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Social Anxiety Disorder: Symptoms, Self-Help & Treatment
A lot of people become nervous or shy in situations when they should give a speech or go through a job interview. But there is something more to social anxiety than just shyness or situational nervousness. In the case of social anxiety, the fear of being mocked or failing is so strong that you avoid the situation triggering it. Regardless of how shy you become and how unbearable the physical sensations are, it’s in your power to overcome your social anxiety and restore this part of your life.
What is social anxiety?
Social anxiety is a disorder when the affected person experiences acute fear of definite social situations. This involves especially the unknown situations and the circumstances when you feel that you’re being closely watched or judged. You are so scared of them that sometimes you feel anxious just thinking of them or put a lot of effort to avoid them.
At the root of social anxiety disorder is fear of being analyzed and judged or being put in an awkward position in public. You are probably scared that people will think badly of you or you’ll be inferior in comparison with others. And even though you most likely understand that your fear of being judged is at least partially irrational and exaggerated, you can’t get rid of social anxiety.
Social anxiety and body dysmorphic disorder
Body dysmorphic disorder (dysmorphophobia) is an anxiety disorder when the affected person is preoccupied with a real (but exaggerated) or imagined physical defect. It is quite widespread among the people struggling with social anxiety or social phobia. Though a lot of people are not completely satisfied with their physical appearance (someone has a nose too big or lips too small), their small imperfections don’t interfere with their daily activities. But a person with a body dysmorphic disorder is obsessed with their real or imagined abnormality to such an extent that they start avoiding other people and social situations. Such isolation sometimes even leads to suicidal thoughts and attempts. However, just as in the case of social anxiety disorder, you can do a lot to overcome the negative ways of thinking related to dysmorphophobia. Take your life back under control!
The widespread social anxiety triggers
Though sometimes it seems you are the only one suffering from this problem, social anxiety is in fact very common. Some people experience anxiety in the majority of social situations and situations of public action – such a problem is called generalized anxiety disorder. Other people’s anxiety is mostly related to some definite social situations, such as talking to a stranger, communicating at a party or speaking in public.
What triggers social anxiety?
At work: public speaking, business meetings, talking to “important” people or authoritative figures, criticism.
At school: performing tasks in front of the class, writing a test, bullying.
At a public place: going to a public restroom, eating and drinking in public, going to a party or other social event, new acquaintances, small talk, performing on a stage.
Other situations: the need to call someone, being supervised while doing something, a date, being the center of attention.
Signs and symptoms of social anxiety
Your nervousness in some kind of social situation doesn’t necessarily mean that you have a social anxiety disorder. A lot of people feel shy or embarrassed from time to time but these emotions don’t interfere with their normal functioning. A social anxiety disorder, on the contrary, disrupts the person’s daily schedule and leads to unthinkable distress.
For example, it’s completely normal to feel anxious before a performance or public speaking. But if you have a social anxiety disorder, your worries begin a few days before the event, you fall ill in order not to attend it, or you are shaking so badly during the speech that you can hardly say anything at all.
The symptoms of social anxiety disorder
- You feel too shy or nervous in everyday social life;
- Intense fear during a few days, weeks, or even months before some kind of social event;
- Obsessive thoughts about the things causing anxiety: despite you try to get rid of them, you can’t help but keep thinking;
- Extreme fear of being watched and judged by others – especially people you don’t know;
- The fear of doing something embarrassing or humiliating in public;
- You are afraid that people around will notice your nervousness.
- The shortness of breath, panting;
- Upset stomach, nausea (internal tremors);
- Trembling or nervous fever (including tremulous voice);
- Sweating or hot flashes;
- Dizziness or fainting.
- Avoiding the certain kinds of social situations to such an extent that it interferes with your daily activities and affects your normal lifestyle;
- Quiet or secretive behavior (“sitting in the back row”) in order to avoid attention;
- A need to be in company of a friend everywhere you go;
- Drinking alcohol before a social event to calm the nerves.
Social anxiety disorder in children
There is nothing abnormal in a shy kid, but the children suffering from a social anxiety disorder feel severely distressed in everyday situations, such as playing with other kids, reading aloud in class, talking to an adult, and writing a test. Such children often don’t want to go to school.
Social anxiety treatment
Challenge your negative thoughts
People with social anxiety disorder often face negative thoughts and convictions which make the anxiety worse. For example:
- “I know I’ll make a fool of myself”
- “Everyone will see that I’m shaken and think I’m pathetic”
- “People will just think I am stupid”
- “I won’t have anything to say. I’m a boring person”
Challenging these unpleasant thoughts is an effective way to reduce the symptoms of social anxiety.
