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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Social Phobia and Self Concept and the Brain

Allan N. Schwartz, LCSW, Ph.D. Updated: Oct 20th 2008

Karen Blair, of the National Institutes of Mental Health reported on the findings of an important research project in which fMRI's were used to study brain responses for those subjects who suffer from Generalized Social Phobia. Social Phobia is the fear and wish to avoid a specific type of social situation, perhaps private parties. A Generalized Social Phobia is the fear of and wish to avoid all social situations. The subject who suffers from GSP experiences constant fear of being judged badly and, as a result, experiences major inability to function at work or in all types social situations. In other words, the subject perceives a threat of such magnitude that they expect humiliation and embarrassment because of other people not liking them.

Brain Parts Involved:

Previously, it was thought that the part of the brain that controlled phobic reactions was the Amygdala. This part of the brain, right and left hemispheres, is responsible for storing memories of emotional reactions. For example, if a person experiences being stuck in an elevator and becomes frightened, the Amygdala will store not only the memory of the event but the frightened reaction as well. Then, a "potential" is established for the individual to become frightened again, in a similar situation such as going into an elevator of any type and anywhere.

The study discussed in this posting confirmed that the Amygdala does become "lit up" on the fMRI's, meaning that the machine traces blood rushing to that brain part when the phobic inducing situation is present. However, what the study also revealed is that the all important Pre Frontal Cortex is also lit up. The pre frontal cortex is responsible for such things as making judgments as to what is good and bad, right and wrong and self concept and self esteem.

When phobic subjects read negative comments about themselves, as individuals, not only did blood rush to the Amygdala but to the pre frontal cortex as well. It is important to mention that non phobic subjects were also used in the study as a control or comparison group. This comparison group did not show any changes in their pre frontal cortex when they read negative or critical comments about themselves.

Implications:

These findings were received by the medical and psychiatric communities very enthusiastically. It means that new medications can be devised to help people overcome their social phobias.

The article does make mention, at the very end, of the fact that psychologists can use Cognitive Behavioral Therapy to enhance their treatment people with GSP.

In My Opinion:

It is not a new idea, it seems to me, that those with social phobias of all types, would experience low self esteem. I welcome my readers to send their comments about this issue because it has always seemed to me that the very nature of social anxiety and social avoidance is that there is a readiness to anticipate rejection. Countless numbers of people with this phobia have told me how they suffer, in all situations, with the dread that others will think badly of them.

While I am not anti medication I am pro psychotherapy. In my humble opinion, and please correct me or argue with me if I am wrong or if you believe I am wrong, but medication will not increase feelings of self esteem. For the phobic, positive social experiences along with Cognitive Behavioral Therapy set the stage for improvements in functioning and self esteem.

I look forward to your comments.

Allan N. Schwartz, PhD

 

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    I Look and Act OK - Betty - Apr 23rd 2011

    I have learned to enjoy conversations with others and seem to be well accepted by most people, where once I felt awkward.  But I find myself being very careful to be complementary and and on the lookout for anything that might be offensive.

    But I still find myself replaying some conversations in my head.  It's mostly concerning people I really want to be respected by.

    I had a very strict upbringing, was very shy.  Got criticized for any missteps.

    OK.  How do I get my amygdala to start behaving?

     

    You're right about meds - Mary Joye - Jan 30th 2010

    Dear Doctor Schwartz:

    I am a media coach with a MA in Counseling. My undergrad is in Theatre and I spent many years professionally as a singer/songwriter after overcoming severe Social Phobia. I have a pretty tried and true method of amelioration of symptoms in 3 sessions, one that must last at least 3-4 hours with short breaks.

    It works!

    You are so right about meds, particularly benzos. They are counterproductive for singers because of the muscle relaxant qualities and the negative effect on the vocal chords which need to be controlled and not chemically relaxed during performance.

    The brain has SO much to do with everything. Wish I knew what you did. I'm working on it!


    Thanks

    Mary

    bonnie12 - Allan N. Schwartz, PhD - Oct 27th 2009

    Hi Danielle,

    I am interested in the results of your study when you are done. If you would like to share your findings I would really appreciate it. Good luck in you work.

