Causes and Treatment of Social Phobia

Causes of Social Phobia

There is no specific reason for social anxiety disorder. Many factors are effective in the formation of social phobia. It is observed that the hereditary transmission, the predisposition of the brain to the formation of phobia, the parenting style of the family and the childhood experiences have an effect on the formation of the disorder. Therefore, it can be said that there is no single cause, biological, psychological and environmental factors are effective in the development of social phobia and these factors play a role at different levels.

Biological Factors

Although the role of hereditary transmission factor is not very strong in the problem of social phobia, it is thought to exist. If there are social phobic people among the relatives of the individual, it is suggested that the risk of experiencing social phobia is slightly higher. When it is questioned whether it is present in the family, the presence of a similar problem in close relatives supports this.

One of the most important factors that come to the fore is that there are some chemical and electrical disorders, irregularities and imbalances in the structure of the brain. In particular, the thing to focus on is; It is whether the chemical called serotonin is less than normal in proportion or whether there is a malfunction in its transmission. Generally, this chemical is relatively low in the brain of social phobic individuals and there are deficiencies in transmission. Therefore, this decrease can cause different reactions in the brain in stressful situations, for example, it can cause anxiety, worry, anxiety. In other words, social phobia can be called an infrastructure preparation.

Considering the biological factors, one of the prominent issues is that the part of the brain called the amygdala, which controls the fear part, is overactive. This excessive activation seriously triggers the formation of social phobia. It can cause a perception as if there is a threat and cause excessive stimulation in the autonomic nervous system. In this case, something close to a panic attack can be experienced, such as a serious acceleration in the heartbeat, excessive movement in the gastrointestinal tract. There are also some cases where fainting is observed.

Psychological Factors

Social phobia is actually a pre-prepared problem. With this preparation, it may sometimes occur after a certain situation or event and may be settled by being conditioned by a traumatic experience. If we give an example of this mental infrastructure; The student makes a mistake while explaining a topic in class and his friends laugh at him. In such a case, the student may feel humiliated and disgraced, so they feel shame and show physical symptoms. The next time he comes back to the board to talk about the subject, his previous negative experience will most likely lead to negative expectations and the environment he is in will trigger his feelings, and previous somatic symptoms will accompany this situation. Therefore, it can be said that the development of the social phobia problem emerged as a result of an embarrassing or humiliating event in the past. Such traumatizing events may eventually occur. Again, as an example of psychological factors; It can be said that shy children are at risk for social anxiety disorder in adulthood. The problem of social phobia that occurs in the individual may be related to the history of abuse and bullying in childhood. Those with social phobia may have developed this phobia by observing what happens to them as a result of the behavior of others (for example, being the subject of ridicule). Some events (such as death, separation) that are important in human life and cause distress and sadness can also cause social phobia.

Although thousands of thoughts go through their minds when social phobic individuals enter the social environment, these can be grouped under two headings as follows:

“Same things will happen every time”

“They call me stupid, abnormal, useless, etc. they will say”

In addition to these two thoughts, the thought of “I will inconvenience others” has been added by the studies conducted in recent years.

Environmental Factors

Individuals who are raised with low self-confidence and lack of self-confidence in societies that do not express themselves very much experience the problem of social phobia. The onset of the problem is often seen in childhood. It can even be seen in preschool age. It is more common in individuals who have had health problems related to their physical appearance or voice. Children who are timid, afraid of approaching others, and isolated are children to be alerted to. Children who cannot learn some social skills that need to be learned in the normal development process and cannot develop them sufficiently are also children who should be in a state of alert.

The way of raising children is also an important factor in the formation of social phobia. In general, children of controlling, overprotective, or rejecting parents are more likely to be socially phobic. Again, if there is pressure in the family, if it is a family environment where emotional warmth is low, if there is a family with oppressive and strict parents, the child is likely to have social phobia. If the child has high expectations and the child who does not meet these high expectations is punished, this may develop a fear of failure in the child. Fear of failure can also cause social phobia. Behavioral inhibition, defined as excessive fear of unfamiliar environments, people and objects, has been said to be a precursor to the development of social phobia. If the parents are critical, the risk of the child being social phobic increases. A child whose every movement is controlled can be agitated and even well-intentioned actions can negatively affect the child. The risk increases in the child who is controlled in every detail of daily life and exposed to psychological and physical violence. Feelings of guilt may settle in, he may see himself as worthless, he may experience insecurity. This leads to the failure of self-expression in school life in the future.

How to Treat Social Phobia

It is among the psychological disorders that have social phobia treatment and this treatment is not difficult and can be successfully treated. Depending on the level of social phobia of the individual, psychotherapy alone and sometimes psychotherapy together with drug treatment can be applied.

Social phobia is a psychological problem that can usually be completely cured with the right treatment. However, many factors can affect the success of treatment. These factors

Coexistence of different psychiatric diseases,

early onset,

the person’s desire for treatment,

It can be counted as the individual’s effort towards improvement in the treatment process.

In the light of these factors, expectations should be realistic.

There are two types of treatment in social phobia: medication and psychotherapy. Depending on the severity of the disease, sometimes only psychotherapy is applied, while it is generally preferred to apply both treatments together.


Psychotherapy improves symptoms in most people with social anxiety disorder. The most effective treatment model is cognitive-behavioral therapy. As a result of the researches, it has been shown that cognitive-behavioral psychotherapy is significantly beneficial in the treatment of social phobia. If what the therapist says is followed to the letter, the treatment process is accelerated and a successful result is obtained.

When a drug treatment is added to this therapy model, the added drug can make the therapy more effective by gradually reducing the symptoms. In cognitive therapy, there are stages such as recognizing feelings of anxiety and the somatic symptoms that occur against this feeling of anxiety, understanding what thoughts are in anxiety-provoking situations, and developing coping strategies against them. The person is taught to react differently to situations that trigger anxiety symptoms. In behavioral therapy, on the other hand, there are methods that can be applied differently for each individual, such as being a model, addressing the complaints, role-playing to perceive the physical symptoms more clearly, relaxation training, and social skills training.

In therapy, it is aimed to recognize and change negative thoughts about oneself. He is also guided to develop skills that will help him gain confidence in social situations. The purpose of CBT is to direct the thoughts of the person diagnosed with social phobia to a more logical place and to ensure that the person does not avoid situations that previously caused anxiety. In this therapy, the cause of the anxiety of the person with social phobia is searched and he is made to face his fears. It is ensured that the person recognizes the previous reactions to any event that causes anxiety and gives a different reaction from the previous ones.

Cognitive behavioral therapy based on systematic desensitization, that is, exposure, is one of the most important goals of cognitive therapy. As a result of systematic desensitization, work is done with the person to face the most feared social situations step by step. This can improve coping skills and help develop self-confidence in dealing with anxiety-provoking situations.

It will also be beneficial to attend skill and role-playing trainings to gain comfort and confidence in social situations. Practices of exposure to social situations are particularly helpful for challenging anxieties.

When physical symptoms are not experienced, the person can control his mind more easily. But it is important to eliminate the underlying thought with therapy.

Perfectionists who do not want to make mistakes may actually have irrational thoughts and these are corrected in therapy. I will be criticized, I will be excluded, negative thoughts on the ground need to be replaced with a healthier one, and these are provided through therapies. Therapy should be accompanied by a psychologist.

The individual gains the ability to control his thoughts by raising awareness about his illness, increasing his motivation, giving feedback on what kind of tensions in his body, differences in temperature and heart rhythm, what kind of error in his breathing and what kind of bioelectrical appearance he has in his brain.


There is a wide variety of drugs used to treat social phobia. Among them, the antidepressant group is selective serotonin reuptake inhibitors (SSRIs). These drugs are often the first type of drug to be tried. When considering drug therapy, drugs that can be effective on the serotonin system are selected. When drug treatment is decided, it should be accepted that a mild nausea, mild headache, sleep disturbance, stomach discomfort and temporary side effects such as these may occur in the first days of treatment. Informing the patient that the body can get used to such symptoms over time may relieve the individual a little more. It is recommended to wait for two to three weeks for the effect of the drug used to appear. Again, at least 10 weeks should pass to decide whether the drug used is effective or not. The duration of treatment is an average of 9-12 months. Cognitive behavioral therapy in addition to drug therapy makes the treatment more effective and reduces symptoms. But drug use alone without psychotherapy is of no long-term benefit. According to studies, drug use alone does not cause a positive effect in most patients, even in the short term.

Other medications may also be used to control symptoms in treatment:

Other antidepressants: Several different antidepressant medications may need to be tried to find the most effective with the fewest side effects.

Anti-anxiety drugs: Drugs in this group can reduce the level of anxiety. It can be said that they are drugs that act quickly.

Beta blockers: These drugs work by blocking the stimulating effect of the hormone adrenaline, which is responsible for the physical symptoms of social phobia. They can reduce heart rate, blood pressure, heart palpitations, voice and tremor in the limbs. Therefore, it can be said to be suitable for occasional use for certain situations such as public speaking.

Psychological Disturbances Caused by Social Phobia

In people with social phobia who are not treated or who do not receive any support, this situation may cause many problems in social life, business life, school life or relationships in the future. It affects the daily life of the person negatively and disrupts the daily routine of the person.

Social phobic people are prone to depression. The person is depressed because of the restrictions in his life. Not being able to get a girlfriend or boyfriend, not being able to get married, not being able to get promoted in the job, not being able to use the opportunities of the environment causes depression. Another common picture may be the use of alcohol to overcome this, and then alcohol dependence or substance abuse. The fear can become aggravated as a result of the lack of social skills or any bad event experienced and turn into a panic attack.

Social phobia also includes many diagnoses of anxiety disorder. Some of those; Separation Anxiety Disorder, Specific Phobia, Social Anxiety Disorder (Social Phobia), Panic Disorder, Generalized Anxiety Disorder, Acute Tension (Stress) Disorder. Trauma and Stressor Related Disorders; Reactive Attachment Disorder, Illness Anxiety Disorder.