How to cope with negative ways of thinking?
The first step is to detect the automatic negative thoughts which are the root of your social anxiety problem. For instance, if you are worried about the upcoming presentation at work, the initial negative thought may be: “I’ll be a failure. Everyone at the presentation will think I’m totally incompetent.”
The next step is to analyze the thought and challenge it. It’ll help if you ask yourself a question about the unsettling idea: “How can I be so sure I’m going to fail?” or “Even if I’ll be nervous, why will other people think I’m incompetent?” With the help of such logical assessment of your negative thoughts, you’ll gradually change them with more realistic and positive ones. Eventually, you will feel more confident about social situations triggering your anxiety.
Sometimes it’s unbelievably scary to even think about a social event, but understanding the causes of your anxiety will help to reduce its negative influence on your life.
Useless ways of thinking
Ask yourself if you ever used the following pointless thinking patterns:
- Mind-reading: you presume that you know what other people think about you, and you’re sure they have the same negative opinion about you which you have about yourself.
- Guesswork. The predicting of future events, usually anticipating the worst-case scenario. You “just know” that everything will be awful, so you feel anxious even before the situation actually happens.
- Catastrophizing. You believe everything is worse than it actually is. For example, if people notice your anxiety it will be “horrible”, “awful”, and “nightmarish”.
- Personalization. You assume that people are focused on your negative traits. Or you believe that what happens to others will also necessarily happen to you.
Focus on other people, not on yourself
When we are trapped in some kind of social situation which makes us nervous we tend to become captives of our own disturbing thoughts and feelings. We trace our physical sensations and try to do everything to control them – the signs of nervousness other people may notice.
We hope that if we pay additional attention to our feelings we’ll manage the situation better. But this additional attention only makes us more aware of how awful we feel which is triggering even worse social anxiety! There is more: it doesn’t allow us to concentrate on what’s happening around us or on what we’re currently doing.
How can I stop thinking that everybody is watching me?
Switching attention from internal to external will be of great help in coping with social anxiety. It’s easier said than done, but you can’t pay close attention to two things at a time. The more you concentrate on what’s happening around you, the less your social anxiety affects you.
- Focus on other people, not on what you imagine they are currently thinking about you! Do everything in your power to get interested in them and feel true contact with them.
- Remember that social anxiety is not as easily noticed as you think it is. And even if someone has noticed your nervousness, it doesn’t mean now they’re thinking you are a bad person.
- You should really listen to what others say instead of your negative thoughts.
- Concentrate on the present instead of worrying about what you are going to say, and don’t blame yourself for the mistakes you’ve already made.
- Don’t put yourself under the pressure of trying to be perfect. Focus on being yourself and pay attention to people around – they’ll be pleased.
Learn to control your breathing
When you enter the state of anxiety, a lot of changes happen in the organism. And the first of them is hyperventilation. Panting disrupts the balance of oxygen and carbon dioxide in the body which leads to even worse physical symptoms of social anxiety, such as dizziness, rapid heartbeat, the feeling of suffocation, and muscle tension.
Controlled breathing will help you to cope with the physical symptoms of social anxiety and regain composure.
Here is the breathing exercise to keep calm in social situations:
- Sit comfortably, back straight, shoulders relaxed. One hand put on your chest, the other hand – on your stomach.
- Inhale slowly and deeply through the nose for 4 seconds. The hand on your stomach should be rising, the hand on the chest – moving very slowly.
- Hold your breath for 2 seconds, and then exhale slowly through the mouth for 6 seconds, pushing out as much air as you can. The hand on your stomach should be moving as you exhale, but the other hand shouldn’t be shifting much.
- Continue breathing in through the nose and out through the mouth. Focus on doing it slowly and evenly, and count: 4 seconds – inhale, 2 seconds – hold your breath, 6 seconds – exhale.
Relaxation techniques for stress-relief
In addition to deep breathing exercise, you should regularly practice such relaxation techniques, as meditation, yoga, and progressive muscle relaxation – they’ll help to take control of the physical symptoms of anxiety.
Face your fears
One of the most effective methods you can use in fighting social anxiety is facing the situations you are so afraid of instead of avoiding them. Avoiding retains the social anxiety disorder. It’s completely normal that you feel nervous, but if you don’t try to fight anxiety it will only become more intense and harder to overcome.
Avoiding leads to bigger problems
Though avoiding the situations that make you nervous helps to feel better for a short time, such a strategy doesn’t make it possible to experience comfort in social situations and learn how to deal with your fear in the long run. In fact, the more you avoid scary situations the stronger your fear grows.
