SOCIAL ANXIETY DISORDER

 

     Social Anxiety Disorder (SAD), also known as Social Phobia, is characterized by a strong and persistent fear of social or performance situations in which humiliation or embarrassment may occur.  While it is common to feel nervous during new social situations, those with Social Anxiety Disorder experience intense distress, self-consciousness, and fear of judgment in everyday social interactions.  This form of anxiety often prevents people from having stable friendships or from pursuing romantic relationships.  It may also cause difficulties interacting with coworkers or classmates.  Social Anxiety Disorder may manifest as physical symptoms, such as insomnia, headaches, and gastrointestinal distress, prior to a social situation or even days to weeks in advance of the event. 

      Social Anxiety Disorder typically begins during childhood or adolescence and, without treatment, can continue indefinitely.  Those who have experienced long-term stress, trauma, other psychological disorders, or a family history of anxiety may have an increased risk of developing Social Anxiety Disorder.  This diagnosis may be based on specific or broad social fears.  Specific situations can include eating in front of another person, speaking in front of a crowd, or talking to a stranger.  Broader situations can include speaking to anyone other than a family member and leaving one’s house.  In more severe cases, this disorder can cause a constant state of distress, often leading to isolation and withdrawal from all social opportunities.  Those with Social Anxiety Disorder often know that their fearful thoughts are unreasonable or unwarranted but remain trapped in a cycle of social avoidance.  If you have experienced at least 4 of the following symptoms on a frequent basis, you could have Social Anxiety Disorder.  These symptoms include: (1) difficulty talking to others, (2) self-consciousness in front of others, (3) frequent feelings of embarrassment, (4) intense fear of rejection or judgment by others, (5) worrying for days or weeks before a public event, (6) experiencing extreme anxiety or panic about social situations, (7) avoidance of public places, (8) difficulty making and keeping friends, (9) blushing, sweating, experiencing nausea, or trembling around others, and (10) using alcohol or other substances to calm oneself during social situations.

 

WHAT CAUSES SOCIAL ANXIETY DISORDER?

   Social Anxiety Disorder has several possible causes and frequently coexists with other diagnoses. Social anxiety can result from childhood trauma, such as growing up in a chaotic family environment, being bullied by peers, or being subjected to physical and/or verbal abuse from a parent.  This type of anxiety can also result from body image insecurities or poor academic functioning.  Children who are introverted, which is typically an inborn trait, are prone to this type of anxiety, due to difficulties with social interactions and establishing relationships.  Lastly, an overprotective parent or a highly critical parent may cause a lack of social confidence in one’s child or adolescent, thus increasing the risk of developing Social Anxiety Disorder.

     The understanding and identification of this disorder is often complicated by its co-occurrence with other disorders, such as Major Depressive Disorder, Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, and even Attention Deficit Disorder or Attention Deficit with Hyperactivity Disorder.  In some cases, a single experience, such as an emotionally abusive romantic relationship, a breakup or divorce, or a job loss or setback, can trigger Social Anxiety Disorder.  Until the specific causes are clarified, this type of anxiety cannot be effectively treated.  This process may require extensive therapy to unravel the life events which led up to one’s excessive, often irrational, thoughts about social interactions.  Finally, other disorders may need to be treated prior to developing coping strategies for Social Anxiety Disorder.

 

WHAT CAN HELP SOMEONE WITH SOCIAL ANXIETY DISORDER?

     Self-talk is a valuable tool for decreasing social anxiety.  Specific and more rational statements can be used to overcome the defeating thoughts which occur during anxious moments.  Thoughts which focus on shame, self-blame, guilt, inadequacy, frustration, and fear can be transformed into more rational, empowering, and managed thoughts through a process of acknowledging them as both real and valid but also as often counterproductive to completing daily tasks, wasteful of one’s daily mental energy, and damaging to one’s interpersonal relationships.  Social anxiety can also be treated by creating a structured and proactive plan for acknowledging disturbing and unproductive thoughts, using thought-stopping strategies when these thoughts create too much emotional pain, using thought-replacement strategies to refocus on the present moment, committing to writing these disturbing thoughts in a daily journal, and continuing to process one’s thoughts during therapy sessions.  An ongoing focus of cognitive restructuring is the client’s movement toward more accurate, balanced thoughts and beliefs in relation to external events.

     Dialectical Behavior Therapy (DBT) has also been very successful in treating this disorder.  This approach uses four main strategies.  First, mindfulness training techniques help the person to devote undistracted time toward becoming more fully aware of the fearful thoughts related to the anxiety reactions.  Secondly, distress tolerance skills help the person to withstand the negative emotions and other aversive reactions to social situations, such as physical discomfort.  Third, emotion regulation skills enable the person to acknowledge the triggering situations and related emotions, so that effective behavioral coping skills can replace the previous anxiety.  Finally, interpersonal effectiveness skills are practiced during therapy sessions, and the client is encouraged to implement these skills in one’s daily life.