Many of us get nervous when it comes to public speaking. We might feel slightly frazzled or shy in social situations. We might even avoid large gatherings or unfamiliar social spaces. But what does it mean if you have a constant fear of social situations? What if you worry about events for days or weeks before they take place? What if your avoidance of social situations affects your career, schooling, or relationships? What if your anxiety is affecting you on a physical level, causing you to become sweaty or nauseated around others? If you have experienced these symptoms, you’re not alone. According to the National Institute of Mental Health, recent statistics suggest about 12.1 percent of U.S. adults experience social anxiety disorder at some point in their lives. There are a few risk factors that increase your chances of having social anxiety disorder, including being divorced or widowed and experiencing stressful life events. Women and girls are more likely to experience social anxiety disorder. “Having negative social experiences and growing up in stressful environments are two environmental factors that can contribute to the development of social anxiety disorder,” says Amy Serin, PhD, a neuropsychologist and founder of The Serin Center. “As with most diagnoses, there is a dynamic interplay between genetics and environment that can determine the eventual development of a disorder.” Fortunately, Serin notes, social anxiety disorder can be effectively treated. Here’s what you need to know.
What exactly is social anxiety disorder?
Social anxiety disorder isn’t simply about being shy or introverted, although a socially anxious person may appear that way to others. Social anxiety disorder typically leads people to avoid social situations entirely, or to have great difficulty in those situations. In some cases, the anxiety stems from being afraid of how people perceive them. “Introverts simply recharge their energy during solitude but can have no anxiety when dealing with others. There is a preference for being alone versus being with others,” Serin says. “Shyness may be a less severe form of social anxiety and occurs when a person may clam up or prefer to avoid social interaction in general.” Social anxiety disorder, on the other hand, includes severe stress responses to social situations. “Social anxiety disorder typically presents as marked fear in social situations, above and beyond what one would typically expect given the situation,” says Jana Scrivani, PsyD, a licensed psychologist with expertise in the diagnosis and treatment of social anxiety. Before a psychologist diagnoses someone with the disorder, certain criteria must be met. Psychologists use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to inform their diagnosis. “In order for a fear of social situations to be considered a disorder, it must interfere in someone’s life,” says Scrivani. In other words, the social anxiety must make it difficult for someone to function to be considered a disorder. “Additionally, the distress needs to persist for at least six months, and not be attributable to something else,” she says. For example, if someone avoids school because of a long-term illness or an unpleasant encounter with a particular teacher or classmate, that’s not attributable to social anxiety. Anxiety disorders can also be accompanied by a number of physical symptoms including heart palpitations, excessive sweating, shaking, hot and cold flashes, shortness of breath, dizziness and lightheadedness, and trouble swallowing. These might seem like symptoms of the flu, but are often linked to anxiety. Anxiety results in these physical experiences by producing a flight-or-fight stress response in our bodies, which in turn affects our hormonal system and ultimately impacts our physical health.
Can social anxiety disorder be treated?
Social anxiety disorder is difficult to live with, but it can be treated successfully, says Scrivani. “I’ve worked with many people throughout the years who have made significant strides in overcoming social anxiety!” she says. “The first step would be to look for a provider who is experienced with social anxiety disorder.” Seeing a therapist is often the first step in managing social anxiety. One of the most effective treatments for social anxiety disorder is cognitive behavioral therapy (CBT), says Lara Fielding, PsyD, EdM, an Los Angeles-based clinical psychologist and author. CBT is commonly used because numerous studies have shown that it’s an effective treatment for social anxiety disorder. CBT teaches people different ways of thinking, understanding, and reacting to situations. Another effective form of therapy for social anxiety disorder is acceptance and commitment therapy, or ACT. This involves linking the client’s values with the necessity to persist through the anxiety. Their values are used to motivate them to work through their anxiety. Exposure therapy is usually used in combination with CBT to treat social anxiety disorder. Fielding explains that during CBT, a therapist might encourage their client to create a hierarchy of feared social situations. These situations range from mildly anxiety inducing to unbearably anxiety inducing. The therapist might then guide them to gradually expose themself to those situations, starting with the least worrisome situation. “The client must stay present to the anxiety until the peak has passed, without engaging in any reassurance-seeking or other safety behaviors, until the anxiety begins to extinguish on its own,” Fielding says. After repeated exposures, the anxiety begins to subside and the client starts to feel more in control. Fielding also notes that mindfulness-based CBT is incredibly effective for the treatment of social anxiety disorder. With anxiety disorders, you experience primary reactions and secondary reactions. The secondary reactions involve you fearing your anxiety and wanting to avoid that discomfort. “In mindfulness the aim is to practice letting go of the reactivity in such a way that the primary pain is accepted, so the secondary reactivity does not take hold.” Fielding says. You’ll take note of your heart pounding, your instinct to run away, and so on. You’ll accept this discomfort and learn that it doesn’t have to dictate your actions. “Mindful awareness of the relationship between the thinking, feelings, and action impulses begins to paradoxically reduce the secondary reactivity,” she says. There are other forms of therapy for social anxiety, such as psychodynamic therapy. However, Fielding says these forms haven’t been studied thoroughly enough. “This type of therapy has little or no evidence for being effective with serious anxiety disorders,” she explains. “CBT and ACT have multiple randomized controlled trials—the gold standard of science—showing them to be effective.” Serin reiterates that social anxiety disorder can be treated. “At Serin Center, we have treated hundreds of individuals with social anxiety disorder with a combination of neurofeedback, therapy, and bilateral alternating stimulation,” she says. Neurofeedback involves mapping brain activity and then using that to inform therapy, while TouchPoints are wearables that vibrate on alternating sides of the body, altering the body’s flight-or-fight response. This soothes the wearer when they’re feeling anxious. Anxious about seeing a therapist? Do some research first to put your mind at ease. Ask for referrals from friends. Consider online therapy options like Talkspace or BetterHelp if the idea of a face-to-face conversation is too intimidating. Remind yourself that it’s an investment in your life: You are worth your own effort.
