Social Phobia
Social phobia is a very common disorder, among children and adults. Millions of people all over the world suffer from it. Like other phobias, Social Phobia is a fear reaction to something that is not actually dangerous, although the body and mind react as if the danger is real. Individuals who suffer from Social Phobia may develop hypersensitivity to criticism, negative evaluation, or rejection. They often have difficulty being assertive; and have a low self-esteem or have feelings of inferiority. They may underachieve at school due to test anxiety or
avoidance of classroom participation. They may underachieve at work because of anxiety during, or avoidance of, speaking in groups, in
public, or to authority figures and colleagues. They often have few friends. In more severe cases, individuals may drop out of school,
be unemployed and not seek work due to difficulty interviewing for jobs.
All the psychiatrists regard social phobia as an emotional disorder, and those suffering with it needing medication. Unfortunately, so too do most psychologists. My therapeutic approach is totally different, since it combines two disciplines of psychology: Positive Psychology and Evolutionary Psychology. I regard all anxiety symptoms as if they are a positive computer program, which God or Evolution created in the brains of all humans, with the goal of survival during the time they were in primordial forests. In accordance with this approach, social phobia is a tendency to being overly-cautious of social competitiveness. (The reader is referred to two chapters on this website:
"Evolutionary Psychology" and
"Cautious vs. Daring".
Humans belong to the group of social animals. All the social animals have a kind of computer program in their brains called social hierarchy. This program is responsible for a tendency toward competitiveness. In Pre-historic times, men with the highest rank on the hierarchy were the leaders (Alpha) who gained more food, as well as had more women courting them. The ones who were average on the hierarchy used to fight one another, with the goal of climbing up the hierarchical scheme. Of the ones ranking lowest, some continued fighting, and some decided, sometimes unconsciously, to refrain from any competition, lest they be injured physically during the fight. In the distant past, social rank of men was mostly on matters related to hunting skills, including fast running, and accuracy in using hunting gear typical to their era. Women fought over their ability to gather more fruit. In modern society, we still carry the genes of social rank competitiveness, but obviously, in every society, the fight relates to matters typical of its culture, such as: achievements in politics, in art, in science, and economic success. Unlike prehistoric humans, in modern civilization, the methods applied in the struggle for rank are usually verbal, with the goal of humiliating each other. In various languages, expressions were created that are powerful in humiliation, for example, “you don’t try enough, you’re lazy, you’re stupid, you’re an idiot, you’re crazy, you’re a scoundrel, you’re a dog, you’re a pig, or you’re shit”.
In modern society, some of the people who feel that their social rank is low, avoid rank competition by avoiding standing out or speaking in public. For example, those in school and even at universities avoid raising their hand in class, standing in front of the class to talk or writing on the blackboard. Some do not suffer from social phobia symptoms, because they have resigned to being in a lower social rank, to accepting themselves.
Research has found that only about 12% of modern human population feels social phobia symptoms, and that a large portion of them are women. In the chapter
"Cautious vs. Daring"
it is explained that women by nature tend towards caution at a higher rate than do men. Therefore, it is natural that they would suffer more than men from social phobia symptoms. The chapter entitled
"Depression"
explains how some depression symptoms also contributed towards retreat from rank competition: Insecurity, low self-esteem, avoidance of social contacts and shutting oneself at home.
The following three reasons may cause a person to feel social phobia:
Genetic tendency: Genetically, 20% of people in the world tend toward over-caution, which manifests itself in a variety of anxieties, including fear of failure in rank competition, called social phobia. This tendency is genetic, and generally is inherited from one of their parents or from a family relative. In the initial meeting with a patient experiencing social phobia, it is important to ascertain who of his parents tends toward over-caution. It is important to explain to the patient that this tendency is normal and that it was positive in its origin by aiding prehistoric man to avoid physical harm while engaging in a power struggle with the leader. Fortunately for the patient, nature differentiated between genetic tendencies which cannot be changed, such as skin color or eye color, and tendencies in personality such as caution and daring, which can be changed following a learning process and practice. In the course of therapy, the patient is guided to accept him/herself as imperfect, like all people, but to try to minimize the level of his social caution while increasing his level of daring.
Criticism from an Aggressive Parent: Some of those experiencing social phobia had a daring character when they were born, but because from a young age, one of the parents tended toward aggressive behavior, and was even aggressive toward them, they internalized the criticism and developed self-criticism. As a result, a negative self-image was formed. In parallel, they expected that other people would see in them the same negative traits which the parent addressed. In the course of the initial meetings with such a patient, he is instructed to have an imaginary conversation with the critical parent, with eyes closed. He needs to share his painful feelings with the parent, including crying or yelling. After thus expressing his emotions, he is instructed to imagine what the parent would reply. The patient is instructed to continue this imaginary conversation between him and the parent, while being instructed to reach improvement in the relationship with the parent, in his imagination. In the event that the aggressive parent is still alive and continues to be critical, it is preferable to first have this imaginary conversation between him and the parent, and afterwards, to actually have a therapy-meeting which includes both of them with the goal of improving the relationship.
