Public speaking: fear vs. phobia

Yesterday I received an e-mail from someone who doesn't believe I should be advertising my services to people who fear public speaking. The rationale was that building skills and practicing public speaking does nothing to resolve the fear, and that public speaking fear is an irrational phobia, which can't be fixed by the likes of public speaking coaches.

I responded that she was referring specifically to people who have phobias, which make up a small percentage of the people who have public speaking anxiety, and that those folks should seek help from a therapist, which I am not.

However, I do believe that people who fear public speaking, whether they are phobic or not, can be helped. And furthermore, I don't recommend eradicating all anxiety, as a small amount of anxiety can actually be helpful to a speaker.

So what about that phobia?

The Ohio State University Anxiety and Stress Disorders Clinic has a page of diagnostic criteria for social phobia (of which public speaking is one form), from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

Under diagnostic features, the page says,

"The fear or avoidance must interfere significantly with the person's normal routine, occupational or academic functioning, or social activities and relationships, or the person must experience marked distress about having the phobia.

For example, a person who is afraid of speaking in public would not receive a diagnosis of social phobia if this activity is not routinely encountered on the job or in the classroom and the person is not particularly distressed about it. Fears of being embarrassed in social situations is common, but usually the degree of distress or impairment is insufficient to warrant a diagnosis of social phobia."

Treatment for social phobia can include medication, but usually centers around cognitive-behavioral therapy (CBT).

From the National Institute of Mental Health:

"The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations."

Then, "When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties." (I believe this refers to "practicing".) (More on Social Phobia and CBT here.)

Finally, back to the OSU Anxiety and Stress Disorders Clinic:

"Epidemiological and community-based studies have reported a lifetime prevalence of social phobia ranging from 3% to 13%. The reported prevalence may vary depending on the threshold used to determine distress or impairment and the number of types of social situations specifically surveyed. In one study, 20% reported excessive fear of public speaking and performance, but only about 2% appeared to experience enough impairment or distress to warrant a diagnosis of social phobia."

So, people with fear of public speaking which is severe enough to warrant a diagnosis of social phobia make up a very small part of the population. People who do have social phobia can be treated, if they so desire.

And people like me, who offer public speaking coaching not just to those who fear public speaking but to anyone who wants to improve their skills and build confidence, can continue to do so, knowing that the majority of people who have public speaking anxiety do not require psychotherapy.

Followups on social phobia and social anxiety here, here, and here.

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