Are you "socially afraid"?
Image credit: giphy
Go to a party with friends, friends have something to go out, leave you alone, before leaving, instruct: I go out, you and everyone talk first.
At the company dinner, you quietly raised your chopsticks to pick up vegetables, and suddenly you were looked at by the surrounding eyes and asked: Why don't you talk?
On the way, I met people who were not very familiar, did not know whether to take a detour or pretend to look at the mobile phone, the eyes dodged, and the inner tangled: do you want to say hello? Say hello and say what?
People who feel the same way may think that they are "socially afraid."
Part 1 What is true social terror?
Social anxiety disorder used to be called social phobia, or social phobia.
It is an emotional experience of feeling uncomfortable, unnatural, nervous, and even frightening when interacting with people.
It is mainly manifested as excessive and unreasonable fear of communicating with people, sometimes knowing that this fear response is excessive or unreasonable, and still difficult to feel fear uncontrollably.
And because of the strong desire to avoid socialization in various ways or to force yourself to endure socialization with fear, it affects your normal life [1].
The U.S. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines it as a common, but sometimes disabling condition, but sometimes at the level of injury.
To be diagnosed with social phobia, in addition to the above symptoms, pay attention to the following key points:
1. Involves social situations that almost always contribute to fear, anxiety or avoidance problems for at least 6 months;
2. Impaired academic, social, and occupational functioning of individuals, even leading to depression and substance abuse [2].
Brief summary:
Social phobia should be satisfied at the same time, the anxiety symptoms are prominent, the duration is longer, and the injury is more serious. In this sense, the prevalence of true social phobia is not high, not a simple personality problem, but a mental and psychological disease.
Part2 How is social phobia generally treated?
Traditional treatments for social phobia include medication, psychotherapy, and physical therapy.
drug therapy
Currently, drugs approved by the U.S. Food and Drug Administration (FDA) include:
Selective serotonin reuptake inhibitors paroxetine, sertraline, and fluvoxamine, and serotonin norepinephrine reuptake inhibitor venlafaxine. Certain monoamine oxidase inhibitors and benzodiazepines have also been shown to be effective against social fear [1].
psychotherapy
Cognitive behavioral therapy is the most classic psychotherapy method for social phobia.
The form includes not only face-to-face guided therapy by a psychotherapist, but also immersion in a virtual environment with the help of a virtual reality VR system.
physiotherapy
Some physiotherapy for magnetic and electrical stimulation is also gradually being used for social phobia treatment, such as repeated transcranial magnetic stimulation, percutaneous AC/DC stimulation, etc.
However, the common disadvantage of these treatments is that they do not work instantaneously.
If you already have symptoms of social phobia at this moment, like an asthma attack, do you expect to be cured quickly?
Advances in medicine are for us to survive better:
A research drug called PH94B, used for the acute treatment of social phobia, is about to fill this treatment gap: spray inside the nose, control social fear, and heal the body and mind!
Part3 with a gentle spray to eliminate social fear?
What is this pharmacological mechanism?
The hypothalamus and amygdala in the brain are important brain regions that cause social fear[3][4][5].
If the area can be regulated at any time, it may relieve symptoms of social phobia within minutes.
Around 1990, researchers found that by dropping synthetic steroids in the nose, it is possible to directly regulate the autonomic and neuroendocrine responses of the brain through the olfactory nerve regulation of specific brain areas that trigger social fear, resulting in a significant decrease in tension and anxiety[6][7][8][9].
(Around 1990, researchers found that after targeting synthetic neuroactive steroids to chemical sensory receptors in the human nose, chemical sensory information can be transmitted through the olfactory nerve to specific brain areas that trigger social fear without waiting for systemic absorption and distribution, thereby directly regulating the autonomic and neuroendocrine responses of the brain and significantly reducing tension and anxiety[6][7][8].
To date, there are not many neurosteroidally active compounds that have been studied to treat anxiety symptoms, and if you are not familiar with PH94B, you may have heard of a drug called RU486, that is, mifepristone (a short-acting contraceptive pill) [9]. ）
In recent years, the R&D company of PH94B Nasal Spray has listed it as an important Phase 3 clinical trial for the treatment of social phobia worldwide.
