In this issue of HEALTHbeat:
  • Do you suffer from social anxiety?
  • Do statins affect blood pressure?

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Harvard Health Publications -- Harvard Medical School blank HEALTHbeat
March 31, 2009

Dear HEALTHbeat subscriber,

Who hasn’t felt nervous about a job inteview, or meeting the in-laws for the first time? It’s not all that uncommon to feel slightly apprehensive before a social situation involving new people. But for some people, social anxiety can seriously impede day-to-day life. This issue of HEALTHbeat can help you determine if you might suffer from social anxiety disorder and describes available therapies to ease overwhelming social fears. Also in this issue, Dr. Richard Lee, editorial board member of the Harvard Heart Letter, discusses the effect of statins on blood pressure.

Wishing you good health,

Nancy Ferrari
Managing Editor
Harvard Health Publications

In This Issue
1 Do you suffer from social anxiety?
2 Notable from Harvard Medical School:
* Coping with Anxiety and    Phobias
* Hypertension: Controlling    the “silent killer”
3 Do statins affect blood pressure?

From Harvard Medical School
Coping with Anxiety and Phobias
Anxiety disorders — which include panic attacks, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias — are among the most common mental illnesses. Thankfully, never before have there been so many therapies to help control anxiety. Coping with Anxiety and Phobias will provide up-to-date information on these treatments, including medications, exposure therapy, cognitive-behavioral therapy, hypnosis, meditation, and exercise.
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1\ Do you suffer from social anxiety?

It’s not unusual to feel nervous about meeting new people or attending parties. But some people may be inordinately uneasy and self-conscious in everyday social situations, and overly fearful of doing or saying something embarrassing and being negatively judged by others. If this sounds familiar, or if you are so anxious that you dread or avoid such situations, you may have social anxiety disorder, also called social phobia.

If you have social phobia, you might be terrified by just the thought of proposing a toast, or even making small talk. Even if you make yourself attend gatherings, you may feel miserable before, during, and afterward — worrying for days about people’s opinion of you. Avoiding these get-togethers is not the answer, of course; it can result in misunderstandings and other personal problems.

Studies have shown that certain medications and types of psychotherapy can help. Meanwhile, scientists have been investigating the roots of the disorder, as a step to discovering new therapies.

What does social phobia look like?

There are two types of social phobia. Specific social anxiety (also called performance anxiety) arises in limited situations. It’s a problem mainly for people whose work (for example, acting, music, or lecturing) requires them to perform in public.

Far more prevalent and disabling is generalized social anxiety. People with this disorder fear common social situations, such as eating or ordering food in public; asking questions or seeking help; meeting new people; speaking to strangers; and even using public facilities, such as restrooms. They may lose out on job opportunities because they’re afraid of interviews; they may forgo training and education because they fear being called on in class.

Symptoms include a racing heart, dry mouth, shaky voice, blushing, trembling, sweating, and nausea. In specific social anxiety, fear that people will notice these symptoms may impair performance, leading to a downward spiral in which worsening performance reinforces worsening anticipatory anxiety. Generalized social anxiety can produce a similar downward spiral: others feel ill at ease when they sense a person’s discomfort, and it’s natural to interpret that discomfort as rejection that justifies further social withdrawal.

Do you have social phobia?

If you answer yes to three or more of the following questions — and medications, substance abuse, a medical condition, or another emotional disorder isn’t the cause of your symptoms — you may have social phobia. If so, talk with a clinician or therapist about your concerns.

  • Do you fear being in certain situations — for example, performing or socializing with people you don’t know well — because you’re afraid you’ll do or say something embarrassing?
  • In these situations, do you experience symptoms of anxiety, such as palpitations, sweating, diarrhea, confusion, or (in severe cases) panic?
  • Do you believe that your fear of these situations is unreasonable or excessive?
  • Do you avoid social or performance situations whenever possible?
  • When you can’t avoid them, do you endure them with intense distress?
  • Does the problem seriously interfere with your daily routine, work, or social life, or do you feel distressed about having the problem?

Adapted from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

What to do

Certain types of psychotherapy and several medications can be helpful in treating and managing social phobia.

Psychotherapy. Cognitive behavioral therapy (CBT) has two parts. The cognitive therapy helps change habitual thoughts (“People will think what I say is stupid”) that prevent you from overcoming your fears. The behavioral element involves working to face those fears directly in anxiety-provoking situations.

