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A SELF-HELP BOOK FOR SOCIAL ANXIETY AND SOCIAL PHOBIA

A Know-How Manual For People Who Experience Discomfort In The Presence Of Others.

A Treatment Book For Their Therapists Who Are Trying To Help Them.

By Vijai P. Sharma, Ph.D

Published By:

Mind Publications

3250 Blueberry Hill Place

Cleveland, TN 37312-4401, USA

All rights reserved. No parts of this book may be reproduced or transmitted in any form or by any reasons, electrical, or mechanical, including photocopying, recording, or information storage and retrieval system without written permission from the author, except for the inclusion of brief quotations in a review.

copyright (c)1996 by Vijai P. Sharma, Ph.D.

Library Of Congress Catalog Card Number (LCCN) 97-72874

ISBN 0-9628382-7-6 $9.95 Softcover

Subject Index:

Social Anxiety; Social Phobia: People-Fear: Anxiety:

People Encounter: Anxious Thoughts: Negative Thoughts:

Interpersonal Anxiety: Social Embarrassment

Includes bibliography and index

Cover and other paintings by Jaqui Streeton

WARNING -- DISCLAIMER
This book is written to provide information regarding the disorders of people fear. The reader should understand that the publisher and author are not engaged in rendering professional, legal, or other expert services. If professional, legal, or other expert assistance is required, the services of a competent professional should be sought. It is not the purpose of this book to provide all the information that is otherwise available to the authors and/or publishers, but to complement other texts on this subject. You are urged to read extensively the available material, learn as much as possible about the social phobia and other anxiety disorders, evaluation, treatment, and self-help techniques, and to tailor the information to your individual situation. Although painstaking effort has been taken to make this book complete and accurate, you may encounter lacunae, gaps, and mistakes in structure and content. Therefore, this text should be used only as a general guide, and not as an ultimate source of information on social anxiety or social phobia.

The aim of this book is to educate and inform. The author and the publisher shall have neither liability nor responsibility to any person or entity with respect to any loss or damage caused, or alleged to be caused, directly or indirectly by the content, style, or format of this book. The book is not intended to substitute for treatment and/or professional advice. In fact, if you have a problem, you must seek professional consultation and evaluation.

If you do not wish to be bound by the above, you may return this book to the publisher for a full refund.

About The Author And The Book

Vijai P. Sharma, Ph.D is a psychologist and author. As a practicing psychologist, he has helped thousands of clients including children, adolescents, adults, couples, and families in his career of thirty years. He has written over two hundred articles and books on personal psychological and relationship problems. He writes a weekly column "Understanding Emotions," a popular feature helping people who are interested in self-help, personal development, and self-initiated growth. His book, "Insane Jealousy," has gained national recognition, especially during the O.J. Simpson trials.

Dr. Sharma, director of Behavioral Medicine Center, a comprehensive psychological treatment clinic in Cleveland, Tennessee. He began his practice in clinical psychology in 1967 after completing postgraduate training in Medical and Social psychology at the Indian National Institute Of Mental Health and Neurosciences. He completed Advance Training In Clinical Psychology at the Tavistock Clinic and Institute, London, UK, and received his doctorate in psychology from Lund University, Sweden. He has been licensed in Tennessee since 1981

The book, People--Fear is an educational program based on Dr. Sharma’s experience in working with the socially anxious and social phobias. This book is for education and general information and is not intended to substitute for treatment and/or professional advice. In fact, if you have social anxiety or phobia problem, you should seek professional consultation and evaluation. Individuals with people discomfort will find this book highly practical and useful in enhancing the benefits of their recovery treatment program. Mental health professionals will find this book an invaluable tool for client-education and for rendering self-help assignments to their clients.

CONTENTS:

Warning/Disclaimer 4

About the Author and the Book 5

Acknowledgements 6

Preface 8

Introduction...................................9

Fear of Being With Other People 12

Face the Fear and Do It. 17

Fear of Humiliation and Embarrassment Can Diminish 20

With Right Practice You Can Set It Right. 24

People-Fear is Fear of People-Encounter..........28

A "12-Steps Program" to Overcome People-Fear 29

Social Anxiety/Phobia Goals 32

Motivating Yourself 34

Bodily Symptoms of Social Anxiety/Phobia 35

Avoidance Behaviors of Social Anxiety/Phobia 36

Anxious and Negative Thoughts of Social Anxiety/Phobia 38

Become an Expert in Rating Your Anxiety 40

Anxiety Scale 41

Become an Expert in Diaphragm Breathing (Belly Breathing) 42

Guide to Diaphragm Breathing Practice Sheet 46

Practice Sheet for Diaphragm Breathing 47

Become an Expert in Controlled Breathing 48

Re-evaluation of Anxious and Negative Thoughts, Expectations and Beliefs 51

Examples of Correct Thoughts and Coping Statements 53

Coping Card 54

My Coping Card 55

The use of Exposure in Recovery from Social Anxiety/Phobia 56

Exposure Hierarchy List 59

Example of an Exposure Hierarchy 60

My Exposure Hierarchy List 61

Make a Victory List 63

My Victory List 64

Reassessment of Negative Thoughts 65

Generate Positive Thoughts overwhelmingly 66

My Positive Thoughts 67

Additional Help 68

References 70

Index 71

PREFACE

The "People-Fear" workbook is a patient-therapist interactive program for persons with social anxiety or phobia. If you are a person who experiences discomfort in presence of other people, you can use it as a self-help book. Therapists can use it as an interactive manual with clients who are experiencing social anxiety or social phobia. It will help to enhance client’s understanding and appreciation of the treatment program a therapist has to offer.

People Fear workbook evolved out of my own need as a therapist to facilitate my work with patients with social anxiety or social phobia. Since I give a lot of self-help assignment during the course of therapy, I like to have assignments and instructions handy so I don’t have to look for them while a client is seated in the waiting room. I also like to provide clients with an overview of the entire treatment program so they know what to expect from the treatment and how I can help them. Recently I had several patients with social phobia, which resulted in my reviewing several books, journals, and chapters in edited books on social anxiety and social phobia. The material was helpful and informative. However, it did not lend itself readily to my actual work with clients. Thus, I had to build bridges between acquired knowledge and required practice.

People Fear interactive workbook provides that necessary transition from a "knowledge book" to a "workbook" for therapists and persons with social anxiety and phobia. Therapists and persons with people- fear can use it cooperatively as a single source of reference for explanation of the problem and providing appropriate self-help assignments .

People Fear was designed in the backdrop of the managed care environment. Most therapists work with third party payers who want to know specifically what a therapist does with a patient and what services they are purchasing from therapists in the name of "therapy." Therapists, therefore, find themselves struggling with the task of formulating behavioral goals and using a language that third party payers understand. The workbook offers the format for a treatment plan and a record of subsequent progress.

Unlike workbooks, textbooks often provide treatment goals, a framework, and a language that is designed for communication among therapists. However, when therapists sit down to talk with their clients, they have to speak a different language if they want to be effective in their communication. This workbook provides mutual goals and procedures for therapists and their clients allowing them to speak the same language.

This is a "12-Step Program" designed to help overcome people-discomfort/fear. Common physical symptoms, avoidant behaviors, and negative thoughts and beliefs are discussed. Techniques to calm body and mind before, during, and after people encounter are presented. Coping thoughts suited for people-encounters are discussed. Readers may identify their own coping thoughts to specifically suit their need. Techniques to outnumber negative thoughts by new coping thoughts are discussed.

The program is educational to enhance understanding of the causes and remedies of people fear and does not replace the need for a professional evaluation and/or treatment.

INTRODUCTION

Social anxiety refers to the nervousness we feel when we are around people. "Stage fright" is the nervousness or fear a performer experiences about his or her public performance. But, what is a "stage," anyhow? Well, that’s open for interpretation. Note, what Shakespeare says:

All the world’s a stage, and all the men and

women merely players. They have their exits

and their entrances; And one man in his

time plays many parts.....

Shakespeare, As You Like It

Ninety percent of people feel stage fright when they face the prospects of a public performance. This includes being asked to give a speech, a recital, a dance performance, or performing a role on stage. At the beginning of one’s career, nearly every public performer reports experiencing stage fright. As performers keep on performing, this begins to diminish. About 20% of people have severe anxiety about public performance and those usually try to do everything they can to get out of a situation that will put them in the spotlight. Individuals, who experience social anxiety, however, have a different kind of "stage fright.’ For them, the whole world is a stage and even informal social situations are nothing less than public performances. Meeting and interacting with other people in an everyday social situation, such as in a work setting, a social club, a concert, etc., is like performing under the scrutiny of an "audience." For a socially anxious person, this audience, is not perceived as a gathering of friends and fans, but of unsparing critics.

Heredity, has been shown to play a part in shy or anxious temperament. These genetic traits contribute to the problem of social anxiety. Life experiences in interaction with such a temperament contribute to self-consciousness and apprehension. The more self-conscious and apprehensive a person is, the more inhibited he or she will be in people-encounters. Self-consciousness raises anxiety about self-presentation, that is, "How will I act and appear to others? " Self-consciousness also raises anxiety regarding other- condemnation, such as, "They will disapprove of me and reject me." These experiences come as stomach "butterflies," sweaty palms, shaky legs, lumpy throat, dry mouth, swimmy head, etc. As these symptoms frequently re-occur, one begins to see oneself as a hopelessly shy and nervous person.