In December 2019, the US FDA granted the PH94B Fast R&D Channel qualification;
On January 7, 2022, the Mainland's State Drug Administration also approved its clinical trial application[10].
Clinical studies of Part4 social phobia sprays yielded positive results
In 2011, a team of scientists published the results of a study in the American Journal of Psychiatry, a top journal of psychiatry, in which PH94B nasal sprays were partially effective in treating societies [11].
Picture translated from the literature[11]
The study, which was divided into two phases, was a standard multicentre, randomized, double-blind, placebo-controlled study. (Highest level of evidence)
Phase 1 included 91 women with social phobia, aged between 19 and 60. Randomly receive a placebo or PH94B nasal spray 15 minutes before treatment, followed by a public speaking or social challenge.
75 percent of subjects who received PH94B felt "very good" or "very good," a result much higher than the positive feedback of 37 percent of subjects who received a placebo.
The research team continues to expand and validate their findings, having registered a larger clinical trial in 2020, hoping that further findings will provide more evidence for the successful treatment of PH94B.
Today, PH94B nasal spray, although still in the Phase 3 clinical trial stage, the continuous positive news seems to give us hope.
We look forward to it together.
bibliography
1. Amir Garakani, James W. Murrough, Rafael C. Freire, Robyn P. Thom, Kaitlyn Larkin, Frank D. Buono,Dan V. Iosifescu.Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Front Psychiatry. 2020. 11: 595584.
2. https://www.psychiatry.org/psychiatrists/practice/dsm.
3. J W Papez.A proposed mechanism of emotion. 1937. J Neuropsychiatry Clin Neurosci. 1995. 7(1): 103-112. doi: 10.1176/jnp.7.1.103.
4. MacLean PD. The limbic system ("visceral brain") and emotional behavior. AMA Arch Neurol Psychiatry. 1955. 73(2): 130-134. doi: 10.1001/archneurpsyc.1955.02330080008004.
5. N Sobel, V Prabhakaran, C A Hartley, J E Desmond, G H Glover, E V Sullivan, J D Gabrieli. Blind smell: brain activation induced by an undetected air-borne chemical. Brain. 1999. 122 (Pt 2): 209-217. doi: 10.1093/brain/122.2.209.
6. L Monti-Bloch, C Jennings-White, D S Dolberg, D. L Berliner. The human vomeronasal system. Psychoneuroendocrinology. 1994. 19(5-7): 673-686. doi: 10.1016/0306-4530(94)90049-3.
7. L Monti-Bloch, B I Grosser. Effect of putative pheromones on the electrical activity of the human vomeronasal organ and olfactory epithelium. J Steroid Biochem Mol Biol. 1991. 39(4B): 573-582. doi: 10.1016/0960-0760(91)90255-4.
8. L Monti-Bloch, C Jennings-White, D L Berliner. The human vomeronasal system. A review. Ann N Y Acad Sci. 1998. 855: 373-89. doi: 10.1111/j.1749-6632.1998.tb10595.x.
9. Daniela Eser, Thomas C Baghai, Cornelius Schüle, Caroline Nothdurfter, Rainer Rupprecht. Neuroactive steroids as endogenous modulators of anxiety. Curr Pharm Des. 2008. 14(33): 3525-3533. doi: 10.2174/138161208786848838.
10. https://www.affamed.com/
11. Liebowitz MR, Salman E, Nicolini H, Rosenthal N, Hanover R, Monti L. Effect of an acute intranasal aerosol dose of PH94B on social and performance anxiety in women with social anxiety disorder. Am J Psychiatry. 2014. 171: 675–682. 10.1176/appi.ajp.2014.12101342
12. Liebowitz MR, Hanover R, Draine A, Lemming R, Careri J, Monti L. Effect of as-needed use of intranasal PH94B on social and performance anxiety in individuals with social anxiety disorder. Depression Anxiety. 2016. 33: 1081–1089. 10.1002/da.22546
Creative Staff:
Author: Hu Qiang, Wei Luo
Review expert: Wang Chunxue| Chief Physician, Professor, Doctoral Supervisor, Director of the Department of Neuropsychiatry and Clinical Psychology, Beijing Tiantan Hospital
Editors: Wei Luo, Zhang Jie, Zhang Liang
Proofreader: Wu Yihe
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