Case study: Philip

  Philip first realized that he had a problem when he had been unable to do a brief presentation in front of his peers as part of his management training course. He felt comfortable in most informal situations such as social gatherings and indeed saw himself as the ‘life and soul’ when mixing with others at a party. He just had an excessive fear of doing formal presentations. He would begin experiencing anxiety weeks before a presentation and was aware that the day before he gave a presentation, he experienced marked physiological symptoms of anxiety, particularly shaking, hot flushes, a churning stomach, a dry mouth and an increased heart rate. His strategy for coping with this anxiety was to spend a great deal of time preparing for the presentation, often for weeks in advance. He spent many hours rehearsing what he was going to say by going through his script dozens of times and repeatedly making minor changes. He also arrived early at the venue to familiarize himself with the room in which he was due to present. However, his anxiety never seemed to reduce.

On a few occasions Philip had managed to complete the presentations with great difficulty by employing a number of safety behaviours which he felt helped him to cope. These included, for example, drinking lots of water before and during the presentation to stop his mouth from drying up, wearing lots of anti-perspirant and opening all the windows to keep the room cool to reduce his sweating. He also began wearing loose-fitting clothing and keeping his hands in his pockets to hide the fact that he was shaking, wearing a high neck jumper to hide the blotches on his neck and positioning the furniture in the room to move himself out of the spotlight. While actually doing the presentations he would avoid eye contact with people, speaking quickly and not allowing time for any questions. He simply wanted to get it over with as soon as possible.

Even when he had finished the presentation, Philip would do a ‘postmortem’ by ruminating on how he had come across to his peers and convincing himself that the event had been a complete disaster. He began to develop a dread of doing presentations and knew in himself that unless he did something to address the problem he would soon be unable to do them and would end up calling in sick. This would have a disastrous effect on his ability to meet the assessment requirements of the course and subsequently his opportunities for career advancement. He knew that he needed to overcome this fear if he was going to make a success of his career.

On reflection, Philip recalled that he had experienced some embarrassing incidents at school when he had been made to stand up in front of the class to read and had stumbled on his words. This had resulted in being teased by his peers and a rebuke from his teacher. After that time he had tried whenever possible to avoid doing public speaking or presentations and had managed to do so quite successfully for a number of years. His experiences at school of having to read out loud seemed to have contributed to the development of beliefs that increased his vulnerability to social anxiety problems in his later life. However, he was no longer able to avoid doing this in his management training because it was a part of being assessed for the course.