Social Anxiety
For millions of Americans, every day is a struggle with debilitating shyness
The first place that Melinda Stanley, professor of behavioral sciences at the University of Texas-Houston Health Science Center, takes many patients is the elevator. Riding up and down, the patient practices greeting and making small talk with fellow passengers. "Sometimes it takes 10 or 15 rides, and sometimes it takes all day," says Stanley, "but the phobic's heart will eventually stop racing for fear of what the newcomer might think of him or her." Eventually, the patients progress to giving speeches in front of Stanley and an audience of graduate-student volunteers. Other therapists take social phobics through practice runs of embarrassing situations, like walking through a hotel lobby with toilet paper on their shoes or spilling a drink. It's not unlike physical training, says Henderson. "Just as our gym workouts get easier as time goes by, to stay socially fit we must push ourselves to engage with others until it is second nature."
When a case is so severe that patients cannot even ride an elevator with a therapist, drugs can enable the social phobic to endure behavioral therapy. The perfect medication has yet to be found. Antidepressants known as monoamine oxidase inhibitors (MAOs) have been used for over a decade, but they can cause side effects such as fainting spells, heart palpitations, and blurred vision, and users must follow strict diets excluding every thing from coffee to cheese to red wine. Re searchers have experimented with Xanax, Valium, and other tranquilizers but have had mixed success, not least because those drugs can cause physical dependence. Some sufferers try beta blockers, which are helpful for surviving a speech or a party but use less as a long-term therapeutic tool.
Most popular now are the antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which have fewer side effects than the old anxiety drugs. "[Patients treated for depression] were spontaneously reporting that they were losing their social anxiety," explains Murray Stein, director of the anxiety clinic at the University of California-San Diego. Studies of the SSRIs Paxil and Luvox show great improvement in about half of social phobics, and studies now underway of other new antidepressants, like Effexor and Serzone, are also showing promise. But Henderson urges caution amid the current hoopla over drugs, which she worries are too often used as temporary crutches. "People tend to relapse as soon as they get off the medication," she warns, adding that research indicates that over the long run, therapy might keep a person in better stead. Just as troubling, says Tylim, is the message that only a drug can save them. "These are people whose very problem is a feeling of inadequacy, and the use of drugs can exacerbate that."
Because some social phobics have been out of the habit of talking with others for so long, therapists often have to help patients brush up on the most basic of social skills. For example, it never dawns on many of the most shy that they should introduce themselves to the person standing in front of them. And they often are stuck in the conversation-killing habit of answering questions with one-word answers. "I had to learn that if someone doesn't seem interested in the first sentence out of my mouth, I should not just turn and walk away cold," says Rick Robbins, a 31-year-old who was voted most shy of his Indiana high school class and whose social anxiety led him to drop out of college.
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