20 July 2004

Internet help for social anxiety disorder

People with social anxiety disorder shy away from other people and experience extreme anxiety in social situations. Read how the internet has helped one woman to cope.

It is somewhat of a miracle that Sally* is sitting in a restaurant, casually eating and exchanging ‘chit-chat’ with a colleague. A few years ago she could barely sip at her mineral water for fear that everyone in the room would scrutinise her every bite if she ordered anything to eat. Casual conversation was the last thing on her mind, when every sip of water brought a flood of anxious thoughts.

She had few friends and mingled in public places as little as possible. When the panic attacks started, Sally sought help and discovered that she was suffering from Social Anxiety disorder (Social Phobia). She has come a long way in the last few years since receiving treatment but her struggle is ongoing. She furrows her brow as she states "Every day is a battle to keep the anxiety at bay".

For millions of South Africans, every day is a struggle with debilitating social anxiety. Anxiety is a universal human trait. We have all had the experience of feeling shy, anxious and self-conscious – whether giving a speech, eating in front of other people or asking the object of your affection out on a date.

When this self-consciousness becomes so intense that a person starts avoiding situations which provoke it, and when the person’s social and/or occupational functioning becomes impaired because of this, it crosses the line from normal anxiety to Social Anxiety disorder.

In this age of technology, people are dealing more and more with ATM’s, answering machines and e-mail, and less and less with actual people. We push buttons instead of shaking hands. It is argued that this techno-culture breeds Social Anxiety disorder by denying people the essential practice needed to develop social skills. However this same techno-culture may also provide help with the problem in the form of the Internet.

Sally discovered the joy of chatting online when her boyfriend installed a PC in their study at home two years ago. "Having been in cognitive-behavioural therapy and on medication for a year already, I was managing better, but still struggling with the practicalities of interacting socially" Sally states. She smiles wryly as she adds, "I’ve always been socially inept". "I have had few friends because I haven’t known where to begin to start making them" she adds. "My self esteem was dangerously low back then and my lack of friends was only feeding into this" she recounts.

Sally then started chatting online. "I found that I could practice certain skills in a very non-threatening environment. I honed my conversational skills, engaged in light conversation, and most of all realised that I am a likeable person. I gained the courage to start using some of the skills I had learnt in real-life settings". She adds "I still chat online and I have formed some meaningful Internet friendships. My social functioning and my self esteem have improved a lot".

Sally’s account represents a success story in support of one side of a very controversial argument. A debate is raging at the moment among health care professionals as to the effects of technology, and the Internet in particular, on our psychological wellbeing. Many people who experience severe anxiety in public may feel quite comfortable expressing themselves in cyberspace.

Stepping stone to real world interaction or place to hide?
Both, says Rick Heimberg Ph.D., director of the Social Anxiety disorder programme at Temple University. Heimberg states that online interaction can be positive if it encourages a socially phobic person to become more extroverted in real-world settings. In contrast, however, it can be negative if excessive time on the Internet replaces face-to-face contact, he says.

Sherry Turkle, a Clinical Psychologist at Massachusetts Institute of Technology, extols the virtues of using the internet to "draw-out" socially phobic people. She states that "people use the Internet to ‘put one toe in the water’ and try out social contacts with which they are less comfortable in the ‘real’".

Dr Marcia Slattery, a psychiatrist at the Mayo Clinic highlights the potential dangers involved. She states that "some people I have seen clinically, have become – for lack of a better word - ‘obsessed’ with staying online". She warns against allowing the Internet to become one’s social network in and of itself, to the neglect of real-time relationships.

She adds "It is best to allow yourself to reap the benefits of having a social connection on the net and then generalise the experience in person-to-person contact".

The issue is a controversial one, and it seems to depend not on the technology itself, but on how this technology is utilised. The professionals differ in their relative enthusiasm for the Internet as a therapeutic tool, but they do unanimously agree on one thing, it seems.

That one thing is that chatting on the Internet needs to be kept in perspective and must not be allowed to eclipse face-to-face interactions. When asked for some useful advice, Sally offered this: "The Internet can be a wonderful and a terrible thing, depending on how you use it. Chatting can be great in bolstering your confidence, and in learning social skills, but these things are only valuable in so far as you incorporate them into your real life".

Some tips on how to use the Internet safely, responsibly and to your best advantage include:

  • Ask yourself how much time you are actually spending on the computer every day. If it’s more than the time you’re spending interacting face-to-face, you may be slipping into dangerous territory.
  • Ask yourself whether your relationships have improved or deteriorated since you started using the Internet.
  • Ask yourself honestly whether you are using the Internet as an aid to interact with the real world, or whether you are hiding there to avoid it.
  • Ask yourself whether you are using what you have experienced on the net to enhance your real-time interactions or not.
  • Look at your behaviour in cyberspace and ask yourself what it shows you about what you’re afraid of, what your vulnerabilities are, but also to reflect your strengths. Be self-reflective.
  • Give yourself time. Sherry Turkle states that in the most cases she’s seen where the "virtual" was used to enhance the "real". It takes a year before any progress can be seen.
  • It is important to keep your Internet usage in perspective.

Help for people with Social Anxiety disorder

Contact the Depression and Anxiety Support Group on (011) 783-1474/6 or 884-1797.

- Natascha Basedau, Depression and Anxiety Support Group

*Not her real name

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