A psychologist explains how to overcome social phobia

Anxiety disorders are very common today, and it is estimated, based on data from several research, that 20% of the population will experience an anxiety crisis throughout their lifetime.

One of the best known anxiety disorders are phobias, among which we can highlight social phobia. But what is social phobia? What can we do to overcome it?

• Related article: "Types of Phobias: Exploring Fear Disorders"

Interview with an expert psychologist in social phobia

In this article we speak with Sandra Isella Perotti, a psychologist with more than 20 years of clinical and psychotherapeutic experience, who works at the Centro Psicológico Cepsim de Madrid, one of the most prestigious Psychology clinics in our country, to help us understand the characteristics of this disorder.

Fear is an emotion that has played a fundamental role in the survival of human beings. But when does it become a problem?

Yes, fear is essential in animals and in humans for survival. It serves mainly to guide us about the dangers that may threaten us at any given time, whether they are perceived in the external world or in the internal world. They activate the flight or fight responses in our body, whichever is more convenient.

It is very easy to see this in animals, for example, in a dog, when he is eating with a great appetite and hears a noise unknown to him, he stops, raises his head, sniffs, looks, that is, he orients himself to see if the stimulus indicates that he has to go out to bark because there is someone, or flee to hide if he scares a lot. In this orientation, the nervous system in a state of alert, helps you to make those decisions. If, when orienting himself, he rules out that there is a danger to him, he will continue eating calmly.

Fear in humans is a kind of alarm that goes off to warn us that something can put ourselves at risk. someone from our close environment or perhaps it may simply be seen at risk, our esteem, our image or our feeling of safety.

The fear reaction originates in the oldest part of our brain, which is characterized by rapid activation, from 0 to 100, instantly. For example, if when crossing a street, we see a car coming, the fright activates our nervous system, first making us jump back, then giving us the feeling of startle and finally we might think “I could to have killed me ”. We see there, how fear activates an immediate response to danger, even before we are aware of it, that is, we can think about it.

Fear becomes a problem when it is activated in us so often or for such a long time that it stops really discriminating risks and dangers, feeling scared more or less constantly, for example when faced with new situations, which do not represent a danger in themselves, but which are lived in a threatening.

And fear also becomes a problem when it arises associated with a stimulus, object or circumstance each time it appears or is made contact with it, and that nevertheless they do not carry in themselves anything threatening or represent a real danger, but they cause the person to constantly avoid them so as not to feel the discomfort that fear produces. This situation is what we call a phobia.

It is like living in a permanent state of alert or alarm, which, being constantly on, no longer only warns about the dangers, but ceases to discriminate and therefore to serve for guidance or rapid reactions in the survival.

It thus becomes a very limiting problem that causes loss of freedom, excessive worry, anxiety, among other difficulties that fundamentally have to do with adapting to the environment, ourselves and others.

So what is a phobia? What are your symptoms?

A phobia is an irrational fear associated with certain external stimuli (phobia of flying, dogs, insects, heights, blood, needles) or certain internal stimuli (phobia of intimacy, social contact, talking in public).

Its symptoms are varied and range from a panic terror, with tachycardias, sweating, psychomotor agitation to paralysis, frostbite, uncontrollable tremors.

Psychologically, these symptoms have to do with not feeling capable of facing something, with feeling overcome and with not seeing oneself in conditions of face an object or situation, with a feeling of risk of life or death and above all, with the conviction of not being able to successfully go through certain Circumstances related to what causes the phobia, which leads the person to avoid everything that may mean an approach to the object or phobic situation.

What types of phobias are there?

Simple phobias generally occur towards a single object. They have a source, from where they come, generally in childhood, where as children we are scared by certain things or situations. As adults and in similar settings, something acts as a trigger and makes us relive those frightening feelings from the past, as if we were still small and defenseless, developing a phobia to something.

There are complex phobias, which are fears related and interspersed with personality characteristics and character. They generally appear in the course of development in childhood, or associated with various traumatic experiences in adolescence that worsen already vulnerable aspects in the first years of life. Mainly, they hinder the relationship with others, intimacy, commitment and aspects of self-concept, such as self-assessment. The social phobia is an example of complex phobias.

Differentiate complex phobias from simple ones and talk about social phobia. What differentiates this type of phobia from shyness?

Shyness is a characteristic of introverted people, who are rather reserved, with a lot of inner life and who sometimes find it difficult to show themselves more socially, appear, have prominence and function socially with skills related to good conversation, be entertaining or fun, be the soul of Party. They tend to be very reflective people with an intense emotional world that is little seen outwards.

