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Residents speak out on social phobia


07/16/2009 10:53 PM | By Biju Mathew, Web Coordinator

Biju Mathew delves deep into the hidden world of social phobia, which is far removed from reality, and finds tales of survival.

Case study 1

A*, a 30-year-old man, used to be uncomfortable in all social situations. During school days, he used to tremble when asked questions in front of his classmates. He used to get confused, forget answers that he knew, and avoided extracurricular activities.

School years passed by uneventfully. Later, he took up a law course hoping that would help him. He avoided practical sessions as far as possible. But the situation changed when he worked as a junior lawyer.

During discussions with senior advocates or while presenting a case in front of his colleagues, A. would sweat and his voice would break and become feeble.

Gradually, he became nervous whenever he met strangers and found it difficult to interact with them. He would be tense and his mouth would dry up when new clients came to see him; he could not initiate a conversation and his hands would shake while writing. A. had similar problems during social gatherings, especially while eating or talking to acquaintances or strangers.

Slowly, he started to avoid social gatherings altogether. The problem became so acute that it started to hamper his social and professional life. He had to quit practising law and take up a job where he had minimal interaction. Even there he found it difficult to meet his boss.

Finally, A. told his problem to his family doctor, who advised him to see a psychiatrist. A. was diagnosed with social phobia. Since he had a severe anxiety problem, he was started on anxiolytic and anti-depressant medication.

This helped to reduce anxiety quickly. He underwent, over a period of 12 weeks, 16 sessions of both individual and group cognitive behaviour therapy, mainly graduated exposure to social situations and cognitive restructuring. Social skill training was also given.

There was significant improvement in his social anxiety. His job performance has improved. The anxiolytic medication was reduced and stopped over a period of six weeks and anti-depressant medication after one year. A. has been off medication for the past six months.

He got a job promotion and now leads a satisfactory social life.

*Name of the patient changed by doctor.

Case study 2

Dubai: S.K.*, a 39-year-old marketing manager, used to be anxious during business meetings.

He used to get extremely nervous if he had to discuss or present topics in front of people.

Even while growing up, he used to avoid social events and gatherings due to anxiety.

Slowly, the problem became so severe that it started to affect his job.

And when he became a manager, it got worse.

Added responsibility and more social interaction could have aggravated his problem.

S.K. was unable to function effectively as a manager.

He was diagnosed with social phobia and treated with anxiolytics, given relaxation therapy and counselling.

The medication was gradually reduced then stopped. The patient attended therapy sessions once a month and recovered completely in six months. S.K. was fully cooperative, which helped in his recovery.

*Name of patient changed by doctor

Case study 3

K.*, a 29-year-old woman, was shy as a child and could remember pretending to be ill to stay away from school.

As she got older, she was more comfortable with her friends. Meeting new people was still difficult, as was public speaking. However, neither situation came up often.

At college, K.'s problem became worse. As part of her studies, she had to do presentations. In addition, because she lived off campus, she found it particularly difficult to meet friends.

The few times she tried to talk to people in class, she felt as though she had nothing to say. Before long, she stopped trying. K. did not avoid class presentations altogether, but she devised her own coping mechanisms such as using projectors since dark rooms helped to reduce her anxiety.

Still during presentations, she used to stop for a breath and could feel her heart pounding and her mouth become dry.

After her first year of college, K. began to avoid any class that required presentations. In addition, she found herself avoiding situations where she thought people might notice her shaking.

She avoided writing in front of others, and other situations that might draw people's attention to her hands. She also avoided engaging in conversations with others.

When people approached her, she tried to end the conversation as quickly as possible. In addition to fearing that others would notice her anxiety, K. felt they might perceive her as weak, unattractive or foolish.

During diagnosis, it was found that K. was suffering from social phobia. She seemed bright and motivated and it was decided that she might benefit from medication and cognitive behaviour therapy (CBT). She was soon started on SSRI (anti-depressants) and sessions of CBT.

In six weeks, K. felt more comfortable around people and decided that she was willing to participate in a 12-session CBT programme.

Treatment included a variety of components, including information about the nature of anxiety and social phobia, cognitive restructuring and role-play exposure to anxiety-provoking situations.

In addition, K. practised "shaking" in front of others, until the symptom was no longer frightening to her. Over the course of the CBT, K.'s medication was gradually discontinued.

Currently, K. is more confident in social situations, no longer has the physical symptoms during presentations, and leads a life as normal as anybody else's.

* Name of the patient changed by doctor.

 
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