Most people experience some degree of shyness from time to time in certain situations. In fact, only about 7% of the population claims that they never feel shy. For the rest of us, shyness can range from being an occasional, minor inconvenience, to being a major problem.

Some people however, are afflicted with a degree of shyness so severe that it is almost disabling. This type of acute shyness is not only very painful to experience, but it can have devastating effects on a person's social life, happiness, and career.

Severe shyness is a complex mix of biology, upbringing, traumatic experiences, and negative self-talk. Severe shyness can co-exist with other debilitating psychological conditions such as low self-esteem, perfectionism, depression and anxiety.

Extreme shyness can take many forms, and can show up differently in different people. Some very shy people have problems being in large gatherings, yet feel comfortable in small groups. Some shy people only feel acute discomfort with persons they have just met, while others are never comfortable around people, even those they have known a long time.

Psychiatrists and psychologists use the term "social anxiety disorder (SAD)" to describe extremely debilitating shyness. There isn't complete agreement about whether severe, disabling social anxiety disorder is simply a more severe type of shyness, or whether it is another type of disorder altogether.

Some very shy people are able to overcome their fears by learning social skills and practicing them frequently in social situations. Many also find it useful to gain some measure of control over their uncomfortable physical reactions such as sweating and trembling, by using special relaxation techniques and bio-feedback training.

Many very shy people deal with their extreme anxiety by simply avoiding any social situations that might trigger their discomfort. This may mean turning down invitations to parties and other social events, crossing the street in order to avoid running into someone they know, and even turning down promotions at work.

Although avoiding the feared situation may seem to the shy person like the perfect solution, it actually makes the problem worse in the long run. Every time a shy person chooses to avoid social interaction, he reinforces in his mind how much he fears dealing with other people. By choosing the short-term benefit of avoiding his anxious feelings, he reinforces the power that his fear holds over him

Psychologists who specialize in the treatment of shyness disorders have discovered that avoiding social situations can actually make the problem worse. Many psychologists who treat people aflicted by shyness recommend a program of repeated and gradually increasing exposure to the feared situation, combined with helping the client learn new ways of thinking.

Various psychological therapies have been used to treat extreme shyness, most of them with limited success. The most successful approaches use some variation of cognitive therapy, or behavioral therapy, or both of these, combined with graduated and increasing exposure to the feared situation.

In cognitive therapy, the patient is taught to notice the thoughts he is thinking while he is in the feared situation. The client learns to challenge his thoughts to see if they fit reality. If these thoughts do not match the reality, the client is taught to substitute more realistic thoughts in their place.

Behavioral therapy aims to change the client's behavior using a program of positive reinforcement of the desired behavior, and negative reinforcement of the undesired behavior.

Both cognitive therapy and behavior therapy focus on teaching the client to deal with situations and symptoms in the present. Neither form of therapy delves into situations in the client's distant past. Those forms of psychotherapy that attempt to deal with shyness by delving into the client's past history have not been shown to be effective. in cognitive therapy techniques.

There are many books that can teach the reader to effectively use cognitive therapy techniques for both depression and loneliness. If your case is not particularly severe, you can often learn enough from reading a book and doing the recommended exercises to greatly relieve your symptoms of shyness or depression. Dr. David Burns, one of the pioneers in bringing cognitive therapy to a wider audience, has written several very useful books and workbooks for the general public, including "Intimate Connections" and "Feeling Good--the New Mood Therapy."

In the past decade, researchers have discovered that some anti-depressant medications, particularly the so-called SSRI's (selective serotonin re-uptake inhibitors), can also be very helpful in the treatment of extreme shyness. One of these SSRI drugs, Paxil, was the first to receive American F.D.A. approval as an effective treatment for social anxiety. In fact, ads for Paxil as a treatment for social anxiety have been marketed directly to the public, not just to doctors. Other anti-depressant drugs in the SSRI group are also believed to help in reliving social anxiety.

Does drug treatment for shyness really work? Some very socially anxious people have tried everything that regular psychotherapy has to offer, including cognitive therapy, yet they still suffer debilitating symptoms of shyness until they try SSRI drugs. In some cases, the improvement in sociability after taking SSRI drugs can be swift and profound. This class of drugs seems to help the socially anxious person turn down the excessive volume of their inner judgmental thoughts.

If you are shy or socially anxious, should you take a pill to make you more friendly? There are pros and cons to be considered when deciding whether or not to take a drug for social anxiety. The SSRI drugs can cause nervous agitation, insomnia, weight gain, and sexual dysfunction, as well as many other less common side effects.

Some doctors and psychologists are concerned that a normal human trait, shyness, has been declared a medical condition requiring expensive pharmaceutical intervention. Because the SSRI drugs are relatively new, it is not yet known what the long-term effects of this class of drugs may be. Nevertheless, the SSRI drugs are very widely prescribed, particularly in North America, for depression and social anxiety.

The difference in shyness experienced with drug therapy can be quite astounding, but it will likely last only as long as the drug is taken on a regular basis. When the drug is discontinued, the symptoms of shyness will likely reappear. With the proper psychotherapy for shyness, the positive results are likely to be long lasting.

In most locations it is easier to find a doctor who will prescribe SSRI medication to combat shyness than it is to find a counselor trained in the use of therapy effective in treating shyness disorders.

This article is an excerpt from the new downloadable book by Royane Real titled "Your Guide to Finding Friends, Making Friends, and Keeping Friends" available at http://www.royanereal.com

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