situations or stimuli that for other people would be totally “normal”, leading them to avoid the feared object or situation or to develop a “panic attack” in said exposure.

For example: in “Social Phobias”, this person most likely does not attend meetings because he or she feels that in the environment there is a lot of attention paid to him or her (which may or may not be real), which undoubtedly includes negative judgment. about his actions. Because of this, he will suffer intense fear (anxiety and anguish) that has no direct relationship with the situation experienced (with what they really think of him in that meeting); thus developing a “Panic Attack”…

Panic Attack: “It is the temporary and isolated appearance of intense fear, which can last a few minutes (of great intensity), and is accompanied by a series of physical and emotional symptoms…

Symptoms of anxiety disorders

The symptoms:

  • palpitations,
  • Tachycardia,
  • sweating,
  • Tremors or shaking,
  • Feeling of suffocation or shortness of breath,
  • chest tightness,
  • Nausea,
  • Dizziness, unsteadiness, fainting,
  • Chills, suffocation,
  • Fear of losing control – Fear of dying or Fear of going crazy…

Social phobias: causes, symptoms and treatment - Anxiety disorders and social phobia

Causes of social phobia

In Social Phobia, and in all Anxiety Disorders in general, these last three are the underlying fears of all pathological manifestation of anxiety. Unconsciously, the person suffers from a strong fear of dying, going crazy, or losing control in some way (many times this has its origin in certain traumatic events that the person has experienced, generally of a sudden nature, and that has impacted them emotionally.

  • This fear arises suddenly and disorganizes the personality.
  • It severely alters your quality of life: (Social, work, family and relationships in general);
  • It causes alterations and damages in the individual’s own capabilities.

Having the necessary basis to know what we mean when we say that someone suffers from Anxiety Disorders, we are going to specify the “Social Phobia” box, which is what we will refer to on this occasion.

In “Social Phobia” the person has an intense fear of being in public situations, where he receives some type of evaluation (or he feels that he receives it), or judgment, because it is very embarrassing… this happens because he also thinks that this situation would undoubtedly lead him to feel humiliated and devalued by others. As you can see, the person fears the “critical gaze” of the other.

Due to these thoughts, his anxiety increases so significantly, that he develops the “Panic Attack” that we described previously (with all or some of the physical manifestations that accompany it, and with a duration and number of episodes, variables according to each subject).

The most frequent fears suffered by people with social phobia

The most frequent fears are:

  • Fear of speaking in public;
  • Oral tests;
  • Associating with strangers;
  • Start emotional relationships;
  • Eating/Drinking in public;
  • Work when observed;
  • Go to social gatherings;
  • Interact in a group; etc

All of these situations would be reflecting a common denominatorgiven by:

  • Fear of making a fool of yourself or feeling embarrassed”;
  • Fear of being evaluated by other people”; and
  • Fear of being the center of attention.”

Finally, the fear is of rejection, of criticism (if we analyze the situation, people with social phobia project onto others a supposed negative criticism or rejection, which in reality they have with themselves before exposing themselves to any situation.

They are what are not accepted in the first instance. Then it will be necessary to evaluate in each particular life story what events or factors led to this lack of self-confidence). We will see the Treatment later.

It is important to consider that although It is a highly disabling pathology. due to the deterioration it causes in personal-work-social relationships, etc., and due to the degree of isolation that is suffered; We also have to say that it is possible for the person to achieve a good recovery through appropriate Diagnosis and Treatment.

Social phobias: causes, symptoms and treatment - The most frequent fears suffered by people with social phobia

Treatment of social phobia

The Treatment will have different characteristics (according to each particular case), but with a common objective: that it is ensure that the person can join a “Therapeutic Group” to overcome this fear of group integration… with the secondary benefit of knowing that there are also many others who suffer (in silence) the same as him, and identifying and enriching himself with the experiences of others (being one of the purposes of Therapies and Group dynamics).

I believe that in some cases it must also be necessary to approach in individual sessions to be able to delve deeper into the origins of that particular phobia (this will be different in each story, and in the experiences that each individual has had of the world throughout their life). In any case, inclusion in a “Therapeutic Group” will be one of the most valuable tools to work with.

As in any group, “identifications” occur with the stories and stories of other people and that will be a very rich factor in being able to help each of the patients to demystify that “that only happens to them…”, so each one You will be able to use tools that will help other people understand how each person is overcoming feared exposure situations…

Finally, in some cases (to be evaluated) it will be complemented with specific medication, where we will work together with the Psychiatrist to address the pathology. At this point in particular, I consider that any patient who can get to the consultation and have a “Containment Network” (family, friends, partner, etc.) to help you in the beginning of your treatment, you would choose to use medication as a resource only if it is unavoidable in the case. In this way the patient will learn to trust “his resources” and not the medication as the necessary element for him to take action…

Other points that should be worked on in therapy

On the other hand, I am going to list some of the most important points to work on within the Treatment with patients with social phobia.

Here again are some guidelines and exercises to consider, which we can apply to patients who suffer from this condition, as well as any other anxiety disorder, given that what we will finally be “exercising” and helping to control in the person will be the common manifestation of all anxiety disorders, which It is the “Panic Attack”.

