Treatment for Social Anxiety Disorder

Reader’s Question

I wanted to know about severe social anxiety. I had it in college, and I still continue to have problems. I don’t know where to look when talking to people. I don’t know how fast or where to walk in the mall. It’s getting to the point where I don’t really want to go out with my friends anymore because I am afraid how I will act, and if they will notice how I am acting. I have been very stubborn in getting treatment for this, and I know I have a problem. It has affected my life and my jobs — several, at that — for quite a while.

It has affected my life in that I can’t perform at my job and end up losing my job, and having my relations strained at home. I just want to be normal, and have what others take for granted! My question is what can I do to save my job while I am getting treatment. I am a business development manager and I call companies with revenues over 700 million. Also, I can’t afford to lose this job. Please if anyone has any suggestions on what I should tell my boss please let me know. It makes me anxious just to think about what could happen.

Our Consulting Clinical Psychologist’s Reply

Social Anxiety Disorder (SAD) or Social Phobia is one of the most common mental health issues. You have described the symptoms very well — a persistent fear and preoccupation related to social performance situations in which embarrassment may occur. As you describe, it typically starts during teen years and persists into adulthood. It can be incapacitating in the home, social and/or work setting.

When a disorder is very common, it’s researched a lot. Treatment is widely available and typically uses two or three threatment programs and strategies at the same time. It sounds complicated, but it isn’t. These treatment approaches include:

• Psychological/Counseling treatment using Cognitive Behavioral Therapy (CBT) has shown great results. As we can tell from your comments, folks with SAD live with thousands of unrealistic and inappropriate worries and beliefs. CBT helps correct unrealistic thinking and provides patient education as well.
• Medication Treatment is without question the most effective approach to SAD. Research provides strong links to SAD and the brain’s neurotransmitter system. There have been a variety of studies that suggest what works, and what doesn’t work as well. Antidepressants, while helpful, are less helpful when used alone. The best medication approach often involves the use of an antidepressant AND a long-acting antianxiety medication such as Klonopin.
• Patient education is very helpful and again; there is a great deal of information available on this topic.

I’d recommend consulting a psychiatrist — the professional best trained in medications for the disorder. Next I’d arrange for a psychologist or counselor, one with training in CBT.

Your situation is very treatable and modern treatment, even with medications, will not prevent effective and efficient job performance. The sooner you arrange for treatment, the faster you’ll recover.