The goal of today’s article is to describe what Social Phobia is, how it manifests, and then delve into the typical methods and interventions of Single Session Therapy when dealing with this issue.
What is Social Phobia?
Social Phobia is an Anxiety Disorder that manifests when exposed to interpersonal or public situations. The person is afraid of being judged or criticized by others, whether in more intimate settings or in front of a larger, unknown audience. The anxiety primarily arises if the exposure requires some form of performance or action.
Shyness or Social Phobia?
It is important to distinguish Social Phobia from common shyness, which does not trigger intense anxiety or fear but makes the person more introverted and less focused on social relationships.
Shyness can evolve into social phobia over time, but what differentiates the two terms is the clinically significant impairment in the person’s life: social phobia is dysfunctional because it terrifies the person in interpersonal situations where they are under observation, often leading to social isolation. Shyness, on the other hand, can remain a character trait that does not interfere with the person’s functioning.
The average age of onset ranges from 8 to 15 years, and the 12-month prevalence in Europe is 2.3%. Females appear to be at higher risk (American Psychiatric Association, 2013).
In Italy, the 12-month prevalence is 1% (ISS-ESEMeD, 2005).
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) describes social phobia as the persistent fear of being judged negatively in interpersonal relationships.
People suffering from this phobia generally fear:
- Performance and/or tasks
- “Egocentric” situations: when the person is required to express their own opinion or point of view.
- Intimate situations: whenever they are asked to talk about themselves, their personal matters, or disclose private information to others.
How to intervene with Single Session Therapy?
The professional must first understand how the problem works (beyond the diagnostic category) with a series of funnel questions to clarify with whom, where, how, and when social phobia manifests. Secondly, the therapist and client will collaboratively define the goal of the session, making that meeting effective and efficient in resolving or improving the phobia.
The therapist’s first maneuver might be to identify the person’s attempted solutions; usually, those with Social Phobia engage in a repertoire of behaviors that, rather than improving the problem, keep it alive and feed it:
- Controlling emotional reactions to hide them from others
- Avoiding social situations that are considered threatening
- Venting and complaining about the problem
- Striving to feel comfortable
Directly blocking dysfunctional behaviors
The therapist may choose to directly block dysfunctional behaviors through prescriptions or reframing that redefine the problem. This way, the person learns which behaviors sustain their fear and can decide to stop them. For example, the therapist might reframe complaining and seeking reassurance as nonfunctional, explaining that, on the contrary, they magnify the fear. Alternatively, the therapist may explain how avoidance represents a false sense of protection from fear because it strengthens, on one hand, the belief that they lack the adequate skills to handle the situation, and on the other hand, labels the situation as truly dangerous.
Are there any exceptions to the problem?
At a later stage, the therapist will investigate “exceptions to the problem,” i.e., how and when the person has faced public situations in the past without feeling fear or with less fear. This approach helps the therapist highlight the client’s resources and suggest how to leverage them to their advantage. The therapist can then experiment with solutions in-session, agreed upon with the client, to take the first small step toward resolution.
One technique used is the “As If” approach: the client is asked to imagine a scenario beyond the problem, where the phobia doesn’t exist, and reflect on what they would do differently if they did not suffer from Social Phobia. The solution-focused talk is useful for describing scenarios beyond the problem and constructing a reality in which it doesn’t exist.
Conclusions
Single Session Therapy is useful for addressing Social Phobia because its method helps to understand how the problem works and identifies the points of blockage. It is a co-construction of a solution between the patient and therapist, aiming to create a different experience for the client to subsequently modify their cognition.
Beatrice Pavoni
Team of the Italian Center for Single Session Therapy
Bibliography
CannistrĂ , F. & Piccirilli, F. (2018). Single Session Therapy: Principles and Practices. Giunti Editore.
American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Raffaello Cortina.
Nardone, G. (1999). Psicosoluzioni, BUR.
Nardone, G. (2000). Beyond the Limits of Fear, BUR.