Adolescence is tough enough without suffering from a fear of social contact. Kids with social phobia dread walking into the school cafeteria, have trouble making friends, and are at greater risk for alcohol abuse. Worst of all, they’re more likely to become depressed.
“We’re learning that children who have social phobia don’t grow out of it unless they get critical intervention,” says Deborah Beidel, PhD, professor of psychology at the University of Maryland. Since 5-10% of high-school-aged kids may have social phobia, many adolescents need help.
A new study of teenage girls with social phobia conducted by Chris Hayward, MD, of Stanford University, and published in the Journal of the American Academy of Child and Adolescent Psychiatry (June 2000) shows promise. After 16 weeks of therapy only 55% of the treated girls had social phobia and 18% were depressed, while 96% of the untreated girls had social phobia and 41% of them were depressed.
“We can now say that cognitive-behavioral therapy protects against social phobia and also against depression for kids who are at risk for it,” says Anne Marie Albano, PhD, assistant professor of psychiatry at New York University School of Medicine, one of the study’s co-authors.
A socially phobic teenager often begins as a temperamentally inhibited child, says Tom Ollendick, PhD, a professor of psychology at Virginia Tech University. But early adolescence, with its emphasis on social life, peer groups, and autonomy, can turn natural reticence into full-blown anxiety. Social phobia can also be triggered by an embarrassing experience. One girl developed it after she flubbed a vocal solo and people laughed at her.
However it begins, social phobia is more than shyness. It interferes with daily life. “A lot of kids with social phobia don’t do well in school because they refuse to get up and read, or they won’t join the swim team because they don’t want anyone to watch them swim,” says Beidel, co-author of Shy Children, Phobic Adults (American Psychological Association, 1997). Still, it’s easy to neglect children with social phobia because they’re so quiet. By adolescence, however, the stakes are higher. Kids may find that drinking helps relieve social pressure, or they may become increasingly depressed over their lack of friends.
Hi My Name is . . .
One way to help teens with social phobia is by teaching them the sort of social skills that more gregarious people take for granted, such as introducing themselves or inviting someone to a party. Beidel teaches her patients how to strike up a conversation. Then, she takes them bowling so they can practice what they’ve learned. One thing that does not help is assuming they’ll outgrow it, or badgering them into sociability. Socially phobic kids need to re-educate themselves.
In the Stanford study 12 adolescent girls with social phobia made lists of anxiety-provoking situations (joining a conversation, giving a talk in class) and ranked them from least to most intimidating. They faced these fearful situations by role-playing with group members and by talking to store clerks and having other real-life experiences.
“We had the girls confront their easy fears first and work up to more anxiety-producing behaviors,” says Susan Varady, a doctoral candidate at George Mason University in Fairfax, Virginia, and another co-author of the Stanford study. “We also gave homework assignments, such as returning an item to a store or ordering a pizza.”
Along the way the girls learned strategies to counteract anxiety. For instance, if they worried that someone would notice their sweaty palms, they could say to themselves, “Do I notice people’s palms?” or “What would be the worst thing if someone did notice?” For their “final exam,” they ordered a meal in a restaurant and talked with the servers.
Management and Success
Because social-phobia treatment is still in its infancy, there are still many questions that need answers. For instance, Albano is just concluding a new study in which she compares group cognitive-behavioral therapy for teens with and without parent involvement. In a smaller, earlier study Albano found fewer symptoms both immediately and 1 year after the group therapy when parents were involved.
Another concern is how to maintain the improvement. One year after the Stanford study, the untreated and treated groups were virtually the same, which might just mean that the untreated teens were getting therapy elsewhere, but could also indicate a need for “booster” sessions to keep the phobic teens socially limber. “What we need are more long-term follow-ups to see these kids through into young adulthood because we know that social phobia doesn’t just go away by itself,” Albano says.
Finally, psychologists speculate that social skills training could reach more needy children if these techniques were implemented in schools. “Could we make these strategies part of the regular curriculum in a health class so that all kids could get help?” Albano wonders.
Social phobia tends to run in families, and although researchers aren’t sure to what extent this is biological or learned, it does mean that parents of socially phobic kids aren’t as good at teaching them the social skills they need and may be more likely to seek outside help. “We have a lot of parents who bring in their child for treatment and say, ‘I don’t want her to be like me,'” Beidel says.
Recognizing Social Phobia
When does shyness cross the line and become social phobia? That’s hard to pin down exactly. Shyness is not as severe, doesn’t last through an entire social encounter, and doesn’t produce the headaches, stomachaches, and other physical symptoms that social phobia does.
Avoidance behavior is an important indicator of social phobia. “If your child is always going to the bathroom when it’s time to order in a restaurant or tries to be absent on days where there’s an oral report due, that could be a sign of social phobia,” says Susan Varady of George Mason University in Fairfax, Virginia.
Although social phobia is more common in adolescents, “We do diagnose it as young as 4,” says Anne Marie Albano, PhD, of New York University School of Medicine. “It looks different in younger kids, though. Some children won’t speak in front of people outside the family. Other children appear to be having separation anxiety but really have anxiety about getting out and mingling with others, even children their own age.”
Social phobia is often linked to depression, so parents should take note when their child stops taking pleasure in what he used to enjoy, seems sad, or irritable.
Article By: Anne Cassidy, Medical Writer