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An estimated 15 million American adults have social anxiety disorder, and 36% of them suffer with symptoms for 10 years or more before seeking help.1Epidemiological studies have shown that social anxiety disorder is the third leading psychological disorder in the U.S.2 Its onset is almost universally in childhood or adolescence.3 Social anxiety disorder(also known as social phobia), like all mental health disorders, can wreak havoc on the lives of those who suffer from it. It often involves significant shyness and a debilitating fear of certain types of social situations, making it particularly disruptive. If left untreated, the consequences can severely impact every aspect of life, often leaving people feeling hopeless and depressed.
Symptoms vary from person to person, but the following are some of the most common for people with social anxiety disorder.1,2
Social anxiety disorder causes many, if not most, social interactions to be extremely uncomfortable. The mere thought of meeting new people or speaking in front of others triggers significant anxiety. As a result, most people decide to withdraw and isolate themselves. When people summon the nerve to socialize, their anxiety often undermines well-meaning efforts. The discomfort and awkwardness they exhibit makes people around them feel uncomfortable. Interactions that are less than satisfactory cause pain and embarrassment — and tend to be indelibly etched in the person’s memory.
Typically, people with social anxiety disorder already have low self-esteem, although suffering from the disorder itself can lead to significantly low self-esteem. Every humiliating or embarrassing interaction reinforces one’s self-doubts and beliefs about being a flawed human being. The longer one suffers from social anxiety disorder, the more deeply ingrained these negative thought patterns become.
Social anxiety prevents people from reaching their full potential and attaining goals. A person could do an excellent job at work, but is afraid to talk to his boss about advancement possibilities within the company. He is overlooked for the promotion and it goes to a colleague who demonstrates self-confidence and assertiveness. Achieving milestones in life involves a good degree of risk-taking, but doing so is too frightening a prospect for people with social anxiety. Instead, they choose the path of least resistance, which may give others the impression that they are unmotivated or lack ambition.
Most people with social anxiety disorder subject themselves to a harsh inner dialogue. Self-deprecating thoughts (e.g. “Why can’t I be like everyone else?” or “Why am I such a loser?”) run rampant and mental self-flagellation can be brutal. People with this disorder start believing these damaging thoughts, which reinforces and perpetuates the fear of social situations.
A large part of developing good social skills comes from interacting with others based on feedback received. When people act appropriately, they are rewarded with positive interactions from others. Conversely, when they behave awkwardly, show ineptitude, or say or do inappropriate things, there are negative consequences. While social interactions often involve more complex factors, accurately interpreting “feedback” is much easier for some people and a struggle for others. Social anxiety limits interactions, therefore people with this disorder never get the opportunity to develop finely tuned “people” skills.
One of the greatest fears is being humiliated, scrutinized or criticized by others. Therefore it is not uncommon for people with this disorder to have a distorted view of interactions with others. Constructive feedback from a boss may be perceived as harsh criticism. A person may misinterpret group laughter as a personal attack. This hypersensitivity causes people to see everything from a highly skewed viewpoint. Little things that others can easily brush off are very uncomfortable or hurtful.
In order to successfully navigate life, some degree of assertiveness is necessary. Although a lot of people have difficulty with this, for people with social anxiety, the concept, much less the action of asserting oneself, seems nearly impossible. Sadly, a lack of assertiveness can lead to relationship problems, lost opportunities and a host of other problems.
About 20% of people with severe social anxiety also suffer from alcohol abuse or substance dependence. A recent study found that the two disorders have a stronger connection among women. Alcohol is often abused because it helps intensely shy or awkward people feel less inhibited. A few drinks may “loosen people up” and transform them from scared wallflowers into social butterflies — perhaps even the life of the party. Alcohol or other substances also provides a temporary escape to numb the emotional pain associated with social anxiety disorder.4
More than 90% of suicidal deaths involve a diagnosable illness such as severe clinical depression or other mental disorder in combination such as anxiety disorders, substance abuse and other treatable mental disorders.5 A prospective study of more than 3,000 patients (ages 14 to 24) showed that adolescents with social anxiety disorder have a higher risk of developing depression as young adults. Furthermore, in adolescents who have both depression and social anxiety disorder, there is a higher risk of subsequent depressive illness with a greater number of suicidal thoughts and attempts.3
SAD can be seriously debilitating and professional treatment is often a necessity. Many people with SAD also benefit from practicing self-help strategies to ease some of the crippling side effects of the disorder. These techniques are often incorporated into formal therapy.