Avoiding also prevents you from doing what you like and from reaching definite goals. For example, the fear of public speaking makes it very hard for you to share your ideas at work, perform in class or make new friends.
Overcome social anxiety step by step
Here is the key: begin with the situation you are sure you can manage, and gradually go over more difficult situations, relying on the confidence you have already gained and on the experience of stress-management you’ve developed on the way up your “anxiety ladder”.
For instance, if you are anxious about talking to a stranger, ask your friend to escort you to the party. When you start feeling comfortable there, try to get acquainted with someone.
Develop your own “social anxiety ladder”
- Don’t try to face your greatest fear at the beginning. It’s not a good idea to move too fast, to take more of a burden than you actually can or to force yourself. Such actions lead to a backlash and intensify the anxiety.
- Be patient. Overcoming social anxiety will require time and practice. It’s a gradual step-by-step process.
- Use the techniques that help you to keep calm. Question the negative thoughts and focus on your breathing.
Establish healthy relationships
Support of the people around you is another effective means of managing your social anxiety disorder.
- Join a social skills development course or confidence training. Local educational centers or universities offer them quite often.
- Become a volunteer and do what you really like. Walk the dogs from an animal shelter, for example. Do anything you like as long as it provides you with an opportunity to meet people who share your interests.
- Work on your social skills. A healthy relationship depends on mutual trust, compassion, and understanding. If it’s hard for you to make new contacts, learn the basics of emotional intelligence.
Change your lifestyle
Though changing lifestyle is not enough for social anxiety treatment, your effort will contribute to your general progress. The following advice will help to reduce the anxiety and prepare the background for successful treatment:
- No caffeine! Coffee, tea, power drinks, and chocolate are stimulators which increase the social anxiety symptoms.
- Don’t drink much alcohol! Sometimes you’re tempted to have a drink to calm down before a social situation, but alcohol increases the risk of a panic attack.
- Give up smoking! Nicotine is another powerful stimulator. Despite a widespread opinion, smoking boosts the anxiety instead of relieving it.
- Sleep well. If you don’t sleep much you become prone to anxiety. But if you are well-rested, it’ll be easier for you to keep calm in a social situation.
What should you do if self-help is not enough?
Sometimes the abovementioned techniques are enough to get rid of social anxiety. But if you have tried all of them and are still suffering from this mental disorder, maybe, you need professional help.
Among all the available methods of professional treatment, cognitive behavioral therapy (CBT) showed the best results in treating social anxiety disorder. CBT is based upon a thesis “what you think affects what you feel, and what you feel affects what you do”. That’s why changing your way of thinking in social situations will make you feel more comfortable.
As a rule, CBT of social anxiety disorder includes:
- Controlling physical symptoms of anxiety with the help of relaxation techniques and breathing exercises.
- Challenging useless ways of thinking which trigger and boost social anxiety. Learning to think more realistically.
- Facing the social situations you are afraid of. Entering such situations gradually and systematically instead of avoiding them.
Though it’s in your power to learn these exercises and practice them on your own, it’ll be better for you to have the support and supervision of a professional therapist, especially if self-help hasn’t been effective.
Other cognitive-behavioral techniques for treating social anxiety include role-playing and social skills training, often offered as a part of group therapy.
Group therapy uses role-playing, video recording and monitoring, mock interviews, and other exercises which make it possible to work on the situations causing anxiety in real life. If you’ve been practicing and preparing for the social situations you find scary, you feel more confident in them and your anxiety begins to subside.
Anxiety medications are sometimes used in order to relieve some of the symptoms, not as a way of treatment. If you stop taking meds, the symptoms are likely to come back in full. Drug therapy is considered the most effective when it’s used as an addition to psychotherapy and self-help strategies.
There are 3 kinds of medications used in social anxiety treatment:
- Beta-blockers are prescribed for relieving the anxiety while being watched by others (during public speaking, for example). Though they don’t affect the emotional symptoms of social anxiety, they help to put the physical symptoms under control (hand tremor, sweating, rapid heartbeat).
- Antidepressants help when social anxiety disorder exhausts the person or takes a severe form.
- Benzodiazepines are prescribed as a fast-acting remedy for social anxiety. However, they have a sedative effect and cause addiction. That’s why doctors recommend them only when other drugs are useless.
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By Maria Shevtsova
Born in Belarus, 1985, a pedagogue and family psychologist. Taking action in support groups organization and social adaptation of the people with mental disorders. Since 2015 is a chief editor of the undepress.net project, selecting the best and up-to-date material for those, who want to get their life back or help someone dear, who got into mental trap.
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