Social Phobia and Self Concept and the Brain

Dr. Allan Schwartz, LCSW, Ph.D. | October 20, 2008

Karen Blair, of the National Institutes of Mental Health reported on the

findings of an important research project in which fMRIs 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 fMRIs, 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.