Xiao Wu, female, 34 years old, employee, when she was in junior high school, she liked a male classmate, tall and handsome, and had good academic performance, but she had ordinary looks and mediocre grades, so she had low self-esteem and did not dare to confess her love to the other party, and did not even dare to talk to him, and was usually nervous when she met him, and her behavior was unnatural in the presence of the male classmate, and gradually developed to feel uncomfortable in public, especially in front of a group of people. When I walk in front of a group of people, I feel that everyone is watching me, I am often so nervous that I don’t know which leg to take, my eyes are fixed on the ground, I don’t dare to look at anyone, I want to find a crack in the ground. When the teacher called on me, I was very nervous and felt that I was blushing and incoherent. After that, gradually when going to other public places also nervous, such as taking the bus, always feel that others are staring at them, very restrained, afraid to look at anyone, ten minutes of travel feels like hours so long. For this reason, I was afraid to go out and stayed at home when I could, and I did not want to interact with people. This has been going on until now. Xiao Li, male, 19 years old, a freshman student. When he was in high school, his desk liked to whisper in class in response to the teacher’s lecture, which made him very disgusted. He had communicated with his desk several times, hoping that he would not respond to the teacher’s words in the future, but the desk promised to maintain only a short period of time, and soon the old attitude reappeared. He was embarrassed to keep talking about him, so he hinted at the table by coughing and moving his shoulders, hoping that he would be more restrained, but the table did not seem to feel his hints at all and remained as usual. At the same time, he felt that the students behind him were staring at him, and felt that everyone could see that he was doing these actions very pretentiously and unnaturally, and he also felt that other people’s coughing or arm movements were directed at him, implying that they did not like him. So he is very concerned about whether others around him are doing these actions, so he cannot pay attention in class and his grades drop. Later, when he went out in public, such as in the car, in the hospital or even at home, whenever others cough, clear their throat or move their arms, he felt that it was directed at him. I don’t dare to go to class, or to other public places. Diagnostic criteria The above two cases are typical of social phobia, what is social phobia? Social phobia is a kind of phobia, that is, excessive and unreasonable fear of social situations (such as eating or speaking in public, parties, meetings, or fear of embarrassing behavior, etc.) and interpersonal contact (such as contact with people in public, fear of eye contact with others, or fear of being scrutinized in relation to the crowd), often accompanied by low self-esteem and fear of criticism. Social phobia must have the following four characteristics: 1, a strong fear of social situations and interpersonal contact, the degree of fear is not proportional to the actual danger. 2, must be in social situations or must be in contact with people will have anxiety and autonomic symptoms, such as nervousness, flushed face, sweating, dry mouth, rapid heartbeat, dizziness, nausea, tremor, the whole body and even the feeling of weakness of the legs. 3, there is repeated or continuous avoidance behavior, patients will intentionally or desperately avoid social situations, avoid going to public places and occasions that require contact with people, so much so that they close themselves off at home for a long time, seriously affecting their social function. 4. Patients know that this fear is excessive, unreasonable, or unnecessary, but it is just uncontrollable and therefore painful. Pathological psychological mechanism Social phobia mostly starts in adolescence, and only a few start after the age of 20. So how does it develop? Different psychological schools of thought have different explanations for the formation of social phobia. Classical psychoanalytic and family systems theories, for example, suggest that the development of social phobia is related to unresolved Oedipusian conflicts in childhood. As children enter the Oedipus period (usually between the ages of 3 and 5 years), they adore their opposite-sex parents and compete with their same-sex parents. If the child feels loved by the opposite sex parent, but the opposite sex parent simultaneously sends the message to the child that your father (for boys) or your mother (for girls) is the best partner for me, and that although you are nice and your mother (for boys) or father (for girls) loves you, you are too young to be my child, not my partner. Children will feel that they are accepted by the opposite sex parent, except that they cannot be a partner to their dad or mom because of their age. Children will then identify with their same-sex parents, hoping that they will grow up to be a man like their dad in order to marry a woman like their mom, or grow up to be a woman like their mom in order to marry a man like their dad. This is a reasonable solution to the Oedipus conflict. But if the child feels that the opposite sex parent does not like him or her, but at the same time is seductive, the child will on the one hand be full of sexual fantasies about the opposite sex parent, on the other hand will feel guilty for his or her fantasies and impulses, will feel that what he or she is thinking or