As my title indicates, there are many forms of Social Phobia. However, the central issue typically boils down to "fear of negative evaluation". Yesterday I saw a client who fears that, if he makes a mistake, others will conclude that he is incompetent and inadequate. This afternoon I saw a client who fears that he will become tongue-tied while speaking in front of a group and the audience will laugh at him. I once worked with an elderly woman who feared that, if she appeared unsteady while walking down the street, people would think she was drunk.
While the specific fears vary, the central concern usually is that others will notice something in my performance/behavior in an interpersonal setting and this will have a serious negative impact on their opinion of me. For performers the fear may be simply of making a mistake and the impact that will have on others' opinions. It may be a fear of becoming so anxious that they "freeze" or "go blank" and be unable to perform at all (and of what others will then think). Sometimes they fear that they will become so anxious that their anxiety will be apparent to others and others will think that they are weird or look down on them because of this.
One of the tricky things about Social Phobia is that one can avoid the feared negative reactions from others by avoiding the situation (public speaking, performing, or whatever), by trying very hard not to make any mistakes (perhaps through excessive rehearsal), by coming up with excuses, etc. Whatever form the avoidance takes, it tends to perpetuate and aggravate the fear.
Usually there are secondary problems due to anticipatory anxiety, excessive self-consciousness, harsh self-criticism, somatic symptoms of anxiety, etc.
One of the central principles of CBT with phobias is in-vivo exposure to the phobic stimuli. However, it is important to remember that the individual does not fear successful performance, they fear an inadequate performance (i.e. making mistakes, getting tongue-tied, looking anxious, etc.) and the reactions of others to their inadequate performance. Therefore, the social phobic needs in-vivo exposure to the risk of inadequate performance and to the reactions of others to their performance.
A good example from my own life: When I first began teaching, I was anxious about public speaking. I feared that I would stutter, get tongue-tied, lose my place in my notes, say something dumb, be unable to answer a question one of the students asked, etc. It seemed that it would be very serious if any of these things happened. I already knew that what I needed to do was to go ahead and teach despite my anxiety in order to get comfortable with it and I did so.
The times when I taught a class and it went fine reduced my anxiety a bit by increasing my confidence that I could do a decent job. However, the experiences that were most helpful were the times when the things which I feared happened, the times when I did stutter, lose my place in my notes, etc. I was amazed to discover that the students were not nearly as aware of my mistakes as I was, that they didn't decide I was an idiot, didn't leave, didn't throw tomatoes, etc.
Obviously, with clinical levels of social phobia it can take some doing to get people to go ahead and face their fears in a way that ends up being therapeutic. Quite a bit has been written on this topic. One source which I like (and which is a good self-help book) is Dying of Embarassment: Help for Social Anxiety and Phobia by Markway, Carmin, Pollard, & Flynn (Published by New Harbinger, 1-800-748-6273).
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