Treatment Of Social Phobia: Overcoming Barriers

While it may be common to feel nervous in social situations at one point or another, social phobia—an anxiety disorder characterized by persistent fear in social settings—goes beyond occasional nervousness. Also known as social anxiety disorder, social phobia can impact relationships and interfere significantly with day-to-day life. 

Therapy is a research-backed method of coping with social anxiety disorder symptoms. However, a treatment gap exists due to barriers like a lack of providers, perceived stigma, time constraints, and financial concerns. Recently, online therapy has emerged as a valuable way of bridging that gap. To understand this condition and its modern treatments, it may be helpful to look at the symptoms and recent studies that add to the growing evidence of the efficacy of online therapy for this condition. 

An overview of social phobia

Social phobia, officially called social anxiety disorder, is characterized by intense worry, anxiety, and nervousness surrounding social situations. Approximately 12.1% of US adults have experienced social anxiety at some point. The condition often arises due to a fear of being judged, embarrassed, or viewed negatively. 

Social phobia can produce severe mental and physical symptoms that often make it difficult for an individual to function and may lead to isolation, relationship conflict, and career challenges. In addition to fear, common symptoms of social anxiety include blushing, sweating, trembling, and a rapid heart rate. Individuals with social phobia may recognize their fear but believe they are unable to change their negative perception of social situations or themselves. 

Barriers to treatment for social phobia 

Social phobia is often treated with psychotherapy, medication, or a combination. Cognitive-behavioral therapy (CBT) is often considered the “gold standard” in treating anxiety disorders, and in most studies, it has produced significant improvements in participants’ anxiety measures.

Despite the efficacy of treatment for social phobia, 36.9% of people experiencing anxiety seek care. A study by the Anxiety and Depression Association of America (ADAA) found that 36% of people with social anxiety experience symptoms for at least ten years before they seek help. A scarcity of skilled therapists compared to those who need help can cause long waiting lists, and the cost of therapy can be prohibitive to some. In addition, a lack of time and transportation prevents individuals from traveling to available therapists.

In cases where these barriers are present, some people with social anxiety disorder may prefer remote treatment options, which can offer distance from the therapist. Chat therapy, which does not require voice or video capabilities, can also be a stepping stone to starting therapy with severe social phobia. 

Research regarding intervention for social phobia via an online self-help manual

Researchers in Sweden examined the efficacy of online therapy for social phobia in a study published in the Journal of Consulting and Clinical Psychology. Specifically, they evaluated an online self-help manual, which, according to the study, could help circumvent common barriers to treatment. 

Participants

Individuals were recruited using newspaper articles, magazine notices, and a link on the home page of the Swedish National Anxiety Association. Initially, 237 people expressed interest, and 163 of them met the following inclusion criteria:

• Fulfillment of the DSM-IV criteria for social phobia
• A fear of public speaking
• A score of less than 31 on the MADRS-S depression scale 
• No history of earlier cognitive-behavioral therapy (CBT) and no other psychological treatment during the study
• Consistent medication dosage during the study
• Having a computer with internet
• 18 years of age or more 

From there, the first 100 people researchers could reach by phone scheduled a Structured Clinical Interview for DSM-IV (SCID), which was used to confirm a diagnosis of social phobia. 

A final 64 people met all inclusion criteria and were randomly assigned to the treatment or control groups, with 32 in each. The mean age of the onset of their social anxiety disorder was 14.3 years old, and almost half had a history of psychiatric diagnoses other than social phobia, such as panic disorder or depression.

The intervention

Treatment consisted of an online self-help manual about social phobia and two groups of in-vivo exposure sessions.

Online self-help manual

The self-help manual included almost 200 pages, divided into nine modules covering automatic thoughts, exposure therapy, listening and conversation skills, and self-focus. Introductory and summary modules bookended the content. Every module included information and practice exercises and ended with three to eight essay questions that discussed what they had learned and how their treatment was proceeding. Participants were also required to score 95% on a multiple-choice quiz and post in a discussion forum to proceed to the next module.

Therapists provided feedback within 24 hours after the participants emailed in their answers. Based on how they responded, participants were given a password to proceed to the next module or instructions for what they needed to do to move on. On average, participants finished 7.5 of the nine modules.