Other Ways to Manage Social Anxiety Disorder
While therapy should be your first port-of-call when it comes to addressing social anxiety disorder, it’s great to have other stress management techniques, too. These coping skills can help you in between sessions or while you’re still looking for a therapist, but they can’t replace a professional healthcare provider altogether. Here are some techniques to consider.
- Practice deep-breathing exercises to help you manage your anxiety. This skill can help you soothe yourself in seconds, whether you’re at home, in the bathroom at the office, or in a quiet room at a party.
- While alcohol or drugs can seem like great social lubricants, relying on them should be avoided. “Resist the urge to use alcohol or other non-doctor-prescribed drugs to manage social anxiety,” Scrivani suggests. “Those coping mechanisms only serve to mask the anxiety, and instead of realizing that you can face a particular situation, you’ll attribute your ability to cope to the alcohol or drug.”
- While your intuition might tell you to avoid social situations, this avoidance makes it worse. “Avoid the avoidance trap!” Scrivani says. “The longer you avoid an anxiety-provoking situation, the more fear and anxiety that situation will elicit the next time you’re faced with it.”
- Remember that, in most social situations, people aren’t scrutinizing you. Gently remind yourself that people are usually self-conscious—they’re thinking about themselves, not you, Scrivani says.
- Consider joining support groups for social anxiety. These groups could be online or in-person. Yes, it seems ironic to suggest a meetup to people with social anxiety, but it can sometimes be comforting and healing to speak to those who have the same fear as you while dealing with that fear. Try meetup.com to find a local support group.
- If you’d like to talk to someone, consider calling an anxiety hotline. A trained responder can listen to your concerns and help you manage your anxiety. Here’s a helpful list of international hotlines, including some that are anxiety specific.
- In some cases, medication might be prescribed as a treatment for social anxiety disorder.
While having social anxiety might make you feel hopeless, it can be effectively managed. “It’s important to understand the diagnosis is not a life sentence of anxiety, avoidance, and narrowing down of potential to avoid social interaction,” Serin says. “It’s important to understand that there is hope for people with social anxiety disorder and there are many professionals who can help.”
How to Support a Child Who Has Social Anxiety
Social anxiety can manifest at a young age. Some statistics show that about 9.1 percent of U.S. teenagers ages 13 and 18 have social anxiety disorder. It’s important that parents are aware of the signs so that they can support their children who might have the disorder. Young children can experience significant struggles to reach out for help, as they might not have the vocabulary to explain how they feel. The most notable sign of social anxiety disorder is if your child tends to avoid social situations. Another is if they seem particularly uncomfortable or noticeably quiet in social situations. Fielding says that the child might even become angry when they have to engage socially, especially in environments outside their comfort zones. “The most important and effective thing anyone can do to help a loved one struggling with social anxiety (or any mental health struggle) is start from a position of understanding and validating the difficulty the other person is having,” says Fielding. “Loved ones can often invalidate the person struggling by telling them to just relax or trying to reassure them too often.” In other words, you might want to remind your child that there’s nothing to be worried about—but if you do this too often, it might come off as dismissive and invalidating. Another thing you shouldn’t do is contribute to your child’s avoidance of social situations, Fielding says. The more someone avoids an anxiety-inducing situation, the scarier the situation can become. While avoiding anxiety-inducing situations seems like a quick fix, it can wind up reinforcing the anxiety. Instead, Fielding suggests responding compassionately to your child and helping them habituate to social situations—that is, helping them get used to interaction by gradually increasing their exposure. If you’re going to a family event, for example, don’t expect them to socialize for hours right away. Go for only an hour or two. Afterward, point out how they were able to handle it. Use this achievement to praise them rather than to invalidate their initial fears. If their anxiety seems severe, consider taking them to see a counselor or a psychologist who works specifically with children and adolescents. The counselor can treat your child while giving you helpful pointers for supporting them. The most important thing to remember about social anxiety disorder is that it’s treatable. It is totally possible to manage the symptoms of social anxiety disorder so that you can live a full life without anxiety interfering. And, while therapy can be a difficult experience, it’s worth it—after all, your mental health is worth the investment.