Understanding the Paradox and Presenting Treatment Options
Many children with severe social phobia are never identified because they
masquerade as extroverts. They always “have to” be surrounded by people, but not because they love the company. They use it as a deflection from unwanted personal attention, and they suffer tremendously internally. Often possessing above-average intelligence and social skills, they overcompensate by cleverly controlling situations to mask social phobia. They frequently can be among the most popular kids and highest achievers – valedictorian, team captain, homecoming queen – who no one would ever know suffers painfully with extreme feelings of embarrassment and isolation. They fall under the radar of teachers and parents who assume popularity and a smile equals confidence.
Some red flags to look for:
- Is the student never alone in public?
- Does she have many friends in school and many extracurricular activities, but has no close friends and doesn’t invite peers home?
- Does no one dislike him?
- Does he have so much to say that he can’t tolerate a pause?
- Does she never get angry or sad?
- Does she do most of the work in group projects and avoid delegating?
- Does he resist doing a solo task in class (hand out supplies, run in-school errands)?
- Can he tolerate being wrong? Or does he purposely say a wrong answer in class — knowing the right one — in order to avoid public praise?
- Is he the class clown?
- Is she never with unpopular classmates? Or, is she always helping less social classmates?
Exposure therapy, a special type of Cognitive Behavioral Therapy, is the only
therapy endorsed by national anxiety disorder organizations. Exposure therapy enables sufferers to very gradually overcome their fears and let go of their avoidant and overcompensating behaviors at a pace with which they feel comfortable, so they are never overwhelmed. Results are achieved in a matter of months not years. Exposure therapy can be more effective than medication, therapy and medication combined, or any other kind of therapy. Medication provides only temporary or partial relief and has side effects; symptoms just come back when you end the medication. Exposure therapy provides permanent relief, essentially eliminating excessive social anxiety forever.
Nevertheless, medication can be very beneficial if someone is in crisis, such as facing school expulsion (or job loss or marital conflict in adults), or if they are too overwhelmed to do the work of therapy. However, medication is used temporarily, and the therapist should work toward the goal of reducing or eliminating dependence on it. Clients should stay on medication until therapy is completed, and then gradually reduce and eliminate it while continuing therapy for another several weeks or months to eliminate the residual symptoms that medication masked.
There are many medications used for social anxiety. The most popular are Paxil, Zoloft, Celexa, and Prozac, as well as short-acting medications such as Xanax and Clonipan, which are used only as needed. (This is not an exhaustive list.)
When considering a therapist, there are two test questions that are helpful to ask before you make an appointment: (1) Is exposure therapy the main technique used? If not, forget about using them. And (2): How many people has this person successfully treated for social anxiety? In major metropolitan areas, there should be no difficulty finding a specialist who has treated a few dozen clients with the same condition. The people should no longer have excessive anxiety, avoidant or overcompensating behaviors, and should not be taking medication any more, if they ever did. They should not say they just helped people “live with” or “manage” their anxiety better.
In light of many “unexplained” teen tragedies, schools would do well to cast a wider glance over the entire classroom and not settle for appearances. The good news is that social phobia is extremely treatable … but only if it is identified.
*The opinions expressed in this article reflect that of the author; RecoveryView.com does not take a position on best approaches for treating various issues.