A fear causes extreme anxiety and excessive self-consciousness especially when person is surrounded by people. Person feel blushing, muscle tension, profuse sweating, shaky feelings, stomach upset, diarrhoea, pounding heart, confusion and difficulty to focus on.

Fear can be weeks or months before an event takes place and a lot of worry about something bad will happen, increases patient’s discomfort. Person lead extremely stressful life with preoccupation of he/she will make mistake, will be humiliated or criticized.
Sometime intensity of fear is so severe people will avoid social events, classes or parties. Fear becomes worse by a lack of social skills or previous bad experience in social situation. Such person is unable to form and maintain good relationship with others.

According to the social anxiety research clinic, at the New York state psychiatric institute and Columbia university medical centre, social anxiety disorder is categorized into two subtypes.

• Generalized type: Patient fear most social and performance situations.
• Non-generalized type: Patient fear is typically limited to public speaking or other performance activity.

Causes
Exact reason for social phobia is still not known. Researchers from the National Institute of Mental Health (NIMH) have found that social phobia runs in families. Involvement of different parts of brain and neurotransmitter imbalance may be the probable reason for anxiety symptoms.
Scientist also thought psychological and environmental factors for occurrence of social phobia. Previous embarrassing experience at social event or after seeing what happens to someone else as the result of their behaviour increases negative feeling in patient of social phobia.

Overcoming with social phobiaDiagnosis of social phobia is done by physical examination and detail history of patient.
Management of social phobia is either by psychotherapy, cognitive behavioural therapy and medicines.

Psychotherapy
Psychotherapy means psychological counselling of patient, which is an effective way to minimise the severity of symptoms of social phobia. Expert counsellor or psychiatrist give training regarding how to handle underlying anxiety, cope with negative symptoms or develop social skills that will help in improvement of self-esteem.

Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is a part of psychotherapy, where main focus is to make patient more comfortable with the situations that trigger anxiety. With cognitive behavioural therapy patient thinks in a more rational way to change own thoughts to tackle with situation. It teaches person about how to react differently to situations that arise fear. It involves systematic desensitization and real life exposure.

In systematic desensitization, patient imagine frightening situation and work on fear in a safe and relaxed environment. While in real life exposure, initially patient is exposed to fear situation. Then patient is trained how to build confidence and handle criticism or rejection and use anxiety management techniques to cope with disappointments. He/she is also trained about how to develop positive response to fear and how to comprehend disapproval.

Medicines
When anxiety symptoms interfere with day-to-day life certain medications are used to reduce intensity of anxiety.

• Anti-depressants

Selective serotonin reuptake inhibitors (SSRI) are first choice of drug for overcoming persistent symptoms of anxiety. Initially drug treatment is started with low dose and then increased gradually to avoid side-effects.

• Anti-anxiety

Anti-anxiety drugs like benzodiazepines are habit forming and sedating and hence used for short-term period only.

• b-blockers

b-blockers are used to control heart symptoms of anxiety such as palpitations, sweating, shaky voice and limbs, and blood pressure. They are not advised as regular treatment but recommended before social event such as giving a speech.

Self-help techniques
Apart from above recommended therapies, self-help techniques can also help to reduce intensity of anxiety.
Self-help techniques involve identifying anxiety causing situations and practicing certain activities to build confidence. Some of them are

• Making friends or increasing contacts
• Eating together with relatives or friends
• Making eye contact with others while communicating
• Preparing for social conversations or class presentation
• Keeping knowledge up-to-date with newspaper reading or watching T.V news
• Adopting stress management techniques like deep breathing

Homeopathy and Hypnotherapy had been found effective and help person to overcome their phobias, providing improved quality life.

Homoeopathy

Hypnotherapy or Hypnosis

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