doing is inappropriate, and at the same time feel inferior because the opposite sex parent does not accept him or her, and think that he or she is awkward and unattractive. This lays the roots of social phobia for the onset of adolescence. This is the case, for example, in Xiao Wu’s case. In Xiao Wu’s eyes, her father was handsome and talented, but he was very strict with herself and her sister, rarely complimenting them, mostly blaming or ignoring them, and she felt that her father was better to her sister, and especially disliked herself. Her father was also a watery man who had many affairs outside the home. Wu’s mother eventually divorced her father because she could not tolerate his behavior. Her sister was raised by her father, and she remarried with her mother. This deepened Wu’s belief that her father did not like her, and she felt inferior for not being able to win his affection. But because her father was seductive again, Wu subconsciously felt ashamed of her fatherly impulses. During adolescence (junior high school) Wu met a boy she liked, and all potential conflicts erupted. She liked the boy on the one hand, but had low self-esteem on the other, and the worst part was that she would feel ashamed of her impulse to like the opposite sex, thinking that this was undeserved and unacceptable, in fact, this shame came from her Oedipusian incest taboo. So there are the symptoms of social terror mentioned above. Humanistic psychology, on the other hand, believes that the formation of the patient’s symptoms is related to the value conditions imposed by the parents. So-called value conditioning is when individuals adopt the values of others as their own guidelines for living in order to gain the approval of others. Why does this happen? For young children, parental love and acceptance is very important; if parents love and accept them, they are good, otherwise they are bad. But not all parents accept and love their children unconditionally, they tend to come with various conditions or make various demands on their children, such as to be obedient, behave well, be brave, etc.. The child does this before the parents will accept and love them. However, these demands are often inconsistent with the child’s innate organismic sense, which is one’s true experience of things and whether this experience can meet the needs of self-actualization tendencies. In order to be loved and accepted by their parents, children suppress their organismic senses and instead act in accordance with value conditions. Whereas value conditioning comes from others and is not the result of one’s own experience, it is dogmatic and rigid and cannot change with the situation or situation, and children become maladaptive. Once they lose the guidance of their organismic senses, children do not know where to go and how exactly to act in order to receive good evaluations from others. This was the case for Xiao Li in the second case. Xiao Li’s mother was very strict with Xiao Li since he was young and would control every aspect of his life, even the kind of clothes he bought had to listen to his mother. Otherwise, his mother would be unhappy, which is what Xiao Li does not want to see. So in order to get his mother’s love and affirmation, Xiao Li suppressed his organic feelings and acted almost exactly according to his mother’s value conditions. He therefore has difficulty expressing his true feelings, occasionally showing them, as he did with his tablemates, and once he suffers a setback, he becomes suspicious of his own behavior and worries about what others think of him, worrying about whether his every move will be inappropriate, and develops symptoms of social phobia. Treatment Social phobia requires comprehensive treatment, including both medication and psychotherapy. Medication: Antidepressants such as paroxetine hydrochloride, sertraline, fluvoxamine, etc. can be given plus small doses of atypical antipsychotics such as olanzapine, quetiapine fumarate, etc. to enhance the efficacy of treatment, such as anxiety is very obvious, but also short-term anxiolytic treatment, such as lorazepam, oxazepam and buspirone, etc. β-blockers such as insulin are effective in reducing palpitations and tremors due to anxiety, and shaking due to fear. The response is very effective. Psychotherapy: There are many methods of psychotherapy, such as behavioral therapy, cognitive therapy, psychodynamic orientation and family therapy. Behavioral therapy: Systematic desensitization therapy can be used, and social training can be given at the same time. That is, the patient is arranged for certain social situations, initially the patient is more familiar, less nervous scenarios, and then gradually arranged for less familiar social situations after adaptation, in order to gradually improve the patient’s social level and reduce anxiety and fear. Cognitive therapy: that is, to change the patient’s misconceptions about themselves. In social phobia patients’ self-depreciation plays an important role in the illness. They already lack self-confidence, on the other hand, they are too demanding of themselves and hate to be praised and liked by everyone with their superb eloquence and demeanor, which inevitably leads to self-defeat and finally the symptoms of social phobia. Therefore, changing the patient’s misconceptions can have a therapeutic effect. Psychodynamic-oriented psychotherapy is a deeper treatment, often taking longer, through which patients gradually realize the subconscious conflicts behind their symptoms, enhance self-awareness and self-awareness, thus reducing their symptoms and improving their personality.