Social anxiety has been with us since the time human beings started hunting and living as a group. Every culture through stories, nursery rhymes, and fairy tales, tries to bring the problem of social anxiety out into the open, holding hopes to future generations that the problem can be overcome. Take example of our culture. We have the Bashful in the story of the Snow White and the Seven Dwarf. The Piglet in Winnie-the-Pooh is shy and nervous. The Lion in the Wizard of Oz is "afraid of everything and everybody."

These stories play an important part in the formation of the psyche of every child. Through characters such as, Bashful, Piglet, and Lion, children have an opportunity to identify with and hopefully appreciate that part within themselves that is timid and fearful. Notice how endearing these characters are. They possess qualities that are highly valued in our society. These characters are modest, sensitive, tactful, and non-intimidating. When we feel frustrated and upset with ourselves, or feel ashamed of our fears, we can derive comfort from these characters and recognize our own positive and likable qualities.

Since I was raised in a different culture, I missed these wonderful fairy tales of the West in my childhood. The other day, I laid my hands on "The Wizard of Oz" and I was amazed. These "tales" are a psychological primer of human emotions, foibles, and frailities. Take for example, the character of the Lion. This character takes you to the psychological depths of fear and courage. Here is what it taught me about fear and courage.

The Lion was "afraid of almost everything and everybody." This is a description of a person who has a pervasive social anxiety and severe social phobia . The Lion was "afraid of his own shadow." This compares to a socially anxious person who is scared by his or her own thoughts and imagined fears.

The Lion wishes to be courageous but his path is also thwarted by a wicked witch. How true. Socially anxious people want to get rid of their fears but their path is also thwarted. The stumbling block, the "wicked witch," represents our reluctance to face the fear. Like the characters of Oz, we must approach (and not avoid) that which we irrationally fear.

Let’s now look at what Oz has to say about courage, which is my favorite:

"But how about my courage?’ asks the Lion anxiously.

"You have plenty of courage. All you really need is some confidence in yourself," replies Oz. "Every living thing is afraid when it faces danger. True courage is facing danger even when you are afraid, and you already have that kind of courage."

L.Frank Baum, The Wizard of Oz

Later, Oz gives Lion the final piece of insight on courage, "You know that courage is always inside." Yes, Oz, that’s where one should look for it!

Any therapist would like to be in the place of Oz with his or her "client." The Lion had full confidence in him. It wasn’t that Oz had any magical power. The power was in Lion’s belief that he can be changed and that Oz can change him. Lo and behold, Oz changed him into a courageous Lion because "Lion imagined that the wizard could do anything."

What do the terms, "people-fear," "people discomfort," "social anxiety," and "social phobia" mean?

I use the terms, people-fear and people-discomfort interchangeably. People-discomfort or people-fear are colloquial terms referring to "social anxiety," or "social phobia." Social anxiety refers to the nervousness we feel when we are around people. .Social phobia is an extreme form of social anxiety. Socially anxious people experience discomfort in the presence of others but they still manage to interact with them and function socially. They may occasionally avoid social encounters to avoid the extra stress that may accompany such an event. They may not volunteer for any roles or activities that will put them in the "spotlight." however, there is no significant impairment in their everyday social functioning. Persons with social phobia, on the other hand, have substantial impairment in their day to day level of social functioning. These "sociophobes" may totally avoid several or most of the social situations or, if they must go through them, do so with severe discomfort. Some may even have a panic attack before attending a social event or during the event.

Various studies identify the incidence of social anxiety between eleven to thirty-seven percent. I am of the opinion that about one in five people frequently experience social anxiety. In this figure, I am not including the anxiety that people experience in expectedly stressful situations such as, interviewing for a job, requesting the boss for a raise, or making a public presentation. Far fewer people have social phobias compared to those with social anxiety. It is estimated that 7.5 million people in the USA suffer from social phobia which comes to about three percent in the general population. Some people, who have social phobia, may experience panic attacks before, during, or after a social event. Here is an example of a social phobic who had her first panic attack as she went for a job interview:

It was as if a total stranger possessed my body. My palms were sweaty, my heart was pounding. I was looking at everything through a "tunnel." Paralyzed with fright, I was unable to speak. I couldn’t even remember my name, let alone remembering why I was there. After that experience, I didn’t have the courage to go for any other interview. I didn’t even want to look at the newspaper job columns, they made me sick.

In cases like this, the primary problem is social phobia and panic attacks follow in the course of social phobia. A careful history needs to be taken to understand the relationship between the panic attacks and social phobia. It may be more beneficial to first get a handle on panic attacks before working on the problem of social phobia.