Living With Social Anxiety: What is Social Anxiety and how to treat it

Living with social anxiety. Calm down, calm down, calm down. But you can’t. Your voice is shaking and your hands are trembling, clutching that piece of paper in front of you like it’s the only thing that can save your life. The black ink seems to be melting right in front of you and the words are disappearing before you get to them. Focus. Yesterday you practiced it about 20 times in front of the mirror. But you can’t.

You can’t focus because there is a huge lump in your throat and the words that you need to say aren’t coming out. You are particularly aware of your sweaty hands, your defensive posture, your unbelievably accelerated heart rate. Are you having a heart attack?

You are very conscious of everything surrounding you. That girl in the front row on your left is on her cell phone; she is probably texting her friend to inform her of how ridiculous you look right now. Those two guys in the back row whispering something to each other, probably talking about you. The teacher is scribbling something down on the paper in front of you, most certainly a comment on how much of a failure you are. You can’t take this anymore. Papers fall on the floor and you hear gasps around the classroom right as the door slams behind you and you run for your life into the nearby bathroom and lock yourself in the stall. In and out. In and out. You are safe now, nobody will get to you in here, nobody knows you are here; your heartbeat slows down eventually and your body stops trembling. The aftershock and embarrassment are excruciating. You will never put yourself through that again.

You are going to escape, you won’t show up during presentation days and you will feel better, you won’t let this happen to you ever again. Living with social anxiety is very difficult and it can become a burden to everyday social and work activities.

Living With Social Anxiety: Definition of Social Anxiety Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, Social Anxiety Disorder is characterized by:

A.  A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.

B.  Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a panic attack.

C.  The person recognizes that this fear is unreasonable or excessive.

D.  The feared situations are avoided or else are endured with intense anxiety and distress.

E.  The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F.  The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.

G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.

People face problems with social anxiety on a daily basis, especially in a contemporary world where all the up-to-date details about people are on display for everybody to see. People face scrutiny and judgment on an everyday basis, but, for some, this “inspection” of their persona gets to be a little too much. Imagine what it is like living with social anxiety and experiencing those unpleasant and negative emotions every time you interact with others.

In the United States, social anxiety disorder is the third largest psychological disorder in the country, after depression and alcoholism.  It is estimated that about 7% of the population suffers from some form of social anxiety at the present time.  The lifetime prevalence rate for developing social anxiety disorder is 13-14%.

Living with Social Anxiety Symptoms

People with social anxiety disorder usually experience significant emotional distress in the following situations:

• Being watched while doing something
• Most social encounters, especially with strangers
• Being introduced to other people
• Meeting people in authority (“important people”)
• Being the center of attention
• Going around the room (or table) in a circle and having to say something
• Being teased or criticized
• Interpersonal relationships, whether friendships or romantic

Living With Social Anxiety: How Does It Develop?

Social anxiety disorder develops due to different reasons. Living with social anxiety is difficult and it may have a genetic and biological predisposition towards the development of the disorder, particularly to do with the high excitation of their sympathetic nervous system and the immediate “fight or flight” effect that they get: they start sweating more and their heart starts beating faster; and they get excited a lot more frequently than a regular person would, others have a traumatic experience that they associate with every time they face the world and social situations.

By escaping from the situation that puts the person into anxiety mode, they feel relief and safety, however, it is one of the worst things that they could do. It is quite ironic, in fact, that what helps the person with anxiety to feel that relief actually puts them back into the vicious cycle of having that anxiety. When they escape they actually reward themselves because they instantly feel better. It’s something that is called negative reinforcement in psychology.

People avoid the negative stimuli (the presentation, parties, social gatherings) and they feel relief and feel better, and the behavior of avoiding that negative stimuli increases. The phrase “facing your fears” is the perfect one for this case.

In order to break the vicious cycle, those who suffer from social anxiety need to start putting themselves into situations that do give them that anxiety in order to start fighting that anxiety. It is a long and hard process but the systematic desensitization to the feared stimuli needs to happen in order to relieve the pains that people with social anxiety experience.

Living with Social Anxiety: Treatments

Living with Social Anxiety can be quiet difficult therefore we always recommend going to a therapist so that they can help ease the symptoms.

The main therapy to treat living with social anxiety is Cognitive Behavioral Therapy. Sometimes antidepressants are used to reduce related anxiety and depression of living with social anxiety. In order to start therapy you should keep in mind that you need:

• An understanding and awareness of the problem,
• A commitment to carry through with cognitive-behavioral therapy even when it is repetitious and difficult,
• Practice, practice, practice to get the cognitive methods, strategies, and concepts deep down into your brain. The idea is to make these cognitive methods become habitual and automatic.
• Participation in a social anxiety therapy group in which you can slowly and gradually work on problems that cause you anxiety in the real world.

There are home remedies that are sometimes effective in reducing symptoms.

• Exercise regularly. Start slowly so that you don’t overdo it. Build up your exercise program bit by bit, and aim for at least 2½ hours a week of moderate exercise.
• Sleep enough. Go to bed early and at the same time every night. Keep your sleep surroundings optimal, quiet and dark. This may reduce distractions and may help you get a good night’s rest.
• Eat a balanced diet by choosing foods low in fat and high in fiber. Avoid foods and beverages that contain caffeine.
• Try some relaxation exercises. Certain breathing exercises and muscle relaxation exercises and mindfulness help reduce anxiety.
• Think Positive. Sometimes excessive negativity might lead to more anxiety and it might make it harder to manage stress. Therefore try to keep your thoughts as positive as possible.

References

U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: https://www.health.gov/paguidelines/guidelines/default.aspx.

American Psychiatric Association (2000). Anxiety disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 429-484. Washington, DC: American Psychiatric Association.

Gale CK, Millichamp J (2011). Generalised anxiety disorder, search date May 2011. BMJ Clinical Evidence. 

Iacoviello BM, Mathew SJ (2010). Anxiety disorder. In EG Nabel, ed., ACP Medicine, section 13, chap. 1. Hamilton, ON: BC Decker

Merikangas Kr, Kalaydjian AE (2009). Epidemiology of anxiety disorders. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1856-1864. Philadelphia: Lippincott Williams and Wilkins.

National Institute for Health and Clinical Excellence (2013). Social Anxiety Disorder: Recognition, Assessment, and Treatment. London: National Institute for Health & Clinical Excellence (NICE). 

Goldin, P.R., Ziv, M., Jazaieri, H., Hahn K., Heimberg, R. (2013, October).  Impact of Cognitive-Behavioral Therapy for Social Anxiety Disorder on the Neural Dynamics of Cognitive Reappraisal of Negative Self-beliefs, JAMA Psychiatry, 2013;70(10):1048-1056.    

Valerie Sidelkivska

Valerie is a psychology student who is trying to pursue a career in Cognitive Neuroscience. She is passionate about the brain and finds it fascinating. She loves learning about new discoveries and research that is going on in the world of psychology and neuroscience. One day she hopes to contribute to the scientific community!