Social phobia, on the other hand, makes the person unable to attend meetings, events, sometimes school or work, in the most serious cases they remain confined at home or who needs to drink or take drugs to establish a satisfactory interaction with others, since social contact is experienced as something very threatening and very scary. Fear and shame are the prevailing affections.

How does social phobia affect the lives of people who suffer from it?

It is very limiting. It can go so far that the person has to live secluded at home, avoiding contact with other people outside of her family. Or also, it is observed when the person finds it difficult to attend usual social activities (study, work, shows) or exceptional ones (weddings, baptisms, graduations).

The fear of being evaluated or being exposed is the predominant affect that these people experience, in addition to having a lot of difficulty showing yourself publicly, being the center of attention of others or standing out for some reason in particular.

It is a very great suffering that they suffer, reaching the extreme of not feeling worthy of being loved by others or having the feeling that there is a fault or a flaw in them that they do not want others see.

In what context does social phobia affect the most?

Social phobia affects more in contexts with little appreciation of feelings, which are experienced as a sign of weakness, in environments of Affective deprivation, where children are not offered experiences of security within the family, so that later they become children who succeed. Also in very overprotective and normative environments, where children do not develop self-affirming feelings of their own value, where everything is given to them solved and they do not have to strain and put their own resources into play to obtain what want.

A fear then develops of going out into the world, of connecting with others as we are, with our defects and our virtues, to deal with our limitations to overcome those obstacles that we face. present. It can also happen that one of our caregivers in childhood has this same problem and we learn in some way those fears or other similar ones.

In any case, even if we have grown up in an adverse environment, we can acquire as adults the security that we do not we obtained in the upbringing in a later form, develop new resources and strengthen ourselves to open our way in the world external. This sometimes happens because there are new, more favorable contexts later in development (partner, educational or sports contexts, family of friends, gangs of college mates, work team) or because people ask for specialized help, medical, psychiatric or psychological to overcome these difficulties.

At Cepsim, what treatment do you perform for people suffering from this disorder?

At Cepsim, we first carry out a thorough diagnosis during the first sessions to assess what the problem is and the context in which is presented, we also value each person in particular and their way of being, case by case, to be able to carry out the most treatment convenient.

In our team, we are trained in various approaches and we know different therapeutic approaches that allow us to adapt the tools to each patient in particular and not the other way around, as well as combining different approaches to achieve recovery in the shortest possible time.

We use third generation therapies, such as Brain Integration Techniques, SensoryMotor therapy or SomaticExperience, Model of the Internal Family, Hypnosis, who are oriented to look for the scenario / s sources of the phobia in the past, to "deactivate" it so to speak somehow, or process it, so that it stops firing in the present whenever a trigger recalls the emotion of fear experienced then. That is in the case of simple phobias.

In the case of complex phobias, the treatments are longer since aspects related to the form of being and personality, focusing on the way of establishing affective ties and managing the world emotional.

One of the most used techniques for the treatment of phobias is systematic desensitization. What exactly does it consist of? Why is exposure to phobic stimuli so helpful?

Systematic desensitization consists of planning the very gradual and progressive exposure to those stimuli that produce the phobia.

The person develops the possibility of approaching what terrifies him with the support of the therapist principle, who acts to Sometimes as a counterphobic companion and through systematic repetitions, which increase the difficulty and time of exposure, it is sought just desensitize, that is to say that you no longer feel fear and that the object of said phobia becomes something not frightening for the person.

Is it possible to overcome a phobia without applying exposure techniques?

Of course. The exposure technique It has been developed by the Cognitive Behavioral approach and certain patients do very well and thus solve their problem.

But we are very used to receiving people who, having experienced this type of specific treatment on a phobia, based on Exposure techniques, with the passage of time develop another similar or the same intensifies, for which it is necessary to apply here other types of treatments oriented in greater depth that allow to work the problem at its root, so that it does not reoccur play.

Can a person with social phobia fully recover?

A person with a social phobia, or any other type of phobia, can recover. You can re-experience much of its functionality, you can develop roles and resources that allow you to go out into the world feeling safe and protected, safely and without fear, recovering a normal relationship with what generated so much fear.

Many times our patients are surprised to discover that something they have suffered for so long can remit giving rise to new experiences and expanding the possibilities of experiences, which were not previously found available.