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PSYCHIATRY HELPS PATIENTS WITH GROUP THERAPY FOR SOCIAL PHOBIA

Chantal, a middle-aged Pretoria resident, spends a lot of time dreading interacting with anyone beyond her immediate family. When she is forced to interact with other people, she sometimes starts to blush or sweat and feels her heart racing and her limbs trembling. Often her thoughts race so quickly that they become jumbled and confused. She is convinced that she makes a fool of herself in social situations, and has started to avoid these kind of embarrassing scenes altogether.

Chantal suffers from a psychological disorder known as “social phobia”. Until recently, this disorder was thought to be a relatively rare occurrence. In accordance with the latest research, however, it is now believed to strike at least one person in ten at some time in their lives.

Social phobic sufferers have an intense fear of scrutiny by other people in social situations, as well as a marked and persistent fear of performance situations in which they may become embarrassed or humiliated. Often these fears lead to the avoidance of social situations.

Group therapy is the ideal situation for treating social phobics in a real life setting. Sufferes confront what they fear head on in a supportive atmosphere. Recent research carried out by Barlow at The Boston Anxiety Clinic in the United States has resulted in a comprehensive and effective programme for treating social phobics in a group setting.

Two prominent South African psychiatrists – Dr Anne-Marie Potgieter and Dr Franco Colin – who visited the Boston Clinic last year and were impressed with what they saw, decided to take the initiative and start their own support group for social phobics in the Pretoria region. In association with the National Depression and Anxiety Support group, they launched a group which has been running successfully for the past 6 months.

The group which currently has between 15 – 20 regular members, is based on a specific cognitive behavioural model aimed at exposing members to their dreaded social fears in a controlled, caring environment. At the beginning of each meeting the bigger group breaks up into smaller groups which are facilitated by Dr Potgieter and Dr Colin. In these smaller groups, the members prepare speeches. They then report back o the larger group and receive constructive feedback from their peers regarding their performance. Although the process can be nerve wracking at times, it reaps great benefits as the members learn to interact more confidently with others. Members are also often surprised when they discover that he honest feedback from their peers is usually far more positive than their own negative evaluations of themselves.

This kind of honest interaction in the group setting has resulted in a strong cohesiveness developing in the group. Members often phone each other up during the months to offer support and encouragement to each other. Furthermore, the group helps in destigmatising the disorder and normalising the fears and emotions that social phobics experience.

Social phobics can be fearful of a wide range of social situations or their fear can be limited to specific activities eg: public speaking. The most common feared events include being introduced to others, meeting people in authority, being watched doing something, writing in front of others, eating in front of others and speaking in public.

A further complication is that a lot of social phobics develop dual disorders along with their social phobia. It is common for social phobics to also suffer from disorder such as simple phobias (eg: fears of heights or spiders), agoraphobia, alcohol abuse, major depression and drug abuse.

Although social phobics do respond well to the latest medication, such as RIMASs (Reversible Mono-Oxidase Inhibitors) and SSRIs (Selective Serotinin Re-uptake Inhibitors), there is also an important psychological component that needs to be dealt with for a comprehensive recovery to occur.

Most therapists aim to reduce social fears and improve social skills in their socially phobic clients. Cognitive interventions which challenge irrational thoughts and faulty assumptions, role playing with candid feedback and social skills training are all effective techniques that are used.

Dr Potgieter believes that it is important to keep the Pretoria group alive and dynamic. “People’s needs change all the time,” she maintains, “and we want to cater for these needs, as well as keeping the group interesting and interactive.” Part of this approach means supplying the members with a wide range of information regarding treatment and alternative approaches. There is also an occupational therapist who helps with the group and supplies the members with relaxation techniques.

Both Dr Potgieter and Dr Colin supply their services free of charge. In a country that has only 250 qualified psychiatrists to assist a growing population of over 42 million, this kind of voluntary work by mental health professionals in the community is invaluable. The Depression and Anxiety Support group, a non-profit privately funded support group with a membership of over 8000, works closely in conjunction with a number of health professionals and organisations, and it is this complementary blend between the two sectors that creates such a successful formula

Other South African Psychiatrists that have got involved at grass roots level include Dr Charl Els from Bloemfontein and Professor Mkhize from Transkei. Both professionals, with the backing of the Depression and Anxiety Support Group have launched successful support groups in their own areas.

In the meantime, Chantal has become an avid member of the Pretoria Support Group. “I won’t stop going there,” she says. ‘It really helps knowing that other people are also struggling with similar problems. Often I think back on the session we had and reflect on what I have learnt.”