First, it is worth clarifying that several years ago, when this pathology was not yet widely diagnosed by doctors, and due to the extensive physical symptoms it has, many patients feared they were suffering from Heart Attacks, or any other more severe organic disease. It was even very common that instead of consulting with the Psychologist or Psychiatrist, the visits were to the offices of Cardiologists, Gastroenterologists or Physicians of the digestive system, Dermatologists, etc.

As the years go by, and also the changes in the quality of life, have unfortunately made it one of the pathologies worldwide with the greatest social impact. But something positive to highlight is that these are usually conditions with a good prognosis in treatments (except in conditions where there is comorbidity between OCD (Obsessive Compulsive Disorder) and a Depressive Condition, which are the most complicated to treat).

Focusing again on Social Phobias, I will mention below some points to take into account in patients with said pathology.

Social phobias: causes, symptoms and treatment - Other points that should be worked on in therapy

Treatment aimed at social phobia

For an anxiety disorder to occur, Two things have to happen:

  1. That the person evaluates a situation as dangerous that is not;
  2. May you feel that you do not have the resources to be able to face it when, in reality, you have them.

Let’s remember the “Most feared situations”:

  • Public speaking,
  • Interact in small groups,
  • Parties or social gatherings,
  • Talk to people in authority
  • Go to urinate in a public bathroom,
  • Eating or drinking in public places,
  • Exam situations (more oral)

Frequent Thoughts:

  • “I’m going to act like a fool,”
  • “I’m going to babble or talk nonsense,”
  • “I’m boring,”
  • “What I have to say is not going to interest anyone,”
  • “I am not very interesting or attractive,”
  • “Everyone is going to notice that I am nervous and they are going to make fun of me.”


  • About your performance,
  • Due to the possibility that others will detect your symptoms,

The symptoms most frequent are:

  • palpitations,
  • Shaking,
  • sweating,
  • gastrointestinal discomfort,
  • Muscle tension,
  • facial flushing etc.

Attention dysfunction:

  1. Body hypervigilance,
  2. Self-observation, constant concern about your image and what it may generate in others,

Pathologically anxious people perceive themselves as having no control (hence the greatest fear is of losing control of themselves, which could even lead to madness or death)… These are fears that are not almost always unconscious.

Signs of Social Threat:

  • light level,
  • Let the others be seated,
  • If you are going to dance,
  • If there are going to be girls, pretty or handsome,
  • What topics will be discussed?
  • Age of people attending the event,
  • Duration of the event, etc.

Underlying Beliefs:

  • Social situations are dangerous…
  • Every issue related to social matters must be perfect…
  • It lacks conditions…


  • Shame,
  • Humiliation,
  • Rejection,
  • Not being considered or taken into account,

Example of social phobia treatment

1st Individual Stage: “Therapist as representative of the social context.

Role of observer-participant”:

  1. Attention to one’s own feelings to generate therapeutic hypotheses in the interaction;
  2. Avoid perpetuating the dysfunctional interpersonal cycle and confirming its pattern;
  3. Work in the “Here and now”, promoting learning based on concrete experience rather than on an abstract intellectual exercise;

Central guidelines of “Individual Treatment”

  1. Psycho-education,
  2. Respiratory retraining (Breathing and Relaxation Exercises),
  3. Refocusing of attention,
  4. cognitive restructuring,
  5. Behavioral tasks to be performed as a “duty” (commitment to your treatment outside of the session),
  6. Cognitive tasks to be performed as “duty” (Idem).

Working with Cognitive Restructuring:

  1. Psycho-education techniques,
  2. Help with anxiety levels,
  3. Fundamental is “Anticipatory Anxiety” (AA)… Anxiety that anticipates anxiety by “knowing (assuming) what is going to happen,
  4. Help discriminate and differentiate feelings from thoughts,
  5. Self-Reports (which it is important that you do them, to see the evolution),

List of Cognitive Distortions:

  • Extremist thinking (all/nothing)… help you create “grays”,
  • Over-generalization (for a given situation, the entire scene is encompassed),
  • Disqualification of the positive (minimizes positive things),
  • Mind reading (“guessing what the other person thinks, or what will happen”),
  • Predict the facts,
  • emotional reasoning,
  • Central guidelines of “Group Treatment”


  • Dramatization,
  • Typical life situations,
  • role reversal,
  • double techniques,
  • Soliloquy,
  • Back to back,
  • Construction of images, etc.

Any proposal must contemplate a gradual and progressive approach that allows us to work on the dysfunctional structures at play.

Create realistic situations so that the patient can face them.

Issues to consider

Before performing a dramatization you have to take into account the following:

  • Select the situation,
  • Set up the context,
  • Keep in mind that other patients will participate,
  • Role that the Professional-Assistant will play,
  • What anxiety triggers am I going to use?
  • Surprise factor.


  • Generate the “movie” in your head,
  • Objective of the dramatization,
  • Identify the cognitive distortions that are going to be worked on.

During the exhibition:

  • Interrupt to identify the dysfunctional process that hinders the patient’s performance,
  • The situation is continued or reenacted.

This was an approach to this pathology that is so common in our times and in many different cultures… But we must not forget that…

“If you are afraid, act… the only way to start fighting fear is action.”

This article is merely informative, at PsychologyFor we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Social phobias: causes, symptoms and treatment we recommend that you enter our Clinical Psychology category.

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