Social phobia
Contents:
Description:
Sociophobia (Latin of socius — "the general, joint", etc. - Greek — "fear") — persistent irrational fear of execution of any public actions (for example, public statements), or the actions accompanied with attention from strangers (fear to be on the street when look at you, impossibility to be engaged in something at observation from outside, etc.), or it is even simple to meet and talk to strangers.
Symptoms of the Social phobia:
Fear — the emotion arising in situations of threat to biological or individual existence of the individual and directed to a source of the valid or imagined danger. The fear changes with rather broad range (fear, fear, a fright, horror). If the source of danger is uncertain or unconscious, the arising state is alarm. Functionally the fear is the warning of the subject of the forthcoming danger, allows to concentrate attention on its source, induces to look for ways of its avoiding. In case the fear reaches the affect force (panic fear, horror), he is capable to impose behavior stereotypes (flight, catalepsy, protective aggression). The created fear reactions are rather resistant and are capable to remain even at understanding of their senselessness. The increased tendency of the person to fear loses adaptive value and traditionally is considered negatively. At sociophobia the subject has persuasive inadequate experiences of fears of specific contents (fear to redden, fear to be mocked on public and so forth) covering the patient in a certain situation (the fear amplifies on the eve of or during responsible situations) and followed vegetative dysfunctions (heartbeat, plentiful sweat, fluctuations of pressure, etc.).
If the patient does not find clear critical understanding of groundlessness, unreasonableness of the fears, then it is most often not a phobia, but pathological doubts (fears), nonsense that already belongs to the register of serious mental conditions at the person. Fear in life at some persons suffering from sociophobia very we mean, sometimes it gains global sense in existence of the individual, prevents to lead full-fledged life and though it can do nothing with it, nevertheless at the patient the critical relation to fear remains.
At social phobias there is a fear of implementation of this or that action in society, the strong-willed component is broken, the person does not have enough self-control in this or that situation. The self-control is that important trait of character which helps the person to manage by itself, own behavior, to keep ability to performance of activity in the most unfavorable conditions. The person with the developed self-control is able to subordinate at any, even emergency situations and circumstances the emotions to a voice of reason, not to allow them to break an organized system of his mental life. The main maintenance of this property is made by operation of two psychological mechanisms: self-checking and correction. By means of self-checking the subject watches an emotional state, revealing possible deviations (in comparison with a background, usual state) in the nature of its course. For this purpose it asks itself(himself) control questions of type: whether "I look now uneasy" whether "not too I gesticulate", whether "I speak excessively quietly or, on the contrary, loudly, too quickly, confusedly", etc. If self-checking fixes the mismatch fact, then this result is a push to start of the mechanism of correction directed to suppression, control of emotional "explosion", to return of normal reaction to a normative bed. At sociophobia of people is in power of doubts.
This state during this or that period of life is tested to 6-8% of population (Libovits, Montgomery, 1995). Impact on own emotions can be carried and anticipating (somewhat — preventive) character, that is even before emergence of strong indications of an emotional imbalance, expecting quite real possibility of such event (a situation of danger, risk, the increased responsibility, etc.), the person by means of special methods of self-influence (self-beliefs, self-orders etc.) aims to prevent its approach.
In certain cases sociophobia are followed by rituals — the persuasive movements and actions gaining protective character for the patient and estimated by it as the demanding repetitions in the same situation for the prevention or elimination of phobias. At the second stage, after self-checking disturbance, at the person protection factors work. Historically the famous Austrian doctor and the psychoanalyst Siegmund Freud was the first scientist who created rather harmonious theory of protective mechanisms "Ya". Now the term "protective mechanism" designates a strong behavioural pattern (the scheme, the stereotype, model) formed with the purpose to provide protection "I" from understanding of the phenomena generating fear and alarm. The main and the general for different types of protective mechanisms as Freud and his followers considered, is that they:
* a) are unconscious, that is the person does not realize either the reasons and motives, or the purpose, or the fact of the protective behavior to a certain phenomenon or an object;
* b) protective mechanisms always distort, forge or substitute reality.
Already in the first works devoted to protective mechanisms, Freud specified that there are two main ways to cope with alarm. In the first, healthier way, it considered a way of interaction with the phenomenon generating alarm: it can be also overcoming obstacles, and to "prototypical" situations:
* loss of a significant object (loved one, favourite little wild beast and so forth);
* loss of the relation with an object (love, approval, recognition from the significant person and so forth);
* loss of, the personality or her part (for example, in cases with sociophobia — fear "to lose face" in a conflict situation or fear of "public derision" in a significant situation, fear of humiliation);
* loss of the attitude towards (fear to lose respect for itself).
Later psychologists, psychoanalysts and psychotherapists began to consider fear as the feeling having the source a certain object, and alarm of which just lack of a specific object and an orientation in the future is characteristic. How the Austrian psychiatrist V. Frankl explains fear? A certain symptom, causes in the patient of fear that it will repeat again, and together with it there is a fear of expectation (phobia) which leads to the fact that the symptom really appears again that only strengthens initial fears of the patient.