Criticism from the Surrounding Environment: With children, who were born with a tendency toward daring, often their tendency may change towards over-caution and they can even develop social phobias. This change is a result of continual criticism from classmates. Among all the social animals, there is a genetic tendency to reject the one different from average. The subconscious goal is to preserve the genes common to their peers which are considered by them to be positive. The story about “The Ugly Duckling” illustrates this tendency. Many children feel rejection from their classmates due to some physical issues, such as: overweight, height different from the average, different skin color, and even different religion. I remember that in first grade, one of my classmates was very fat. During recess, while we were at the playground, the students used to run after him singing: Fatso, Fat…
When social phobia is at an extreme level, the person may imagine that every person looking at him sees negative character traits. Sometimes, extreme level of fear causes classical symptoms and sometimes even causes a person to completely avoid leaving his home. In the course of the initial meetings, I explain to the patient, that we live in a democratic country, and therefore every person is fully entitled to think negative thoughts about other people, and therefore, he too is permitted to think negative things about them.
In the course of therapy, the patient receives the following homework, to be done in stages:
1) When the patient walks down the street, and in his imagination, the person approaching him thinks negative things about him, he should observe the external appearance of that other person and identify things that do not look nice, such as: height that is different from average, unattractive hair and unattractive clothes. He should think about the character of the other person and imagine negative things, such as: He is stupid, mean, and unsociable. Most importantly, the patient should think negative thought about other people only while he imagines that they are thinking negative things about him. Upon returning home, he should write down what he imagined that people said about him, and what he thought about them, and bring these notes to the next therapy session.
2) When the patient walks down the street, and in his imagination, the person approaching him is thinking negative things about him, at first he should observe the external appearance of that other person and identify things that do look nice. At a later stage, he should imagine what is nice about the other’s personality. Upon returning home, he should write down what were the positive things he observed or imagined about the other person, and bring these notes to the next therapy session.
3) The patient is asked to look at himself in a large mirror at home, and to observe his body from head to toe. He needs to write down every body part which seems attractive or reasonably so, and to bring the notes to the next session.
4) The patient is asked to make a list at home of every character trait of his which seems positive to him, even if only on a low level. This includes level of intellectual skills, for example: in math, literature, art, computers, science, and also all the positive traits, such as: his relationship with his family, social skills, and even his relationship with neighbors or strangers. The patient needs to bring the notes to the next session.
5) Every night at bedtime, the patient is asked to write down three things that gave him pleasant sensations. He should write even minute things, such as: I walked alone outdoors, and the weather was very pleasant, I saw a beautiful flower, I talked for a minute with a friend, and the conversation was pleasant. These notes too should be brought to the next session.
Every patient suffering from social phobia is asked to write in a daily journal every time a thought related to social criticism pops up in his head, and of course also if anyone was critical in a hurtful way, what is the sentence he fears someone may say, or what anyone actually said. At the therapy session, the patient is instructed to imagine how he would respond, whether aggressively or assertively, according to the humiliating sentence that he imagines someone may think about him or hurt him verbally in the future. If, for example, he makes a mistake, and a classmate criticizes aggressively or insultingly, such as “You’re an idiot”, he should imagine replying: “You are right, I made a mistake, but the way you are criticizing me is very aggressive and inappropriate to our culture.” If the patient feels that the criticism about him is unjust, but aggressive or insulting, he should respond: “Your opinion is different from mine, and it’s your right to think about me whatever you want, just as it is my right to think about you whatever I want, but the way you criticize me is very aggressive and inappropriate to our culture.” Generally, the patient is instructed with the method of role-playing, in which the therapist says a sentence to him which the patient takes as critical, and he has to respond in an aggressive way, or in an assertive way. If the patient still lives with his parents, I include them in the sessions, because in my opinion, they can continue instructing him in this manner even after the therapy ends.
Social Phobia A Case Study
Like many other anxiety disorders, genes may play a role. If a biological parent or sibling has or has had Social Phobia, there is at greater risk for it. Environmental factors, such as an overprotective or hypercritical parent, or being rejected and humiliated in school, may lead to Social Phobia. An interesting study was performed on very young butterflies that were hatched in the laboratory. When the investigators
made a sharp noise in the corner of the cage, some of the butterflies flew in the direction of the noise, apparently to investigate its
source, while others flew away and hid. People who raise dog puppies are aware that some of the puppies are afraid of sharp noise, and run fast to hide or seek the protection of their mother, whereas others moved closer to the source of the noise and barked. The same is
the case with very young children. Some cry when they see a stranger, while others smile.
