Social Anxiety — Zencare

Social Anxiety

From time to time, everyone feels nervous about social situations like giving an important presentation in front of colleagues or going on a first date. Other people might feel just shyness or have occasional worries about social situations like attending a party. This is completely normal, and nothing to be worried about.

However, some people have an extreme fear of social situations that is overwhelming and affects their everyday activities and daily lives. They may dread or worry excessively about social situations for weeks, fearing that they will do something embarrassing or be rejected, and will go to great lengths to avoid the situations or otherwise endure it with distress.

This intense, debilitating experience is called social anxiety disorder (previously called social phobia). Social anxiety disorder is a type of mental health condition in the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), which is the guide used by mental health professionals for diagnosis.

Many people develop social anxiety disorder; however, it is not always clear how. There is some evidence to suggest that social anxiety may have some genetic factors that run in families, although other risk factors indicate a combined effect from multiple biological and environmental factors that play a role in developing social phobia.

Without treatment, social anxiety disorder can develop into other mental health conditions including major depression or avoidant personality disorder and is often accompanied by substance abuse problems, poor social skills, and low self-esteem. Fortunately, social anxiety disorder is a relatively common problem that can be treated successfully with many different approaches. Some of the ways to overcome social anxiety disorder will be described below.

Social anxiety disorder symptoms

People with generalized social anxiety disorder have a mix of physical, behavioral, and psychological symptoms that occur in connection with intense fear of social interactions and situations. The types of feared situations and outcomes can vary widely from person to person but will always cause intense anxiety as a fear response.

More than just extreme shyness or self-consciousness, some examples of feared social situations that people with social anxiety disorder may struggle with include:

  • Meeting new people
  • Eating in front of others
  • Speaking in front of others
  • Parties and other social functions
  • Performance tasks, like giving a presentation

Physical symptoms of social anxiety disorder that are related to irrational fear of social situations include:

  • Heart racing
  • Blushing
  • Muscle tension
  • Sweating
  • Feeling lightheaded or nauseous
  • Shaking
  • Panic attacks

Thoughts related to feared outcomes of social interaction and situations might include:

  • Worrying that you are going to embarrass or humiliate yourself
  • Worrying that people won’t like you or will reject you
  • Worrying that you’ll be negatively evaluated, people will judge you or think badly of you
  • Worrying that you’ll sound stupid, incompetent, or boring
  • Worrying that people will notice the physical symptoms of anxiety (for example, that people will see you blushing or sweating)
  • After the event, you continue to worry about it and relive the details

Behavioral symptoms of social anxiety disorder may include:

  • Avoiding social situations that trigger anxiety
  • Using alcohol or other substances to cope with social situations
  • Avoiding eye contact
  • Leaving the situation triggering the anxiety

If some of these symptoms have been intense, persistent, and affect your ability to go about your daily life for six or more months, you may have a social anxiety disorder.

Prevalence of social anxiety disorder

Generalized Anxiety Disorder is one of the most common categories of mental health issues, and social anxiety disorder is no exception. Survey data suggests that around 12.1% of Americans experience social phobia at some point during their lives (1).

Despite the availability of very successful treatment options, relatively few people with social anxiety disorder receive treatment. Data from one survey suggested that over 80% of those with social anxiety disorder do not receive treatment (2). And those that do receive treatment were related to other specific psychiatric disorders.

How to treat social anxiety disorder

People with social anxiety disorder are often hesitant to seek help, however, it’s important to take this step to successfully overcome your significant anxiety and persistent fear. If you think you might have social anxiety disorder, consider one or more of the following options for treating social anxiety disorder:

  • Therapy: Therapy can really help people learn strategies for managing and reducing fear or anxiety. Both individual and group therapy can be beneficial. See more tips below on types of therapy and selecting a therapist.
  • Check-up: Talk your social anxiety symptoms over with your doctor to explore and rule out any underlying medical conditions that could be contributing. This is important, because some symptoms could be due to either anxiety or a physical cause.
  • Medication: Some people find anti-anxiety medications to be a helpful part of treatment, as they can help relieve anxiety symptoms. Generally, SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Selective Norepinephrine Reuptake Inhibitors) are effective to treat depression and are often used to treat other anxiety disorders. To explore the role of medication in your own treatment, seek an evaluation from a psychiatrist, who can provide an opinion and prescribe. It’s important to consider the risks and benefits. If you decide to include medication, take it carefully, as directed by your psychiatrist.
  • Hotlines: If you’re having thoughts of suicide or need immediate support, call the National Suicide Prevention Hotline at 1-800-273-8255.
  • Online and self-help resources: Exploring self-guided resources online or reading about the experiences of others can also be helpful in treating social anxiety disorder. Online, you’ll also be able to learn relaxation techniques, such as progressive muscle relaxation, to help manage your anxiety.
  • Self-care: Pay attention to your diet, try to maintain a regular sleep pattern, and exercise regularly. Find activities that you enjoy and make time for them in your schedule. Such lifestyle factors can help to regulate your mood and anxiety (3,4,5).
  • Social support: Talking to a family member and friends about your experiences and feelings can help. It can be hard to do but maintaining strong personal relationships means that these people are better placed to support and encourage you, once they understand how you feel.
  • Support groups: The Anxiety and Depression Association of America website is a good place to look for social anxiety support groups in your local area. Sharing experiences and learning in a supportive and safe social environment can be helpful.

Therapy for social anxiety disorder

Many effective types of therapy can help treat social anxiety disorder. Common evidence-based therapeutic approaches include:

  • Cognitive Behavioral Therapy (CBT): CBT helps us to become aware of and change unhelpful thinking patterns and behaviors that perpetuate social anxiety disorder. Breathing and relaxation techniques can help manage the physical symptoms of social anxiety, while techniques like systematic desensitization and exposure therapy help us to become less uncomfortable when we feel feal or anxiety, and more comfortable with the situations that usually trigger anxiety. CBT is generally considered to be the best treatment for social anxiety disorder.
  • Mindfulness Practices: Mindfulness helps us to be self-conscious and aware of the sensations of anxiety without automatically reacting to them as problematic. It also encourages a focus on the present moment, rather than getting caught up in the thinking patterns and environmental factors that fuel social anxiety.
  • Acceptance and Commitment Therapy (ACT): ACT involves components of both CBT and mindfulness as well as other strategies to help us take an acceptance approach to respond differently to social phobia.
  • Interpersonal Therapy (IPT): The focus in IPT is on communication and interpersonal skills training. Participants are encouraged to build their social network and improve poor social skills. This may be individual therapy or in a support group setting.
  • Psychodynamic Therapy: Psychodynamic therapy involves the exploration of past experiences and how they influence current patterns of thought, emotion, and behavior. This can help people who want to gain insight into how their past has shaped their experience in developing social anxiety disorder today.

It’s important to consider different therapy types and how they resonate with you before choosing. If you’re unsure, your prospective therapist is a great person to seek advice from.

What to look for in a therapist for social anxiety disorder

There are several factors to keep in mind when selecting a mental health professional, including:

Qualifications: With so many different providers available, it can be difficult to decide which type of mental health professional to see. The most important thing is to look for a currently licensed therapist.

That said, if you think anti-anxiety medication might be needed, make sure you see a psychiatrist. This particular type of mental health professional is able to prescribe.

Specialization: Look for a therapist who has experience and specialized training in social anxiety disorders or the therapy type that resonates with you. They will often include this information on their website or online profile.

Personal fit: The trusting relationship between you and your therapist, known as the “therapeutic alliance,” has a huge impact on the efficacy of therapy. Finding a therapist you feel comfortable with is particularly important for people who experience social anxiety, who may feel highly anxious about working with a therapist.

The best way to judge how you might feel about a therapist is to ask for a preliminary phone call. This also enables you to ask about their experience and what therapy with them will be like. Try to speak to a few different therapists before deciding on a provider.

Sources and references

  • (1) Harvard Medical School, 2007, National Comorbidity Survey (NCS). Retrieved online as PDF at https://www.hcp.med.harvard.edu/ncs/ftpdir/table_ncsr_LTprevgenderxage.pdf.
  • (2) Grant, B.F., et al., 2005, “The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions”, J Clin Psychiatry, 66(11). Abstract retrieved online at https://www.ncbi.nlm.nih.gov/pubmed/16420070
  • (3) Walsh, R., 2011 “Lifestyle and Mental Health”, American Psychologist, 66(7). PDF accessed online at https://escholarship.org/content/qt0786x6tw/qt0786x6tw.pdf
  • (4) Hearing, C.M., et al., 2016, “Physical Exercise for Treatment of Mood Disorders: A Critical Review”, Current Behavioral Neuroscience Reports, 3(4). Accessed online Deceber 2019 at https://link.springer.com/article/10.1007/s40473-016-0089-y
  • (5) Reid, K.J., et al., 2006, “Sleep: A Marker of Physical and Mental Health in the Elderly”, The American Journal of Geriatric Psychiatry, 14(10). Accessed online December 2019 at https://www.sciencedirect.com/science/article/abs/pii/S1064748112608628
  • National Health Service, United Kingdom, “Social anxiety (social phobia)”, retrieved online at https://www.nhs.uk/conditions/social-anxiety/
  • National Institute of Mental Health, “Anxiety Disorders”, retrieved online at https://www.nimh.nih.gov/health/topics/anxiety-disorders/
  • British Psychological Society, National Collaborating Centre for Mental Health (UK), 2013, “Social Anxiety Disorder: Recognition, Assessment and Treatment”, chapter retrieved online at https://www.ncbi.nlm.nih.gov/books/NBK327674/