    Dr. Schwartz

    interesting - Danielle Kaui - Oct 27th 2009

    wow this is great information and very interesting. im doing a study on social Phobia and this helped me alot about it

    The role of adrenal stress in reforming self-image - Peyton - May 4th 2009

    I have trained elite combat forces and I am psychologist by academic training. I dropped out of my doctorial program in 1975 because one half of my doctorial board did not believe PTSD was real, The neurological and biochemical basis of PTSD was the subject of my thesis. They seem to feel that PTSD was partially a fiction of Hollywood.   I have manageable PTSD symptoms myself.  My work and research gave me very significant insights into the role of adrenal stress in the formation of learning and memory. The reality is I was just decades ahead of my time with my research.  My therapy involves the eliciting high adrenal levels in the patient then having them perform positively under this stress. Now people come from many parts of the world for my treatments, which are in part originated from my work with combat teams.  Cognitive therapy does help some, but adrenal stress therapy is dramatically more effective. It almost does not seem to matter specifically what the subject’s initial condition or “pathology” or “non serving” or “self-defeating’ behavior is either.  The program I employ challenges the subject incrementally and induces progressively higher levels of adrenal complex stressors, The person then performs tasks at the level I determine is just at the threshold of their ability to succeed with. This ranges from dealing with harsh verbal abuse, ridicule and rejection and physical threats in the first phase.  They learn to maintain their calm and to reclaim their ability to vocalize, and to overcome audio exclusion and tachi-psyche effects. Then they practice projecting a strong and totally congruent verbal boundary to the therapist who is playing the role of the antagonist.  Each session is done in group format and after each module there is grouped discussion of their experience. The “trauma” of the experience very quickly bonds the groups (not unlike combat does but with less destructive side effects),  Even socially withdrawn or even partly socio phobic persons will frequently very quickly feel comfortable in relating past experiences of trauma, often that they have never confided to anyone before. These include forcible rape (with mostly women, but on occasion men as well).  In some cases a specific adrenal scenario will be constructed to give a woman an alternative outcome to her rape for example. But less traumatic events, even the failure to stand up to high school bully 25 years ago can surprisingly weigh heavily and non-productively and in a self-limiting fashion on some persons.  In such a case we replay the incident with the alternative outcome. That alternative outcome plays out under adrenal complex of course, thus forming a new adrenal memory. As you may know adrenal memories are stored in the neural nets of the brain differently than are things learned under non-adrenal conditions.  But the central thing that must and always is accomplished by this therapeutic approach is a genuine elevation of the subjects’ personal self-image and feelings of personal self worth. The basic mechanism is their facing, experiencing and overcoming a fear.  I have noted a side benefit to this approach too. In several cases it has almost completely cured “stuttering” behavior in some people afflicted with this condition, and in as little as 14 hours of this therapy.  I first began to work in this way with what I called in 1975 “Implosion therapy”. What the person was afraid of, or conversely had a “fetish” for they were inundated with until the non-productive and undesirable behavior was extinguished. Of course there were obvious limits to this methodology. For example, one could not cure heroin addict by this means of course.  There is a risk here just as there was with pushing a soldier to far beyond their limits physically and psychologically. But I have not had any negative effects using this approach of any significance at all. Yet I wonder if the people who come to me for treatment, having read my books etc, have already to an extent accepted that they can be cured. That mindset possibility does confound variables for me.

    Same Life - jeffrey - Apr 15th 2009

    wow hank me and u have the SAME EXACT life

    wasting my youth - hank - Jan 15th 2009

    This disorder is such a nuisance. I feel i am wasting my youth. I was never like this, i would take the bull by the hornes... everything was so bright and positive. Now i just justify my position by finding hate in everything i should be partaking in. when i do go out with my friends (whom i've known for many years and still act weird around) i have to get drunk to minimize the angst. The fact that i even have this disorder is the biggest blow to my self-esteem.  My parents think i'm gay because i'm good looking and "still" dont have a girlfriend. i just dont think i could make one happy. actually i think it was a girl that i loved that helped develop this disorder. I replay the most trivial conversations over and over in my head to pick out the stupid things i said. Through that i developed the biggest sense of guilt. To help correct all this and get me back to where i was, i have been attempting cognitive behavioral therapy via podcast. I have found that aspects of it help such as blocking automatic negative thoughts but to me it doesn't seem like anything that will go away anytime soon.

    He got it right. - - Dec 17th 2008
    The previous comment is spot on. I was diagnozed with generalized anxiety and I am excessively self aware of myself and how I interact with others. On a one to one basis, I am usually very comfortable talking and discussing things. I think this is due to the level of trust you develop when you hang out with someone 1 to 1. In a group setting, I am as the previous user posted, completely lost. I don't know what to say or who to interact with, I become overwhelmed when being looked at and presumably judged by mutiple people when I am talking therefore I try to say as little as much, and when I do talk its very blunt, brief and boring.

    scared of being judged badly - - Oct 24th 2008

    I find that, as you mention, I am scared of being judged badly. Mostly I am scared of being inadequate, not fitting in, not knowing what to say and people thinking that I am just plain boring. I think upbringing may play a part in how one can interact with people and feel at ease in social situations. I was kept very much at home and my parents refused that I go to parties and the like. I never really could go out when I was younger. I find I am really good on a one to one basis, but in a group I am lost. It takes a lot of time for me not to avoid going out with a group, and if I do, then that means that I actually know the majority of the people taking part in the event and I know them well and I am used talking to them.

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