The therapist typically begins by asking you to record your thoughts and level of anxiety in various situations. Then, you and the therapist discuss these thoughts, evaluate how realistic they are, and work together to substitute more productive thought patterns. The behavioral component involves a strategy called exposure, or desensitization, in which you face your fears — sometimes through role-play, sometimes by imagining and describing the situations that make you anxious.

Your therapist may also ask you to put yourself in a real-life situation (like a party) that sparks your worst fears, to let you practice recognizing negative thoughts and exchanging them for more realistic ones. With repeated exposure, you may eventually become desensitized to these fear-provoking situations. A related behavioral strategy teaches you coping skills for such situations. If parties are your worst nightmare, for example, you may work on conversational skills. CBT may also include learning relaxation techniques, such as deep breathing.

A therapist-guided variation of exposure therapy, called exposure and response prevention, aims to not only desensitize you to the feared situation but also prevent you from reacting with the usual avoidance behaviors.

Medications. As research uncovers the roots of anxiety in brain chemistry, anti-anxiety medications have become increasingly important, usually in combination with CBT. Typically, the first choice is a selective serotonin reuptake inhibitor (SSRI), often with a benzodiazepine tranquilizer added to quell symptoms for the four to six weeks until the SSRI kicks in. Some dual (norepinephrine and serotonin) reuptake inhibitor antidepressants are also effective. For people who have a lot of physical symptoms, such as heart pounding, a beta blocker may be prescribed.

For more information about social anxiety disorder, order our Special Health Report, Coping with Anxiety and Phobias, at

For more information about social anxiety disorders, order our Special Health Report, Coping with Anxiety and Phobias.
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2\ Notable from Harvard Medical School
** Coping with Anxiety and Phobias
Anxiety disorders — which include panic attacks, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias — are among the most common mental illnesses. Thankfully, never before have there been so many therapies to help control anxiety. Coping with Anxiety and Phobias will provide up-to-date information on these treatments, including medications, exposure therapy, cognitive-behavioral therapy, hypnosis, meditation, and exercise.
** Hypertension: Controlling the “silent killer”
An alarming one in three American adults has this high blood pressure, known medically as hypertension. If you are among them, you can take steps today to protect yourself from the damage it causes. Fortunately, high blood pressure is easy to detect and treat. Hypertension: Controlling the “silent killer” lays out a step-by-step lifestyle program you can use to lower your blood pressure, including a special section on the best diet for keeping your blood pressure in check.
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3\ Do statins affect blood pressure?

Q: I have been arguing with a friend about whether the statin drugs lower blood pressure. Do they, or don’t they?

A. Statins may lower blood pressure — the evidence is still thin — but if they do, the effect is small. Few of the multitude of trials testing these cholesterol-lowering medicines checked blood pressure before and after and kept the use of blood pressure medicines constant. An analysis of the results of the few small trials that took these steps showed a reduction of almost 2 points in systolic blood pressure (the upper number of a blood pressure reading) and a reduction of under 1 point for the diastolic pressure (the bottom number). Note that these are average changes, and the effect in individuals can be bigger or smaller.

What does this mean for people who take one of the six statins currently on the market — atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), or simvastatin (Zocor)? Not much. For those with high blood pressure, these medications certainly can’t take the place of blood pressure medicine. For those with a healthy blood pressure, taking a statin to keep cholesterol in check may help a bit to keep blood pressure in the safety zone.

— Richard Lee, M.D.
Associate Editor, Harvard Heart Letter

This Question and Answer first appeared in the March 2009 Harvard Heart Letter, available at

For more information on high blood pressure, order our Special Health Report, Hypertension: Controlling the “silent killer”



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Harvard Medical School publishes authoritative Special Health Reports on a wide range of topics. Each report delivers practical information on diagnosis, treatment, and prevention of major health concerns in clear, easy-to-understand language. For more information on a specific topic, click the appropriate link below:

Alzheimer’s, Arthritis, Bladder, Cholesterol, Depression, Diabetes, Digestion, Energy, Exercise, Eye Disease, Headache, Heart Disease, High Blood Pressure, Memory, Menopause, Prostate, Sexuality, Sleep, Stroke, Vitamins

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Harvard Medical School offers special reports on over 50 health topics. Visit our Web site at to find reports of interest to you and your family.

Copyright 2009 by Harvard University.