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Social Anxiety Disorder Therapy

Updated on June 4, 2008

Social Anxiety Disorder: Causes and Treatment

by Helen Borel, Ph.D.

Social Anxiety Disorder (SAD), a fairly recently classified, frequently disabling, emotional and behavioral condition, used to be considered a normal, tolerable state and was generally referred to as "shyness." Or, sometimes, severe sufferers were labeled "painfully shy."

Today, SAD is taken much more seriously by psychiatrists and psychotherapists due to clinical recognition of the high levels of human suffering it causes. And because, now, both psychotherapy and psychotropic drugs - or often psychotherapy alone - can effectively treat it.

Some Causes of SAD

According to Drs. Mathew and Ho, reporting in a 2006 Supplement of the Journal of Clinical Psychiatry,1"SAD is characterized by fear and/or avoidance of most social situations" engendered by genetic, temperamental and environmental influences on the individual - as well as by modes of socialization learned from one's parents.

Self-inhibitions and shyness are traits that are probably inherited, as is the tendency to worry about being thought badly of by others. While parental rejecting actions and words combined with overprotective behaviors and admonitions, during a child's formative years, further inhibit such a sensitive personality.

How Brain Function Impacts SAD

Some areas of the brain that are believed to play various roles in the development and perpetuation of SAD include the amygdala and the hippocampus - segments of the limbic system (clusters of nerve cells) that act automatically on physical and emotional functions and can produce emotional abnormalities like easily-triggered rage, unrealistic fears, sobbing or laughter for no apparent reason, and heightened anxiety without a known triggering event.

And certain genes and neurotransmitters (brain chemicals) may also play their part in SAD. These factors are being studied and the results of these studies should help refine the Rx armamentarium now available to help control SAD patients' disquieting symptoms. Because the more specific to the condition a medication or therapeutic modality can be, the more accurately it can target troublesome symptoms.

Neuroimaging Can Pinpoint Brain Activity

These days, it is possible to observe brain chemical reactions and changes in brain structure itself via various neuroradiologic (brain imaging) techniques. These include modalities such as positron emission transaxial tomography (PETT) scans - which depict, in color, brain chemical metabolism. As well as magnetic resonance imaging (MRIs) - which depict brain structures and locations of lesions (e.g., tumors or other defects).

Such imaging studies, of the brains of patients with SAD, have been able to pinpoint somewhat more clearly, for example, how fears arise, how learning is extinguished, the effects of conditioned responses, even the individual's reactions to disgust. But the scientific, neurologic and biochemical terminologies necessary to fully elucidate these brain responses are too technically complex to be useful in this brief discussion for a non-academic audience.

The Value of Psychotherapy for Social Anxiety Disorder

Suffice to say, these same imaging tools have recently demonstrated the high value of psychotherapy for various emotional conditions by imaging positive neurochemical changes via PETT scans and positive cerebral (brain) anatomical alterations via computerized axial tomography (CAT) scans in patients with diverse mental health problems who have undergone psychotherapy.

Yes, certain prescription medications can be useful in quelling the anxieties and other symptoms sometimes associated with SAD. However, because SAD is a condition which not only interferes with a full life, but which makes patients vulnerable to the development of full-blown depression with its risk of suicide, psychotherapy is an essential component of any treatent program for SAD patients.

The Focus of SAD-Specific Psychotherapy

Psychotherapy sessions will help reduce the socially sensitive patient's social inhibitions. It will also decrease worrisome thinking and fears of rejection. The focus will be on elimination of avoidance of relationships and interactions as therapy will also guide patients in learning how to feel safe and "non-rejectable."

Furthermore, sensitivities to excessive general fears and performance anxieties, such as stage fright, will be replaced by greater Self confidence and improved life functioning.

Finally, along with these thought and behavioral changes, psychotherapy techniques will lead to improved feelings and mood states that will contribute to a happier, fuller life.

1. Mathew, SJ and Ho, S: J. Clin. Psychiatry, "Etiology and Neurobiology of Social Anxiety Disorder," 2006;67 (suppl 12)

For more information about this or any other emotional health topic, email me at:


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