Under the known conditions the fear can be that, the patient is afraid of repetition of what. Patients speak about fear of fear (fobofobiya). How they motivate this fear? At sotsiofobiya, for example — fear to redden in society. And how they react at the own risk? Flight. For example, they try not to leave the house. Morbidity (pathogenicity) of this reaction consists that fears and persuasive states are caused, in particular, by the aspiration to avoid the situations causing alarm. V. Frankl speaks about the following that the patient suffering from a phobia has to learn not do something, despite of fear of it but also do what he is afraid of, to look for those situations in which he usually feels fear. The fear will recede "as wise as before", it represents a biological response of alarm which aims to sabotage this or that action or to avoid this or that situation which the fear represents as dangerous. If the patient learned to act "by" fear, then the fear will gradually cease, as if atrophying from inaction.
At a social phobia, unlike panic frustration, there is always an only, situational reason accurate, as a rule, starting the cascade of psychovegetative manifestations which at height can be indistinguishable from the panic attacks (face reddening, tachycardia, heartbeat, perspiration, a tremor, диспноэ, etc.). The alarm of expectation and behavior of avoiding are also indispensable attributes of a social phobia and most often arise in connection with an opportunity to get into an observation situation from strangers. Many signs of a social phobia, such as fear of public statements, are present at healthy faces therefore the diagnosis is exposed only if the alarm causes considerable discomfort, and phobic experiences are estimated as excessive and unreasonable.
On the phenomenological manifestations the social phobia reminds panic frustration; difference consists in the basic available of the steady social situation causing this state. As independent diagnostic category the social phobia is seldom distinguished by doctors. Usually its manifestations are considered within simple phobias, personal pathology (a generalized form) or as extreme option of cultural bashfulness.
Prevalence of a social phobia in population varies from 3 to 13%. Being observed most often at lonely women with the low social and economic status, it is often combined with depressions, and also with other frustration of an alarming range. The generalized form of a social phobia (at distribution of fears on many public situations) is very often combined with the alarming (evading) type of the personality.
Reasons of the Social phobia:
Both biological, and psychological hypotheses were developed for an explanation of an etiology of a social phobia. At the same time the attention to the importance of neuroendocrinal anomalies, genetic factors, the injuring experiences, deficit of social skills and some other factors is paid. Remains however not clear what of them play the major "pathogenic" role.
Treatment of the Social phobia:
Drug treatment.
From pharmacological drugs at sociophobia serotonergic antidepressants, anxiolytics (mainly, a benzodiazepine row), beta-blockers (for stopping of vegetative manifestations), MAO inhibitors (reversible) and triazolovy benzodiazepines are most often used. Also certain class of antidepressants is known as the MAO reversible inhibitors, for example, моклобемид. They are effective at sociophobia, in particular, in cases of social alarm. Physical symptoms of tension can be lowered as a result of use of beta-blockers (пропанолол or атенолол). They are often written out in cases of fear of emergence of such physical symptoms as, for example, a shiver at a performance at a meeting. Chances of achievement steady положительного effect of use of antidepressants increase if to combine medicines with behavioural therapy. In cases of the general alarming frustration the combination of drug treatment to behavioural therapy yields the most optimum results.
Behavioural therapy.
Behavioural therapy is oriented to a resistant reduction of symptoms. At the very beginning of therapeutic work it is necessary to be defined that is the reason of symptoms and that supports them. Treatment is selected according to a certain plan. The behavior therapist selects methods and technicians whose efficiency is already proved in work with these symptoms. In intervals between visits of the therapist patients perform homeworks which gradually, step by step, become complicated.
In behavioural therapy of sociophobia select three important provisions:
1. Work with the thoughts causing alarm.
2. Development of social skills.
3. Overcoming alienation.
These three provisions can both be combined, and to use independently from each other.
Work with the thoughts causing alarm.
It is known also as cognitive therapy (knowledge = a thought). The first step consists in tracking of negative thoughts (for example, "I am sure that I will have a shiver", or "They will count me as the bore", or "It will be awful if I am not pleasant to it").
Such thoughts are traced to define their compliance to the valid state of affairs. Whenever possible they are transformed to more realistic and often become positive.
Acquisition of social skills.
It is proved that at the majority suffering from sociophobia alarm it is caused by a lack of certain social skills. The risk to be misunderstood increases when the person cannot begin a conversation or refuse in response to a request. Acquisition of social skills usually happens in the conditions of group where in the course of role-playing games these or those social situations are modelled, discussed and played. One of important points of overcoming sociophobia is the daily training of the slow speech. It is necessary to give 30 minutes a day on a training of the slow speech. And, houses should be done it in completely quiet state in the absence of other people. Several weeks of daily trainings later it is possible to practice the slow speech with the most entrusted people.
Overcoming alienation.
Behavioural therapy cannot be successful, alienation is not overcome yet. Exercises "on disclosure", especially in the situations provoking alarm are very effective. Begin usually with simple situations, gradually complicating them. Patients, for example, can go to a party, return defective goods to shop or visit cafe and drink there a cup of coffee (even if at the same time they shake hands). The alarm arising when performing these exercises will gradually decrease. When performing such tasks of people finds out that the negative effect expected by it is not true, and it approaches the following situation with great self-reliance.