Setting incremental goals can set the stage for bigger leaps into socialization later on. Instead of planning on spending an entire evening at a party, tell the hosts you will drop by for a little while – if you feel comfortable, you can always stay longer. For example, try committing to attend a party for an hour versus forcing yourself to stay the whole night. Or spend time in social settings with supportive and understanding people versus a huge group of complete strangers. When you set and attain goals, even small ones, the sense of accomplishment can help you take bigger steps toward overcoming social anxiety.
Choose a gathering in which you know and feel comfortable with the setting and at least some of the people attending. When you arrive, find a quiet place to gather your thoughts. Talk with a few close friends before diving into the full party crowd. Surrounding yourself with people you know or with whom you’re comfortable can serve as a buffer.
When you feel anxious, repeating a calming word or phrase helps refocus attention from undesirable anxious thoughts to a calm, reassuring state of mind. Simply choose any word you like, even a made-up one. In much the same way as a mantra, slow breathing can be calming, energizing and help you feel grounded in the present.
Knowing you can easily leave a situation can help alleviate social anxiety because you won’t feel trapped in a situation. Choose to drive yourself rather than with friends or if you did carpool, having the Uber or Lyft app on your phone can ensure a quick getaway if the situation becomes too uncomfortable.
Being a good listener reduces the feeling you need to steer the topic of conversations. Gravitating toward the proverbial extrovert (life of the party) who needs to entertain people is another tactic. They love a good audience and will appreciate when you laugh appropriately at their jokes and nod in agreement.
Alcohol is often abused because it helps intensely shy or awkward people feel less inhibited. Drinking excessively in a social situation may feel like it loosens you up, but the risks are too high. Alcohol increases anxiety, irritability and depression and may lead to a co-occurring substance use disorder and major depression.
More than 1,000 outcome studies have been done on the use of CBT as a primary and adjuvant therapy for psychiatric disorders, and it has been found to be highly effective for social anxiety disorder.6 Social skills training may be incorporated into CBT, focusing on building stronger conversational and listening skills, as well as assertiveness. Some psychiatrists prescribe antianxiety medications or antidepressants, but medication alone is generally not as effective as psychotherapy, especially when it is the only treatment.
Many studies have shown cognitive-behavioral therapy (CBT) is superior to other psychological treatments and/or combined treatment with medications. Research on alternative options for individuals who do not respond efficaciously to CBT continues. Among these are metacognitive therapy (MCT) and mindfulness-based cognitive therapy (MBCT).
CBT focuses on cognition rather than metacognition and is based on the theory negative beliefs (e.g. “I’m a failure”) give rise to self-processing and social anxiety. The metacognitive model theorizes that metacognitive beliefs (e.g. “I cannot control my thinking”) are a more significant contributing factor in SAD.
A small-scale 2018 study found MCT substantially reduced all measures of social anxiety symptoms at post-treatment and at six-month follow-up. Moreover, MCT appeared to be associated with changes in underlying cognitive style (e.g. worry and self-focus attention) and metacognitive beliefs implicated in the cause and maintenance of SAD, according to the metacognitive model. Researchers concluded MCT appeared to be a suitable treatment associated with positive outcomes for individuals with different presentations of SAD.
Recent evidence suggests that unlike other anxiety disorders, SAD displays unique characteristics of depressive symptoms and low positive affect (PA). Past research suggested MBCT may mitigate PA deficits and this approach has been gaining empirical support for use in anxiety and mood disorders. A small 2018 pilot study suggested MBCT may be efficacious in mitigating social anxiety symptoms, and this therapeutic effect may be associated with improvements in PA. Due to the small sample size, researchers noted the need for larger-scale studies to further explore the efficacy of MBCT in the treatment of SAD, as well as generalized anxiety disorder.
If you or someone you love is suffering from social anxiety disorder, rest assured that there is hope. Life is too short to suffer from the serious emotional problems related to this disorder. Contact a mental health professional today for an evaluation. Proper treatment can make a world of difference, opening up a whole new life for people who have suffered in silence from this treatable disorder.