Q. I'm so shy I can't go to lunch with my co-workers. They think I'm a snob, but really I just don't know what to say during conversation. I can't even ask sales clerks for help or use public restrooms! What can I do?

A. While 25 percent of adults are shy, 5 percent to 10 percent have social phobia. These people experience such intense anxiety before and during social interactions or while doing something in front of others that it interferes with work, school and relationships. This fear of negative judgment from others often begins during the early teens, and may lead to depression and substance abuse.

But there's hope. Find a cognitive behavior therapist. Cognitive behavior therapy (CBT) uses exposure therapy, which helps you become more comfortable with scary situations, either imaginary or real.

The first step of CBT introduces you to the feared situation. The second increases the risk for disapproval in that situation to build confidence, allowing you to handle rejection or criticism. The third stage teaches you techniques to cope with disapproval. You imagine your worst fear and develop constructive responses to whatever happens — even disapproval.

Social phobics tend to amplify minor mistakes, and need reassurance that making an error doesn't signify global failure and won't make others reject them.

It's helpful to read up on the subject. Some suggestions: "Dying of Embarrassment: Help for Social Anxiety & Phobia" (New Harbinger Publications, $13.95), by Barbara Markway, Alex Pollard and Cheryl Carmin; and "The Shyness & Social Anxiety Workbook" (New Harbinger Publications, $16.95) by Martin Antony and Richard Swinson.

Finally, nonaddictive drugs such as Celexa, Fluvoxamine, Fluoxetine and Zoloft can be a godsend if therapy fails.

The important thing to realize is that you don't have to live forever with debilitating anxiety whenever you are in the company of fellow humans. Social phobia is a treatable condition.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Hono-lulu, HI 96802; fax 535-8170; or islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.