Social anxiety, also known as social phobia, can be described as a fear of social situations or of interacting with people other than one’s close friends and family. When social anxiety is persistent or has a detrimental effect on one's daily life, therapy may be helpful in addressing this issue and exploring treatment and coping methods.
The third largest mental health issue in the world, social anxiety is reported to affect nearly 7% of the population at any given time, and almost 13% of the population will experience social anxiety at some point in their lives. The condition is treatable, but it does not typically resolve without treatment. Situations that may trigger social anxiety include dates, job interviews, parties, business meetings, and public speaking. Some individuals might also experience difficulty in other public situations, such as meeting with figures of authority or reading aloud in class.
There are two types of social anxiety: generalized and non-generalized. A person with generalized social anxiety tends to avoid most social situations out of fear of negative judgment, while a person with non-generalized social anxiety typically does not experience a significant amount of anxiety when not in a certain type of social situation, such as going on a date or attending a party.
Most people will experience some anxiety about social interactions in their lives, and nearly all individuals are likely to experience some concern over what others think of them and worry about being liked by others. However, when this anxiety is severe and persistent, social interactions often become difficult and unpleasant, and individuals may become unable to make real connections with others, although they wish to do so.
Agoraphobia, a phobia associated with anxiety, may often be considered to be similar to social anxiety. However, a person with agoraphobia fears large or unknown public places, often to the point of avoidance, out of worry that a panic attack may occur. The phobia is linked to avoidance of shame and embarrassment, but it is typically not a social phobia.
Social anxiety is often considered to be more than a fear of interacting with others. The primary fear of those experiencing social anxiety tends to be the fear that others will judge them negatively. The condition may be mild, but when it is severe, it often can have a significant negative impact on one's quality of life. Those who have social anxiety often want to enjoy social interactions, make friends, and be included in group activities, but because their anxiety prevents them from doing so, they may seem withdrawn, shy, or disinterested in social activities.
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A person experiencing social anxiety may exhibit symptoms such as increased sweat, shortness of breath, faintness, increased heart rate, or shaking. Anxious thoughts, such as "No one will like me," or "I don't belong," are also common. Those with social anxiety might also apologize often, seek frequent reassurance from others, spend a significant amount of time preparing for social situations, avoid entering social situations, or leave situations abruptly.
Social anxiety is believed to occur as a result of a combination of factors. A person's genes, brain, and life experiences are all believed to play a part in the development of social anxiety.
Genes: An individual who has a family history of anxiety may be more likely to develop social anxiety or another form of anxiety.
Brain: Studies have shown that some areas of the brain, such as the amygdala, are sometimes more active in those who experience social anxiety.
Life experience: People who consistently find themselves in situations where they experience a feeling of difference, inadequacy, or negative judgment may be more likely to develop social anxiety. Additionally, those who experience consistent negativity in social situations often come to believe that all social situations will proceed in the same manner and come to avoid and fear them as a result. Social anxiety may also stem from feelings and beliefs gained in childhood that may have caused feelings of inadequacy, incompetence, worthlessness, disempowerment, or shame.
Social anxiety is a treatable condition. Therapy is often very effective at addressing the concerns experienced by those with social anxiety. One form of therapy shown to be effective at treating the condition is cognitive behavioral therapy, in which the therapist and the person in treatment work together to develop strategies to overcome anxiety and establish new skills for the individual to continue to address the condition individually. Cognitive restructuring, during which the person in treatment works to identify negative beliefs in order to combat them, is often a helpful way for a person to examine the inner self and any beliefs that may contribute to social anxiety.
Social skills training may also take place in therapy, giving those in treatment stronger conversation and listening skills as well as practice with assertiveness.
Exposure to both social situations that a person tends to avoid (in vivo exposure) and disliked sensations that occur as a result of one's anxiety (interoceptive exposure) may also be helpful in reducing social anxiety. When one is frequently exposed to an intimidating situation or unpleasant sensation with no negative results, the anxiety regarding that situation or feeling will often diminish.
Some psychiatrists may prescribe antianxiety medications, or in some cases, an antidepressant, along with therapy. However, medication has been shown to not be as effective as therapy at treating social anxiety, especially when taken alone.
Recent research shows that those experiencing social anxiety who performed random acts of kindness for others experienced a reduction in their levels of social anxiety. Because kindness often generates a positive result, when those experiencing anxiety offered to do a favor or good deed for someone else, the positive response they received seemed to help alleviate some symptoms of anxiety and made those individuals more likely to engage socially again.
- Therapy to treat fear of public situations: Ezekiel, 29, seeks help for his fear of going out in public. He experiences significant anxiety when he notices others looking at him in public places, and he does any necessary tasks quickly, avoiding conversations with strangers whenever possible. He tells his therapist he "just knows" he will say the wrong thing and embarrass himself. Although Ezekiel has been taking an anti-anxiety medication for a few months, he reports no improvement. The therapist works with Ezekiel to uncover the origins of his fears, and before long, he is able to discover feelings of anger toward his parents—who frequently reprimanded him in public in his youth, often for no great offense—as well as feelings of shame and a lingering fear of his own inadequacy. Ezekiel's therapist helps him work through these feelings, and, encouraged by his therapist, Ezekiel begins to venture out in public for longer periods of time, accompanied by his best friend. Eventually this exposure helps to reduce Ezekiel's anxiety, and he finds himself able to speak to strangers and make eye contact with them. He continues in therapy in order to further improve.
- Treating feelings of rage experienced in crowds: Kay, 59, has a long history of experiencing severe anxiety and feelings of rage when in crowds, and she has been in therapy off and on for many years to treat this anxiety. Her current level of stress at work and some anxiety about her age have triggered an increase in panic attacks, and she finds herself running home after work and locking herself in her apartment all night, where she reads or watches movies in bed, seeing and talking to no one. Compounding her anxiety is a sense of shame about her feelings and actions: She has always considered herself to be a strong person and is embarrassed that she is afraid of crowds and public spaces. Kay has little insight into her behaviors, knowing only that when at home she feels calm and when in public she panics. Her previous therapist recommended she take a disability leave, but after a week at home her anxiety gave way to depression and it was even harder to go out than it had been when she was working. Her new therapist encourages Kay to spend an hour outside every night, even if she has a panic attack. The therapist recommends against medications and points out the irrational nature of Kay’s fear, praising and encouraging Kay every time she makes an appointment, as doing so requires her to walk for several blocks in a crowded part of town. Kay begins to unravel her attitude toward other people: She deeply fears their judgment and resents and judges them as a defense against shame. She recognizes that working on her self-image, rather than avoiding frightening situations, is what may be able to help her regain confidence and function normally.
- Dallas, M. (2015, July 10). For those with social anxiety, acts of kindness may be therapeutic. Retrieved from http://health.usnews.com/health-news/articles/2015/07/10/for-those-with-social-anxiety-acts-of-kindness-may-be-therapeutic
- Jacobs, A., & Antony, M. (n.d.). Social Anxiety Support. Retrieved from http://www.socialanxietysupport.com/disorder/#treatassess
- Richards, T. (n.d.). Social Anxiety Fact Sheet: What is Social Anxiety Disorder? Symptoms, Treatment, Prevalence, Medications, Insight, Prognosis. Retrieved from http://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis