What is social anxiety also known as social phobia? Often it's misrepresented as someone that is not interested in being social or engaging with groups of people. The fact is, the true definition, is actually that they "avoid" socializing though they actually enjoy and desire to do so. How does this make sense, you ask? Imagine wanting to try something new, and exciting, but also being nervous and overwhelmed by the idea, and thus delaying your activity. Imagine this happens every day, multiple times a day, and eventually you never actually do this new and exciting thing you actually really want to do because you can never overcome the worrying, apprehension or restlessness preceding the activity. 

The worry, or apprehension mainly comes down to the fear of humiliating one self. Most have felt the sensation of feeling self-conscious or embarrassed. Social Anxiety or Social Phobia, is this emotion, but it being constant, daily, and quite debilitating. 

Though self-talk, positive self-talk, can be helpful to some extent, quite often the need for an SSRI or a TCA is required in addition to cognitive behavioral talk therapy. Woah, you say. Dr. Kunam, you are throwing alot of acronyms and fancy words around, you say. 

Here's the breakdown:
Serotonin is a big brain chemical (neurotransmitter) that helps use regulate our emotions, fears, feelings, etc. The theory behind the use of Prozac, Paxil, Lexapro, Celexa, etc is that they help our brain have more Serotonin to work with to help us regulate our emotions better. How does this help with social anxiety/social phobia? The serotonin that sticks around longer in the brain, for the brain to use, helps reduce anxiety, reduce restlessness, reduce worry, reduce sadness, reduce irritability, etc. This in turn, helps the person worrying, calm down, and actually listen to their own thoughts of "this is going to be fine, I know these people, why do I even feel nervous about meeting up with my cousins?" This is where Cognitive Behavioral Therapy (CBT) comes in. Though many of us know what it means to be positive, think positively, be around positive people, if we don't have enough serotonin to help us listen to those people, or positive thoughts, we are still going feel anxious, worried, with our heart beating fast, and our palms getting sweaty. 

That being said, how does one manage the "physical" symptoms of anxiety that can be present in social phobia? Often SSRI's are a great way to reduce daily worry/avoidance, but when symptoms come on strong and quick or as we say "acutely"... we can turn to medications or skills that lower the heart rate, lower the blood pressure, lower trembling, and other physical symptoms. Often your doctor may prescribe an "as needed" or "only once in a while" medication like a blood pressure medication to help reduce the physical symptoms of anxiety. These can be used right before a public event, public speaking, or group activity. Sometimes an alternative to blood pressure medications can be offered, such as benzodiazepines, which are considered sedatives. Though these medications are highly effective in reducing severe anxiety quickly, the body does become tolerant to the chemical, and requires higher and higher doses, if taken regularly and often. Unfortunately there is no way to avoid the tolerance to the medication unless you just make sure to use it infrequently. 

Wait, did we go over the coping skills yet? Let's not skip over the power of thoughts and talk. This is where psychotherapy fits in. The skills taught by a therapist/psychologist or other health care professional can be as "simple" as deep breathing, or splashing water on your face, but with some professional guidance, becomes truly effective "belly breathing" and "diving reflex based water immersion." Taking advantage of the body's natural phenomena in reducing blood pressure, heart rate, stress hormones, is a great way to tackle anxiety either alone, or with the combination of medications.

Look into seeing a Licensed Healthcare Professional, like a Licensed Therapist, Psychologist, PHD, or MD/DO to discuss the risks and benefits of all these options and combinations. Remember this blog post is not a substitute for medical advice, and you should never change, stop or start a treatment based on a blog post even if written by a healthcare professional. This information is for educaitonal purposes, and you should follow the advice of your own personal health care professional after an evaluation of your current symptoms.