A patient, who was instrumental in my developing the relaxation technique, which I dub the "Protective Shield", was a
32-year old I'll call Mark.
From an early age, Mark suffered from various fears, which increased once he graduated college with a Bachelor's degree in Economics and began
working in an industrial plant. The plant's manager was extremely authoritative and critical. Most of the employees feared him but learned to cope. Mark, on the other hand, being very sensitive, was extremely hurt. As a result, he began feeling anxious and depressed for several days after each incident. In the beginning of Mark's treatment, he related that he father was also very critical. During his childhood, Mark feared his father and tried hard not to anger him. I explained to Mark that he experiences his boss in the same way a doe in the jungle experiences a predator chasing her. Even though the predator does not physically harm the doe, the doe is always on the lookout.
"I understand that what you mean is that I related to my father as if he were a lion" Mark responded to my explanation. "It is important that you understand that today my father is practically senile. He resembles an old toothless lion, and as for me I am now an adult, much stronger than he is. Why is it that I still fear him? In any case, my boss is not my father, so why is it that I am afraid of him?"
"Let's imagine that the doe who lived in the jungle all her life, moves to a location where there are no beasts of prey and befriends a local doe. When an unfamiliar sound is heard, the doe who came from the jungle would take flight, while the other one will turn to the location of the sound in astonishment."
"Is that what I can expect for the rest of my life? To take flight when I hear any little sound?" asked Mark frustrated.
"Do not blame yourself." I answered. "This is nature, or a higher power, that programmed our brains. An animal residing in a place where there are beasts of prey will immediately be overly cautious, and certainly much more so
than those who reside in a totally protected environment."
"You keep explaining to me what happens with jungle creatures, but I am neither a doe nor a rabbit, I am an intelligent human being, a college graduate, who had never resided in the jungle. I live in a large metropolis where other humans reside, sometimes with dogs or cats but not beasts of prey."
"You are correct, you are neither a doe nor a rabbit and neither am I. All of us, however, contain within us the primitive instincts of our ancestors. Since human history began developing, approximately ten thousand years ago, we learned to control some of our primal instincts. As an example, men do not rape the women whom they desire. They court them and conduct their sexual activities privately by mutual consent.
When we are hungry, we do not steal food from stores and climb trees to consume it. We buy fruits and vegetables in the market and when we come home, we clean them, peel them, set the table, wash our hands and then consume the food in a civilized manner. Despite these changes in education and culture, however, the primitive survival instinct has not undergone much change. When we perceive something as dangerous, or when we anticipate trouble, our bodies change gear from relaxed to cautious."
"Is it possible for me to learn to control the survival instinct? Will you be able to help me develop a protective shield such as an elephant has, so that I will not be afraid of every comment my father or my boss make?" Mark asked defiantly.
On my way home, I wondered "would Mark really be happy with an elephant's skin?" With an elephant's skin will his wife continue to love him? Will he be as good a father to his children as he is today? Will he be able to continue to enjoy an exciting movie or book? And, in fact, what is the harm with thick skin? After all, there are many people with thick skins, such as politicians and CEO's who do marry, have children and have loving families. The thick-skinned people often search partners with thicker skins. They complement one another. And, what would happen to Mark's marriage if I help him develop a thick skin? Would his wife, who is a strong woman and somewhat authoritative, will be able to get along with the newly formed Mark?" I answered myself with an unequivocal "No!" Even a lengthy couple therapy would be unable to allow two individuals with thin skins to live together happily. They would quarrel, or become apathetic and indifferent to one another. So what is the solution? Perhaps I need to teach Mark to develop "flexible skin".
In our following session, I explained to Mark the following: "I gave your request to help you develop thick skin much thought. I came to the conclusion that you should be happy you do not possess thick skin, since both skin types have advantages and disadvantages. The advantage of a thin skin is that it affords its owner positive sensitivity to other people and the environment. People who possess thin skin usually
develop very deep and significant relationships with family and friends. They rarely offend or hurt people they come in contact with, as they are familiar with the consequences. They also find the landscape, good art and a sad movie exciting and moving. The disadvantage of thin skin is that those possessing it are easily hurt. On the other hand, thick skinned people are less offended. Mostly they take on leadership roles, such as your boss. However, unfortunately, they do tend to hurt and offend people. I would assume that they are not particularly moved by any landscape or a sad movie. Since we are now living in an advanced technological era, the choice is not between a thick or a thin one, but a flexible skin which a person may choose to change at any given time by himself at will."
