Many children with severe social phobia are never identified because they masquerade as extroverts. They “have to” be the center of attention, but suffer tremendously internally. Often of above average intelligence, they overcompensate by cleverly controlling situations to mask insecurities. They are frequently among the most popular kids and highest achievers who “no one would ever know” suffers painfully with extreme feelings of embarrassment and isolation. They fall under the radar of teachers and parents, who assume popularity and a smile equals confidence.
These are red flags: Is the child NEVER alone in public? Does she have many friends in school and many extracurricular activities, but never invite a friend home. Does NO ONE dislike him? Does he have so much to say that he can’t tolerate a pause? Does she never get angry or sad? Does she do most of group projects and avoid delegating? Does he resist doing a solo task in class (hand out supplies, run in-school errands)? Can he tolerate being wrong? Is he the class clown? Is she NEVER with unpopular classmates? Or, is she ALWAYS helping less social classmates.
Exposure therapy, a special type of Cognitive Behavioral Therapy, is the only therapy endorsed by national anxiety disorder organizations for social anxiety. Exposure therapy enables sufferers to very gradually overcome their fears and let go of their avoidant and overcompensating behaviors at a pace with which they feel comfortable, so they are never overwhelmed. Results are achieved in a matter of months not years. Exposure therapy is more effective than medication, therapy and medication combined, or any other kind of therapy. Medication provides only temporary or partial relief and has side effects; symptoms just come back when you end the medication. Exposure therapy provides permanent relief, essentially eliminating excessive social anxiety forever.
Nevertheless, medication can be very beneficial if someone is in a crisis, such as possible school expulsion, job loss, or marital conflict, or if they are too overwhelmed to do the work of therapy. However, medication is used temporarily, and the therapist should work toward the goal of reducing or eliminating dependence on it. Clients should stay on medication until therapy is complete and then gradually reduce and eliminate it while continuing therapy for another several weeks or months to eliminate the residual symptoms that medication masked.
There are many medications used for social anxiety. The most popular are Paxil, Zoloft,Celexa, and Prozac, as well as short acting medications like Xanax and Clonipan, which are used only as needed. (This is not an exhaustive list.)
When considering a therapist, there are two “test” questions you must ask them before you make an appointment: (1) Is exposure therapy the main technique they use? If they don’t, forget about using them. And (2) How many people have they SUCCESSFULLY treated FOR SOCIAL ANXIETY? In major metropolitan areas, there should be no difficulty finding a specialist who has treated a few dozen clients with the same condition, the people should not longer have excessive anxiety, avoidant or overcompensating behaviors, and should not be taking medication any more, if they ever did. They should NOT say they just helped people “live with” or “manage” their anxiety better.
In light of many “unexplained” teen tragedies, schools need to cast a wider glance over the entire classroom and not settle for appearances. The good news is social phobia is extremely treatable, but only if it identified.
