Phobia Symptoms and Treatment: Specific Phobias and Social Anxiety Disorder
Phobia treatment shares commonalities with the treatment of other anxiety disorders, as phobias belong to the classification of anxiety disorders. However, in phobia cases, you may not have any manifestation or symptoms until you encounter the source of your phobia.
Specific Phobia
Specific phobia is relatively foreseeable and linked to the particular situation. Confrontation of the feared situation or object or even the expectation of doing so generates an immediate strong anxiety response. The patient may know that the fear is either extreme or irrational (phobic children may lack this understanding). Nevertheless, they remain scared of the provoking stimulus and anxious about its occurrence or anticipation of its happening. The closer the client approaches the feared stimulus, the more extreme the fear response assuming there is no chance to escape or avoid it. Functional impairment ranges from none (e.g. fear of flying without a necessity to fly) to considerable (e.g. the terror of bridges when one lives in Venice). Patients can often alleviate their dread by simply avoiding it, but some things are impossible to avoid.
Social Phobia (Social Anxiety Disorder)
In social phobia (currently diagnosed as social anxiety disorder), phobic anxiety is similar to the specific phobia in that anxiety is triggered by recognisable external factors, i.e. social exchanges. Social anxiety features a consistent fear of engaging in social interactions or public presentations, driven by worries about potential embarrassment, humiliation or unfavourable judgment from others. At the core of social phobia is a fear of negative evaluation from others. Consequently, communication with other people incites a phobic response. In this sense, the characteristics of social phobia resemble panic disorder because the person cannot always control or predict when social contact happens.
Social phobia often involves extreme discomfort in a wide range of social situations. Some people experience social anxiety only in particular circumstances. These individuals can feel socially competent in usual social situations (with family members, for instance), but they experience intense anxiety on certain occasions (e.g. public speaking or public washrooms). Individuals with social phobia usually acknowledge their unreasonable beliefs about social situations and exhibit avoidance behaviours.
The Liebowitz Social Anxiety Scale (LSAS) as a Self-Report Instrument
One of the most widely utilised measures for assessing social phobia is the Liebowitz Social Anxiety Scale (LSAS), developed by psychiatrist Michael R. Liebowitz in 1987. This tool is administered by clinicians and gauges both fear and avoidance across various social scenarios.
The scale comprises 24 items, each depicting distinct social situations. For every situation, the person’s fear and avoidance levels are tested using a four-point Likert scale. Beyond the fear and avoidance subscales, the LSAS is further segmented into two subcategories for scoring: social interaction (11 items) and performance situations (13 items). This assessment generates a comprehensive score as well as six additional scores representing fear and avoidance: overall fear, social fear, performance fear, overall avoidance, social avoidance and performance avoidance.
The Liebowitz Social Anxiety Scale is accessible online as a self-report evaluation, potentially serving as a supplementary component to a clinical examination:
https://psychology-tools.com/test/liebowitz-social-anxiety-scale
Panic Attacks Associated with Specific Phobias and Social Anxiety Disorder
Social anxiety disorder and specific phobias may be accompanied by outbursts of panic attacks. These attacks are characterised by the misinterpretation of physical symptoms as catastrophic, which can include sensations like dizziness, trembling, muscle tension, a rapid heartbeat and difficulty breathing.
Phobia Treatment
Cognitive-behavioural therapy (CBT), skill training and counselling have proved their value in managing both specific and social phobias. The integrative fusion of cognitive behavioural therapy or counselling (which is less structured than therapy) with coping skills training, social skills development and mindfulness-based interventions is particularly effective for phobia treatment.
An integrative approach to phobia treatment usually includes the following interventions:
- Psychoeducation
- Progressive muscle relaxation (PMR)
- Breathing techniques
- Mindfulness training
- Systematic desensitisation
- Exposure and response prevention (ERP)
- Cognitive reappraisal and restructuring
- Social skills training
Cognitive reappraisal and exposure are two remarkably powerful cognitive-behavioural techniques for achieving lasting relief from phobias.
Psychiatric medications are sometimes indicated on a short-term basis to treat the marks of phobias, such as severe anxiety or panic attacks.
Bibliography:
- Anxiety Disorders in Adults. DOI: 10.1093/med:psych/9780195116250.001.0001