As reported by the New Britain Herald, January 17, 2005.

Researcher Studying Social Embarrassment

By Tricia Stuart

FARMINGTON -- It’s safe to say that everyone has suffered embarrassment at some time, but for those who have anxiety disorder, it is pervasively disabling, causing severe loneliness and isolation. Social anxiety disorder is a hyperactive social danger response.

Dr. Nicholas DeMartinis, assistant professor of psychiatry at the University of Connecticut Health Center, is studying the efficacy of a medication, sometimes in combination with cognitive behavioral therapy, to help people overcome anxiety disorder.

"Social embarrassment is useful to help prepare one for public speaking," said DeMartinis. Sixty percent of the population suffers from public speaking fear." But social anxiety impedes that. People are held back by symptoms that interfere instead of being helpful," he said.

Physical symptoms include panic attacks, anxiety, heart pounding, sweating, flushing (red face), shakiness, palpitations, and dryness of the mouth.

"It’s hard to detect. People who have social anxiety disorder find it hard to talk to someone. They may have a cool, wet handshake. But some people talk to everyone in a comfortable setting where their skills are clear; but they couldn’t go to a neighbor’s house, a PTA meeting, or engage in regular social interaction," he said.

The anxiety is so strong that people with the disorder avoid social situations. Desensitization, through repeated social interactions, doesn’t occur.

Cognitive behavioral therapy requires the person to extend extra effort by consciously thinking about and identifying the thought processes, as anxiousness arises, in a step-by-step process. The patient is taught how to talk back to the dysfunctional thought, write it down, and come up with a rational response and a more realistic view of the thought. The process is repeatedly practiced and home work sheets are filled out about what the patient thought and how much s/he believed that thought.

Behavioral exercises are tailored for the individuals and their situations in life, DeMartinis says.

"At least two times this week, while you’re in the grocery store, you will talk to a person behind you in line about the weather. For some people, ordering a pizza is incredibly difficult," he said.

The person is taught relaxation exercises to prepare to go into each of those situations.

The person with anxiety disorder has insecure thoughts, feels anxious, has a more intense insecure thought, feels even more anxious, and "it’s like a snowball running down hill," said DeMartinis.

Eight percent of people in the U.S. will have excessive social anxiety that is worthy of treatment, which includes up to 25 million people in the U.S.

"Asian cultures look like they have social anxiety, even though it is the cultural norm, where women in China are taught to not speak up in public. In the U.S., people worry they are going to embarrass themselves in front of others. In the Japanese culture, people worry about doing something that may offend others, which is a big taboo," he said.

Social anxiety prevents people from engaging in activities, prevents achievement, marriage, and educational attainment. Undergraduates sometimes do well in large classrooms of 250 students but have problems and drop out when they have to participate in small groups and make presentations. People with social anxiety are at double the risk of suffering from depression, and have higher rates of alcoholism. The earliest occurring of all anxiety disorders begins at age 13.

"People don’t realize they have a problem; they say they have always been this way. Parties are difficult. People don’t feel better until they get out of the situation," he said.

Anti-depressants, surprisingly, are good at helping anxiety.

"If we had used them first with anxiety, we would have called them anti-anxiety medicines, instead of anti-depressants," he said.

DeMartinis said people who don’t socialize and go to parties, who are given one of three anti-depressants (Paxil, Zoloft, or Effexor), go to parties and socialize again. Symptoms go away partially or completely. One-third of the patients experience total remission of social anxiety disorder. Some people who are no longer anxious still avoid situations out of habit, and that is where cognitive therapy helps. Most people usually have the symptoms for 10 to 15 years before seeking treatment because the anxiety prevents them from making the contact necessary to seek help.

"One person I treated began to first learn to handle handshakes. Then he joined a meeting, later volunteered for a committee, then went to seminary school, and then he became a priest and is handling public speaking fine now. He had thought about becoming a priest when he was a kid but was always afraid to do that. Now he’s finally doing what he wants to do in life," said DeMartinis.

Very often, there is a strong genetic tendency, or predisposition, that causes the person to be anxious. Parental modeling or an overly critical parent may cause it.

"Even without environmental experiences, most of it is a combination of the two," he said.

The purpose of the study is to identify the biological predisposition for social anxiety disorder; it is not a treatment study. The study will hopefully reveal how cortisol, the main stress hormone, helps maintain the body’s stress response. Brain chemicals regulate how much cortisol is released.

"We are trying to see if the endorphin system is involved in the biology of social anxiety disorder, which also identifies the risk for alcoholism," he said.

Biological differences determine whether one medicine works better than another, with or without cognitive therapy. But some people may not respond to the medicines so he is studying different planned treatments for people.

"You have to give each treatment at least three months to see if it will work out," he said.

One out of four people experience queasiness and insomnia within the first two weeks of using the medications. Some people experience sexual dysfunction for several weeks, and for others, sexual dysfunction doesn’t go away. One out of 20 people have to stay on the medication for life.

People who are interested in the free social anxiety study must be between 18 and 45 years of age. No treatment is included.

Call 887-252-2225 or 860-679-6775 for more information.