Seven therapists supervised the study, and throughout the entire treatment, they spent an average of three hours giving feedback, sending emails, and monitoring the discussion forum per each participant, along with the six hours allotted for exposure therapy. 

In vivo exposure therapy

Each participant was invited to two three-hour exposure sessions, held in groups of six to eight and run by two therapists. During the first session, they performed two simple exposure activities that helped them identify and correct negative thoughts with the support of other group members and the therapists.

During the second session, everyone gave a five-minute oral presentation to an audience of 10 to 15 people. The audience rated the quality of each presentation; the audience and the participants rated signs of nervousness. After everyone presented, participants watched videotapes of their presentation and discussed their perceptions of how the audience perceived their speaking.

Although every participant attended the first exposure session, only 59% attended the second. One contributing factor to the decreased attendance may have been the challenging nature of the task. Once the treatment group finished the intervention, the control group was also provided treatment.

Results

Several social anxiety scales were used to measure outcomes, and all were administered through paper assessments. Researchers compared baseline assessments to posttreatment assessments of the treatment group and found that a large portion of intervention participants experienced clinically significant improvements on many scales.

• 7% reached clinically significant improvement in the Quality-of-Life Inventory
• 73% reached clinically significant improvement on the Social Phobia Screening Questionnaire
• 73% reached clinically significant improvement on the Personal Report of Confidence as a Speaker
• 70% reached clinically significant improvement on the Montgomery Asberg Depression Rating Scale
• 60% reached clinically significant improvement on the Social Interaction Anxiety Scale

While these improvements dipped slightly at the one-year mark, they all remained markedly high compared to before the intervention.

In summary

Sixty-four people participated in a study examining the impact of online treatment on social phobia. By completing a nine-module self-help program and attending two group in-vivo exposure therapy sessions, most of the treatment group saw significant improvements in their social anxiety, depression, quality of life, and public speaking fears.

Future research

Researchers noted that participants who attended the second exposure therapy session—with the public speaking practice—scored significantly higher on several assessments than those who did not. They recommend adapting the exposure activities to match the severity of each person’s condition and provide greater motivation for participation, which could be tested in future research.

Out of all participants, 83% felt like treatment progressed too rapidly, considering each module required reading approximately 20 pages, answering up to eight essay questions, and completing a multiple-choice quiz within a week. Finding a balance between keeping individuals engaged but not overwhelmed could be the focus of future studies targeting social phobia. Possibilities include extending deadlines to allow more time or condensing the content within each module.

Strategies for managing social phobia

In addition to online therapy, you can manage symptoms of social phobia on your own time in several ways. The following techniques can help you interact, reduce fear and worry in social situations, and improve your mental health. 

Communicate with those you’re comfortable with

Take time to consider people you feel comfortable being around. Have an honest conversation with them about what you’re experiencing. Communicating honestly with people you trust may help you build a support team that can stand beside you during anxiety-provoking social situations. Your support team can accompany you to new social settings and help you practice what to say and how to act so that you feel better prepared.

Join a support group

You are not alone if you experience social anxiety. Support groups offer a way to connect with others who have similar experiences so that you can receive encouragement and feedback. Attending an in-person support group may allow you to practice your behavior in uncomfortable or unfamiliar social settings. However, an online group may feel more suitable for someone uncomfortable around others. 

Implement lifestyle changes

Physical health can lead to improved mental and emotional health. Strive to follow healthy habits that include staying physically active, getting adequate sleep, staying hydrated and well-nourished, and limiting or eliminating substances that might help trigger your anxiety, such as alcohol, drugs, caffeine, and nicotine.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

Seek treatment for social phobia with an online program 

It can make a difference to have thorough, getting mental healthcare as you navigate social anxiety or similar concerns. Through online platforms like BetterHelp, therapists can offer remote support so you can enjoy social scenarios with less fear and anxiety. 

With an online platform, you can reach out to your therapist outside of sessions. If you have a question about social phobia or forgot to mention a topic during therapy, you can send your therapist a message, and they’ll respond when they can. You may also receive helpful tools, like at-home exercises, that can reinforce essential concepts and allow you to continue working through social anxiety symptoms independently.  

Other studies have also backed up the effectiveness of online treatment programs. One study found that online cognitive-behavioral therapy could be as effective as face-to-face therapy in treating common conditions like depression and social anxiety disorder. These results can be similar to or better than those of in-person studies.