We are social creatures. Our lives involve interacting with those around us usually on a daily basis. There may be times we feel uneasy around others, however actively avoiding interacting with others or social situations is problematic. Social anxiety, or social phobia, is more than simply feeling shy or uneasy in social situations, it is an extreme fear of being negatively evaluated by others. From the outside, individuals with social anxiety may seem withdrawn, shy, or even aloof. In reality, they are suffering from intense fear of being scrutinized by others. This can be present in even the most benign of experiences such as going to the grocery store, going out to dinner, or going to the gym. Considering social interactions are a part of daily life, social anxiety can become very overwhelming. The good news is there are evidence-based strategies to deal with social anxiety. Today we explore what social anxiety is and ways to address it.
When we talk about social anxiety disorder, the biggest indicator is a very intense fear of being negatively evaluated by others. No one likes to feel judged or that others view them negatively, however social anxiety is problematic when it gets in the way of daily functioning and we start changing our behavior to accommodate it. Some of the hallmark symptoms of social anxiety according to the DSM-V include:
Significant fear or anxiety about being in social situations when there is potential of being scrutinized by others. This may consist of: being observed by others while doing normal activities (e.g., eating, working out), performing in front of others (e.g., singing, public speaking), or interacting with others directly (e.g., having a conversation).
Fear of acting anxious in front of others which will result in being negatively evaluated (worry about being embarrassed, getting rejected, etc.).
Social situations almost always provoke anxiety.
Situations are avoided. If they are endured it coincides with intense fear.
The fear/anxiety doesn’t match the actual threat posed by the situation.
The fear or avoidance patterns last for at least 6 months and cause impairments of functioning in important areas of life (e.g., social or occupational).
As with most anxiety disorders, when we fear something we want to avoid it. The avoidance may help in the short term, but actually worsens the anxiety. Over time, the fear of being scrutinized becomes more intense, leading to increased avoidance of social situations and can result in isolation. Individuals with social anxiety may also make decisions to accommodate their fear that are not necessarily in their best interest. This may mean turning down job promotions if they involve more interactions with people or public speaking, avoiding dating even though one would like to be in a relationship, or missing out on opportunities they would otherwise take.
Other Facts about Social Anxiety (SA):
In the United States and Europe, approximately 7% of adults live with SA, however prevalence seems to decrease with age.
SA typically emerges between the ages of 8 and 15.
Blushing is a common physical symptom, which can create even more anxiety.
Self medicating with substances is common (i.e., drinking to ease anxiety in social situations) which can create additional problems.
SA may be present across several types of social situations or be specific to specific situations such as dating, performance fears (e.g., such as having to give speeches or presentations).
The good news is social anxiety responds well to cognitive-behavioral strategies. In fact, a large review study came out in 2014 that examined different treatment approaches and found that CBT (cognitive behavioral therapy) had the best success in treating social anxiety. Even when combined with SSRI (selective serotonin reuptake inhibitors) medications, CBT alone was deemed best. This is empowering! We have the ability to impact our emotions (anxiety) by modifying behavior and thought patterns. It may not feel comfortable at first, but it does get easier over time. Below are some tips and examples of strategies used to address social anxiety.
TIPS for managing social anxiety:
Seek professional help. Working with a professional that offers CBT is a great place to start. They can help identify patterns of avoidance, situations that are problematic, and provide tailored exposure exercises to address the anxiety.
Identify specific situations that make you anxious. Creating a list of all of the situations that make you feel anxious and rate each one using the SUDS (subjective units of distress scale shown above). Once you make your list, a therapist will explore these situations and avoidance behaviors with you and develop a plan to engage in the activities that create anxiety. This is called exposure, and while it may seem uncomfortable at first, it actually reduces distress in the long term. Your therapist may also develop practice exercises to do in therapy which allows you to practice social skills in a safe and supportive environment before doing them in the real world. These may include initiating conversations with strangers or giving a presentation. Once you engage in the activities on your list, you revisit your SUDS scores and see if they have changed.
Take small steps. Once you create your list, tackling lower anxiety events can be helpful. For example if you put talking to a grocery store clerk on the list and rated it a 30 and put giving a presentation at work and rated it 100, then it makes sense to start with the grocery store clerk. Maybe this means you initiate the conversation, ask a question, say thank you and goodbye during an interaction. They key is to personalize the assignment to what makes you feel anxious. As you complete tasks, confidence builds making the more challenging items on the list feel approachable.
Allow the anxiety to calm before leaving a situation. Sometimes we don’t think we are avoiding, but we are in a more subtle way. For instance, if someone who feels very anxious about attending a party goes, feels anxiety increase and then leaves in a heightened state, that can have a counterproductive effect. Alternatively, we want to set ourselves up for success. If you decide to go to the party, it may be helpful to go with a trusted friend to feel supported. If you notice anxiety increase, engage in coping skills (e.g., you language) and wait for the anxiety to come down before leaving the situation.
Challenging automatic thoughts. Just because we think something does not mean it’s factual or true. These thoughts are automatic and tend to make anxiety worse. CBT strategies are used to challenge negative thoughts, which are often not accurate, and explore other more balanced alternative thoughts. Often it is our interpretation of a situation, rather than the situation itself, that increases anxiety and distress. For example, if someone you know passes by you on the street and doesn’t say hello, the automatic thought may be they are intentionally ignoring you, are upset with you, or don’t like you. However, it could also be the case that they were preoccupied and simply didn’t see you.
Accept some discomfort. Learning new coping skills and engaging in exposure exercises isn’t easy at first. It takes courage to face our fears, however if we do, especially when social anxiety is concerned, it can have lasting benefits.
Social anxiety can be a challenge for many individuals and it may go unnoticed by those around them. Many of us don’t have social anxiety, however we can be helpful to those who do. If we are aware that someone feels uncomfortable, we can show kindness by making an effort to talk to them. Try not to put them on the spot or ask a lot of questions, instead, share something about yourself, talk about lighthearted or observational topics, or offer them a compliment. We can all relate to social anxiety on some level perhaps by experiencing some discomfort before giving a presentation or being in a room full of strangers. No one wants to feel distress especially the kind that leaves us feeling disconnected from others. As a therapist, I have worked with individuals who experience social anxiety and it brings me great joy to see my clients improve their quality of life and connect with others. I also recognize the courage it takes to face their fears and trust the process. It isn’t easy, but it is worth it.
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