"That makes sense to me! Come on now, teach me how to control my skin" Mark requested.
At the conclusion of a relaxation exercise which lasted about ten minutes, I continued with a guided imagery. "Imagine, Mark, that your skin is covered by a transparent "Protective Shield". Similar to natural skin, soft and flexible, but somewhat thicker... This Protective Shield covers your entire body from top to bottom, and affords you a feeling of safety and security. It shields you from outside pressure. The shield is transparent, light and flexible. You can also control its thickness. There will be instances when you will prefer a thinner skin, when you are with your wife and children for example, when you read a book or see an exciting movie. However, there will also be times when you will prefer to be covered by a thicker skin which will protect you from outside pain. The advantage of this method is that you are in
control of the thickness of this shield by taking several deep breaths
(for more details review chapter:
"Deep Breathing").
The shield expands exactly in proportion to the stressful situation in which you find yourself. You need several relaxation breaths that will expand the protective shield. I will be quiet now for a few minutes at which time I ask you to recall one or two situations that occurred recently, in which you reacted as you always have. Use situations in which you felt hurt. I suggest that in the first stage you reconstruct in your imagination the exact situation and your original response to it. In the second stage, remember the hurtful sentences said to you. Take a deep breath which will blow up your Protective Shield. In your imagination, the insulting sentences will touch the Protective Shield, break up into syllables and disintegrate. At this time, since you will be relaxed, you will be able to respond in a manner you deem appropriate. When you feel you are satisfied with the new scenario, you will take a deep breath, smile and open your eyes."
I observed Mark's body and face for about five minutes as he moved deeper and deeper into the world of imagination. Sometimes his face expressed pain and sometimes a winning smile. When he opened his eyes, his face seemed relaxed. He said that he reconstructed in his imagination two situations. In the first one, he saw the manager being angry with him in front of other employees. The manager's words to him
were very hurtful. Mark took three deep breaths and saw these words hitting his Protective Shield disintegrating. He answered the manager firmly, yet in a relaxed manner. He explained to the manger that it is not acceptable for him (Mark) to hear this tone of voice. Mark told the manager that if he has anything to say to him, he should invite him to his office and talk about it in private and in an acceptable tone of voice. In the second scenario, Mark imagined himself to be 15-years old and have his father yelling at him for watching TV instead of studying for an exam. Mark again expanded his Protective Shield, looked directly in his father's eyes, a thing he never dared to do in the past, and in short sentences told his father that the exam was his own personal business. That if he chooses to fail the exam it is his prerogative. He is no longer a young boy who takes orders from his father. Mark imagined his father being stunned by his firm approach, and for the first time in their relationship, the father lowered his eyes and left the room.
I acknowledged Mark for his success in imagining and using the Protective Shield and for his ability to both deal with the manager and his father in such a positive and respectable manner. However, I also needed to prepare him for setbacks. I explained to him that the new Protective Shield needs many adjustments and tryouts. Experience and recurring usage gives us confidence in our responses. In order to
empower Mark's achievements and overcome the fear of failure, I told him that I hope that this week the manager will scold him more
times than in the past in the company of other employees, and that his father will look at him disapprovingly more frequently as well. At
first, Mark felt uncomfortable with this request, but he calmed down when I reminded him that "what does not kill us, strengthens us."
Mark continued in therapy and focused on experiences from the past, which caused him pain. With the help of the imaginary Protective Shield, he began developing positive coping mechanisms.
In 1991, during the Desert Storm operation, I worked as a psychologist in an Israeli hospital. I was asked by the hospital's director to prepare subliminal relaxation tapes in order to assist the hospital's staff and their families, as well as the patients, to cope with fears due to the Iraqi attacks. With the help of a donation, I was able to tape and copy approximately 1000 tapes called "Protective Shield". These tapes were highly acclaimed. These recordings can be heard in Hebrew under the title of "Coping with Stress and Anxiety" on the website
www.baruch-elitzur.com. Currently these tapes help many of Israel's citizens who reside in the areas which the Hamas attacks with rockets.
I encourage everyone who suffers from Social Phobia to try to help himself/herself by practicing relaxation techniques and mental imagery. If these steps are not sufficient, it is highly recommended to seek professional help.
People suffering from social phobia, tend to have a cautious personality more than their peers. Since “knowledge is power”, it eases for self-acceptance and for positive coping with social phobia, reading of the chapter
"Cautious vs. Daring" is recommended.
Translation from the Hebrew Website by Ruth A. Rin,
"www.AlefBetTranslation.com"