Amid all the excitement and rejoicing attached to the end of year holidays some people live in emotional misery. What people think of them is the subject of their obsessive fears. Some overwhelmed by those fears are driven to either avoid altogether being in the society of others or, if avoiding is impossible, to endure in utter misery. Needless to say the upcoming holidays are not their favorite time of year.
A fairly common problem, this is called “social phobia”. The distinction between social phobia and normally introverted personality is a matter of degree. When the fear is intense enough to interfere with a person’s normal lifestyle we speak of a disorder and recommend twofold treatment: pharmacological to address directly the over-excitability of the brain centers responsible for fear conditioning, and cognitive behavioral therapy to realign the faulty thought patterns that lead to irrational fears.
Psychiatrists (physicians who have had years of specialized training in neurobehavioral medicine) have about a half dozen classes of drugs to choose from depending on the particular symptoms of the patient and on his tolerance for side effects. Even so individual differences are so intricate that optimal results may not be reached with the first try. Do not quit! A good patient/clinical team can achieve life altering changes enabling the patient to go well beyond the ability to attend parties comfortably. Marriages have been saved thanks to this kind of two-pronged therapy, careers have been launched on new paths, performing artists have reached new depths in their art, children of previously anxious parents have blossomed beyond all expectations. The benefits are countless.
Cognitive-behavioral therapy (or CBT) is a systematic restructuring of a person’s unique view of himself. That self-image is made of the feedback we get from the environment interpreted through the sieve of our inborn temperament. Some people are outgoing and gregarious by nature; we call them extraverts. The introverts, as the name suggests, are people who even as infants were self-contained, happier with their own company or that of a small circle of familiar figures and often guarded with strangers and new situations.
There is room under the sun for both types of personalities and neither need to change so long as they remain free to realize their life choices. But imagine a concert pianist who suffers panic attacks at the very thought of walking alone onto the stage. Or an Olympic- class athlete who cannot silence the speech inside his head harassing him with predictions of failure…Clearly such people are not just normal introverts. They are suffering needless misery because of the way they learned to think –erroneously-- of themselves.
CBT is a very structured form of therapy with a limited interest in the familial and personal histories. The responsibility for progress rests largely on the patient’s motivation.
Social phobics will heave a sigh of relief as the holiday seasons ends. But the phobia will continue to wreak havoc in many lives.
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