Social phobias

The variety of forms that social phobias take can also be explained in terms of our biology.

The most common social phobias are fear of speaking in public; fear of writing in public; fear of blushing; and fear of eating in public. At the heart of them all is the fear of being judged negatively. If we look at these situational fears individually, we can see that they are focused on one or other aspects of the normal fight-or-flight response, which is triggered in stressful situations.

For instance, a phobia about eating in public can often develop as a result of experiencing a panic attack in a restaurant. One person might become hyper-aware of the choking sensation that occurs when oxygen doesn't reach the tissues, because of shallow breathing; another might become hyper-aware that their saliva has dried up and their throat muscles are constricted, literally making it impossible to eat. Both of these aspects of a panic attack could understandably lead to a fear of eating in public.

Another physiological aspect of the panic response is the sensation that our tongue isn't working and we are unable to speak properly. Of course, when we are very highly aroused, we cannot think straight either. All this could easily translate into a fear of speaking in public, whether giving a presentation to colleagues or a speech at your best friend's wedding.

We also shake when we are panicked. Having that experience when eyes are upon us can easily lead to a fear of doing anything in public that might draw attention to our hands -such as writing a cheque.

A lot of people fear blushing. Yet this again is a natural part of the fight-or-flight response - blood rushes to the face. When blood courses through the muscles of the face, we see it as 'blushing'. But, of course, blushing occurs all over the body when we are aroused; it's just that, normally, we are only aware of the face and neck area.

So different social phobias arise, as a result of our focusing on one particular aspect of the whole cascade of fight-or-flight responses, rather than another. A psychologist once treated a young doctor who had developed a phobia about eating in public after an occasion when he was having a meal in a restaurant with a friend. The doctor saw a couple of people he knew and noticed that they were looking at him and then speaking together as if they were discussing him. He was already in a highly vulnerable state, as his girlfriend had very recently broken off their engagement. That was devastating enough. But now he assumed that she must have told these people about it, and they were looking at him and laughing at him for getting dumped. He began to feel extremely self-conscious and anxious. As he went to swallow the food in his mouth, he found he had no saliva and so really did start to choke. And then everyone in the restaurant was looking at him.

After that, he couldn't eat in a restaurant again. But then he soon found that he couldn't eat in the hospital canteen either. And then he started avoiding pubs, in case people offered peanuts around and he might feel obliged to take some. By the time he came to see the psychologist, he couldn't even drink a cup of coffee in the presence of another person, and his whole social life had collapsed. Not only was he fearful a great deal of the time but he had also become increasingly withdrawn and lonely. Fortunately, the psychologist was able to cure him very quickly by the means described later in these articles, which can be used for all social phobias.

A phobia about speaking in public is very often triggered by a bad experience of being made to read aloud to the class, when a child at school. Children who feel nervous naturally find their mouths going dry and the words coming out funny, so their fear of doing badly is confirmed by the reality - and, to compound their shame, they are often laughed at or told off by their teacher, to boot. Such an experience can cause a lasting fear of performing in public, unless addressed.

Another common trigger of this particular fear is temperaental shyness. Some people are, by nature, more introverted than others. But that doesn't mean that shy people can't learn to be skilful speakers, or to enjoy social gatherings; it just means they have to work a bit harder at it. (If children are shy, it is enormously helpful to encourage them to take speech and drama classes; they learn confidence and social skills that make the process so much easier. Natural introverts never stop being introverted but they can manage their temperament instead of their temperament managing them.)

Continued in this article: Obsessive-compulsive behaviour