Generalized anxiety disorder is a state of negative expectation that spans the day. Most of the time, there is no reason for this situation, but the person constantly experiences a situation with physical complaints such as a pressure in the chest, a feeling of anxiety, shortness of breath, tension in the muscles, dry mouth, numbness in the hands, arms and face. This situation is more common in women.


Although financial status and social position are common among those who are inadequate, never married, unemployed and have a low education level, not being able to go out into society enough in the early stages of the disease is also among the risk factors. More than heredity, parenting style, poor family contact with others, and parental pattern are more important. People who have been extremely shy from childhood have a higher risk of developing Social Phobia in the future.

Two subtypes are defined as “SPECIFIC AND COMMON SOCIAL PHOBIA”. Specific social phobia is experiencing fear only in certain situations, such as speaking in public. In generalized social phobia, the person feels restless, anxious and nervous in almost all social situations. Generalized social phobia is the most common. When distinguishing according to the social phobia subtype, there is information that the common type starts at an earlier age. Although social phobia varies according to its subtype, it begins between adolescence (10-17 years). The age of onset is less than 10 in 40% of patients. In 95% of the patients, the baseline is below 20. There are studies showing that children with school phobia may be more likely to develop social phobia in the future. The behavior of avoiding the feared situation is usually very pronounced. It can lead to complete social loneliness, and this loneliness can also bring other mental illnesses.

Social phobia is the third most common mental disorder after depression and alcoholism. Between 7 and 8% of the general population is diagnosed with social phobia. The prevalence of social phobia is 2.3% in women and 1.1% in men. Most studies reveal that social phobia is more common in women than men. In clinical studies, it is noteworthy that social phobia is found at equal rates in both genders or that men are in the majority.

Social phobia is one of the problems with genetic features. It increases the probability of being in the family. One of the most important factors is the presence of certain chemical disorders or imbalances in the brain. In addition, SF, whose mental infrastructure has been prepared in advance, may sometimes come to light after a certain event and be conditioned by a traumatic experience. Especially as a result of traumatic experiences such as being mocked, excluded, and humiliated during childhood, the child begins to experience extreme stress in social environments. When this process takes a long time, since the secretion of stress hormones is more intense and continuous, there will be deterioration in the chemical balance.

People with social fear acquire this fear by observing the behavior of the people around them and/or by being influenced by some negative experiences. Negative experiences, especially in the family and school environment, create a traumatic effect and play a very important role in the development of this fear.

Children learn how to approach social situations with the education they receive from their parents, especially during their pre-school development period, and their behavior develops in this direction. Overprotective parents restrict their child’s access to social environments or do not allow them to express themselves in these environments, and the development of social skills is prevented. These people are more likely to develop social fear than other people.

The early age of onset of social phobia poses serious problems. The supplement can also lead to the emergence of many psychiatric disorders. The most important of these are depression, alcohol addiction and drug addiction. Especially in studies conducted in western countries, alcohol use in social phobia was found to be 2.5 times higher than in normal society individuals. This can be explained by the fact that alcohol provides a more comfortable behavior, which increases the risk of alcohol dependence over time. In a study conducted among alcoholics, it was determined that the incidence of social phobia was 9 times higher than normal.

Although it varies according to the type of social phobia, it usually starts in early and late adolescence, that is, between the ages of 13-20. As a result of a study, social phobia disorder was found in 24% of university students in Turkey.

In Which Societies Is Social Phobia More Common?

It is known to be slightly more common in eastern societies. The percentages should be looked at, but it is known that it is high in eastern societies with the contribution of conservative structures and environmental factors. In the clinic, the male and female ratios are seen as equal, that is, it is observed. However, it can also be said that those who apply for treatment are mostly men, since women are not supported to go out into the social environment in societies like ours.

Social Phobia and Career

Under normal conditions, social phobic individuals exhibit avoidance behavior in social environments. He avoids even entering the environments he goes to every day. However, if his position is available, he can manage the situation up to a certain position, but the situation gets worse as the position rises. For example, we see people who have been promoted, who have been promoted in their careers, who need to go abroad and who are expected to make presentations at meetings. Of course, they’re having a hard time at this point. However, those who have come to this position begin to investigate their own situation and learn that it is a disease. Thus, the treatment is planned and the treatment is started.

Success in People with Social Phobia

If there is no other problem in terms of trust in social phobia, if there is no difficulty with special learning, very few people can be negatively affected in terms of success. In general, social phobia does not cause very large deviations. However, their quality of life declines, their relationships at work or employment create difficulties in maintaining their career, or if they run their own business and cannot assert themselves, these can pose serious problems.

Those Who Succeed with Social Phobia

1. Princeton University Professor of Theoretical Physics Albert Einstein achieved great success with his “Theory of Relativity”.

2. Neil Armstrong is the first man to walk on the moon.

3. Grammy-winning famous British singers Adele and David Bowie struggled with social phobia for a while.

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