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But things don't have to be so bleak. While social phobias do not respond to a single intensive exposure session as specific phobias do, therapy can still be relatively straightforward. A successful treatment regimen may involve no more than a dozen sessions of cognitive-behavioral therapy, in which patients slowly expose themselves to the places and circumstances that frighten them and reframe the catastrophic thinking that torments them. They are taught to tone down their "attentional bias," a tendency to stress their supposed social stumbles, and their "interpretation bias," a habit of picking up neutral cues from other people and interpreting them as evidence of failing socially. Often group therapy works better than one-on-one therapy. It provides more than a supportive circle of fellow sufferers: the very act of gathering with other people can serve as a first, critical rebellion against the disorder.
If such therapy doesn't help social phobics, drugs can. Ever since the popularization of Prozac in the early 1990s, the family of modern psychopharmacological drugs has grown steadily. Most of these medications are selective serotonin reuptake inhibitors--or SSRIs--which, as the name implies, selectively block the brain's reabsorption of the neurotransmitter serotonin, helping produce feelings of satisfaction and kick-start recovery. Last year the drug manufacturer SmithKline Beecham asked the Food and Drug Administration to take a second look at the popular SSRI Paxil and consider approving it specifically for the treatment of social-anxiety disorder. The FDA agreed, making Paxil the first drug ever to be formally endorsed for such use.
While the flood of marketing tends to overstate the case, the fact is, Paxil works--not by eliminating anxiety entirely but by controlling it enough for traditional therapy to take hold. And with the pharmacological door now open, makers of similar drugs like Luvox, Prozac and Celexa will probably seek the same certification. "Paxil is not unique among these drugs," says Barlow. "It was just first in line."
Progress in treating social-anxiety disorder is also providing hope for the last--and most disabling--of the family of phobias: panic disorder. Panic disorder is to anxiety conditions what a tornado is to weather conditions: a devastating sneak attack that appears from nowhere, wreaks havoc and then simply vanishes. Unlike the specific phobic and the social phobic who know what will trigger their fear, the victim of panic attacks never knows where or when one will hit. Someone who experiences an attack in, say, a supermarket will often not return there, associating the once neutral place with the traumatic event. But the perceived circle of safety can quickly shrink, until sufferers may be confined entirely to their homes. When this begins to happen, panic disorder mutates into full-blown agoraphobia. "For some people, even the house becomes too big," says Fordham University psychology professor Dean McKay. "They may limit their world to just a few rooms."