Social Phobia, Social Anxiety, and Paranoia

Feeling nervous in social situations is something we all experience from time to time, more often in situations where we may face criticism or experience rejection or evaluation; for example, going on a date, giving a presentation, or attending an interview. For most of us, this feeling may be little more than a dose of the "butterflies" or "nerves," however with social anxiety disorder, also called social phobia or what we might call paranoia, everyday social interactions, or even contemplation of them, can cause significant impairment, anxiety, fear, and intense self-consciousness. The embarrassment and fear of being scrutinized or judged by others can often lead to significant forms of avoidance that can extend across people's lives and severely affect their social, professional, and even personality development. For some, social phobia can see patients developing rituals that seem to help them handle fear-laden situations and can in many cases lead to obsessive-compulsive disorder.

Social anxiety disorder affects 15 million adults, or 6.8% of the population. SAD is equally common among men and women and, according to most research, typically begins around age 13. According to a 2007 survey, 36% of people with social anxiety disorder report experiencing symptoms for 10 or more years before seeking help. Social anxiety can be an extremely painful experience, but the good news is it can be overcome with effective therapy (Gibson, 2021a).

Signs and symptoms of social anxiety disorder can include:

• Fear of situations in which you may be judged.
• Worrying about embarrassing or humiliating yourself.
• Intense fear of interacting or talking with strangers.
• Fear that others will notice that you look anxious.
• Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling, or having a shaky voice.
• Avoiding doing things or speaking to people out of fear of embarrassment.
• Avoiding situations where you might be the centre of attention.
• Having anxiety in anticipation of a feared activity or event.
• Enduring a social situation with intense fear or anxiety.
• Spending time after a social situation analysing your performance and identifying flaws in your interactions.
• Expecting the worst possible consequences from a negative experience during a social situation.

An Alternative Approach to Social Phobia and Paranoia

Through painstaking clinical research (Gibson et al., 2018, 2021,2022; Portelli et al., 2016; Nardone 2013), we have redefined social phobia as a form of paranoia. Paranoia is a belief that the person holds that seems to become true, not because it was inevitable, but because the person has made it become inevitable through the behaviours that they have put in place. These behaviours, which are used to resolve their fear of feeling rejected, persecuted, or being treated unfairly by others, actually bring about the very event they prophesised. The objective for treatment, as for the other disorders, is to interrupt the patient's ineffective and dysfunctional attempts at solving their problem. Treatment once again is achieved through direct, indirect, and paradoxical strategies, which are part of what is known as "non-ordinary" logic (which I will post about here later). This is essentially a way of thinking and acting that allows us to use everything at our disposal in a creative way to overcome some of the most complex psychological disorders in a very brief time (Gibson, 2019, 2021, 2022).

Feelings of Incompetence

In social phobia, the fear of not being good enough, funny enough, or interesting enough in social situations often finds patients perceiving others as judging them harshly. This is especially true when one is "convinced" that they are not interesting. So the fear of blushing or making mistakes, etc., makes the patient overregulate their physical reactions and they become obsessively focused on the possibility that others may notice their physical reactions. In such situations, people may become nervous about signing their name on official documents, while some fear sweating, blushing, or making a mistake. The very attempt to control that which cannot be controlled by force leads to the very loss of control the person is most fearful of.

One of the unusual paradoxes is that this is more likely to happen to very obsessive people more often than not those that fear not being perfect. In such situations, the patient’s obsessive attempt at control is actually the thing that drives their problem and so their phobic problem grows by virtue of the fact that they are so capable of trying to stop it. Digestive noises after lunch, trembling hands, blushing, etc., produce the person's paranoid fear of receiving the negative judgment of others. The avoidance of eating lunch or breakfast, and over-reliance on makeup or clothes to cover these fearful reactions, promote the growth of the problem in many areas of the person’s life. For the socially paranoid individual, where the problem has taken on a pathological rigour, they can either adopt strict avoidance measures of all social relations or else suffer the humiliation of being forced to push through them, feeling like a white "knuckle-ride" and experiencing failure each time. These experiences leave the person with an unpalatable "reality" in their mind's eye that they are "actually" incapable, weak, or uninteresting.

Prophecy of the Event

The phenomenon of the self-fulfilling prophecy, the basis of most paranoid disorders, was proposed by American sociologist Robert K. Merton. In 1948, he stated that "a supposition or prophecy, by the mere fact of having been pronounced, leads to the event of the thing prophesised, thus further confirming the truth of the prophecy." William Thomas also once said, "If men define certain situations as real, they are real in their consequences." In social relations, if we truly expect a person to be cold or aloof, sociable or extroverted, they will tend to condition themselves to act in this way. These social and personal expectations highly influence our self-perception and the effect can be both positive or negative. Those who expect to do well will often do better, and those who expect to fail in life tend to fail more often. It is for this reason that we tend to avoid talking about social phobia and instead talk of paranoid disorder. However, the paranoid disorder can transform into a phobia because of the person's avoidance and can eventually become a form of delusional paranoia.

Common Behaviours

• Patients choose to react continually by defending themselves in advance of a perceived attack with avoidance or isolation.
• Some patients defend themselves by attacking, both verbally or physically, their perceived persecutor.

When working effectively with patients, we have observed these main ways in which people try, unsuccessfully, to resolve their problem and it is these mechanisms that we must act on in therapy if treatment is to be successful.

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