Medication to treat social
anxiety disorder to be explored
BY WALTER HANGAD
Delivering an important
presentation can make most people a bit nervous -- even
seasoned public speakers. Sweaty palms, heart
palpitations or dry mouth are typical symptoms before
"The Big Talk."
But for a person with
social anxiety disorder, the phrase "Never let them
see you sweat" becomes painfully amplified: The
speaker senses the audience noticing how his hands are
trembling furiously and how he's sweating profusely. With
each successive stammer and each fumbled phrase, he's
painfully aware that his expertise is being questioned.
Suddenly, his mind goes blank, and he finds himself
caught in a roomful of people waiting impatiently for the
next word. He begins to feel lightheaded and fears the
further embarrassment of passing out before he can come
up with another word.
The stammering or
trembling are not necessarily more prevalent -- or even
more noticeable -- in people with social anxiety
disorder. But people with the disorder have an acute fear
of others noticing their anxiousness and are much more
afraid of the external manifestations of anxiety than is
typical, said Chris Hayward, MD, MPH, associate professor
of psychiatry. Hayward is beginning clinical trials at
Stanford investigating the efficacy of medications for
treating this largely neglected disorder.
Social anxiety disorder --
sometimes referred to as social phobia -- affects one in
12 Americans. Often people with the disorder are
dismissed as just being shy. But for those with social
phobia, an intense fear of scrutiny lies behind the
reticence of their shyness. It is not uncommon for people
with social phobia to want to be with other people, and
they may be in situations where socializing is an
important part of their occupation.
"People who suffer
from this disorder are extremely afraid of potential
scrutiny by others in a social situation; so much so that
they either avoid particular social situations or, in
extreme cases, all social situations," said Hayward.
Being in the public eye
can elicit such a disabling fear in people with the
disorder that they may even shy away from seemingly
non-threatening activities. Eating out at a restaurant or
even using a public restroom can become terrifying
experiences.
In less severe cases, the
disorder can still interfere with work, school and
personal relationships. In adolescence -- where the
disorder sometimes begins -- children may become fearful
of participating in class or after school activities or
asking their teacher questions. In some cases they may
avoid school altogether. In adults, the disorder can
interfere with talking to one's boss, writing in the
presence of other people or talking on the phone.
Left untreated, people
suffering from social anxiety disorder are often prone to
depression and alcohol abuse -- which is sometimes used
as a way of "loosening up" in front of others.
"The Stanford trials
are preliminary efforts to see if the medications are
efficacious at all for people with social anxiety
disorder," said Hayward.
The disorder can be
treated without medication through a psychotherapeutic
alternative like cognitive behavioral therapy --
restructuring one's thought processes to cope with
perceived anxiety-provoking situations -- or
"exposure therapy," in which individuals
gradually learn to overcome their anxiety by slowly
increasing practice in social settings. With the results
of the Stanford trials and other research on the
disorder, Hayward aims to determine whether those with
social anxiety disorder should be treated with
psychotherapy, medication or a combination of both. The
trials will also test the efficacy of medications in
adolescents.
For more information on
the studies or to volunteer, contact research coordinator
Holly Thompson at 725-5584 or hollybt@stanford.edu. SR
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