Understanding Social Anxiety From the 1980s Through Now

By Frank Schneier, M.D

I became interested in studying social anxiety in the late 1980s, as I was finishing my psychiatry residency. I was hoping to find an area of research that was ripe for advancement, and the first journal articles on what was then the newly-described condition of “social phobia” caught my eye. At that time, panic disorder and other forms of anxiety had become a hot topic that was leading to ideas for new treatments. But social anxiety was new and unexplored – it had never even been discussed in my residency training. At the time, social phobia was thought to be a relatively rare condition limited to “performance” situations, like stage fright.

I began a research fellowship at Columbia University Medical Center, under the mentorship of Dr. Michael Liebowitz, who had already developed the rating scale most commonly used to measure social anxiety. Through the process of recruiting patients for our studies, it became clear to me that social anxiety disorder was far more common and more impairing than previously believed. As our research got publicity, patients came out of the woodwork, telling us they had been suffering silently for years, unaware that anything could be done about their social anxiety. Now they were hopeful.

In our early studies we were able to offer medication treatment for these patients, and we saw very exciting results. Patients experienced improvements, sometime dramatically, and we felt like we were onto something important. We integrated new cognitive-behavioral therapies in our studies as another effective approach. We observed that social anxiety seemed much more common and serious than originally thought, often extending into fear and avoidance of most social situations. In the mid-‘90s, a large national survey validated our impression, showing social anxiety disorder to be the third most common mental disorder, after alcoholism and depression. That recognition led to increased support for social anxiety research and treatment development.

In recent years, I’ve shifted the direction of my research to try to understand brain mechanisms involved in the development and treatment of social anxiety. It’s clear that both genetics and life experiences can play a role in the development of social anxiety problems. If we can get a better handle on what makes some people vulnerable to developing these problems, and how this vulnerability is shaped by life events, we should be able to come up with even better and more individualized treatments.

It’s important to remember that social anxiety is a normal part of life, but having too much of it can interfere. Ironically, the very embarrassment at the heart of this problem also prevents many suffers from seeking treatment. So I encourage people who are distressed by their social anxiety or concerned about family members with this issue to educate themselves and find out if there is help that could be right for you. If you can find the courage to seek out opportunities to change you may open the door to surprising possibilities. The most rewarding part of my work occurs not in the research laboratory, but when I’m able to help someone along the journey to a better life.