What is social anxiety?
Social anxiety is an anxiety disorder characterised by an irrational fear of social situations. The person behaves in a shy and anxious way in these types of settings, and this makes it difficult to engage or interact with other people, which can have a tangible impact on the person’s daily life.
It is considered a disorder when the intensity of the phobia or fear experienced is intense and excessive, irrational, and impacts the person’s life.
Some of the worries or thoughts that cause the anxiety are:
- Worry or desire to avoid being the centre of attention at all costs.
- Fear to be seen eating or drinking in public.
- Fear to talk in front of other people or even with friends.
- Difficulty facing specific tasks at work that involve making complaints.
- Tendency to avoid closed places where there are other people.
- Fear to suffer embarrassment in public.
The cognitive model of social anxiety gives a comprehensive explanation of how social phobia works.
Causes
People that suffer from social anxiety feel an irrational fear when facing social situations, as they believe other people can look at them or judge them.
The National Institute of Mental Health (NIMH) explains that this disorder “sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety”.
The problem can start during teenagehood, and the trigger can be having overprotective parents or limited social opportunities.
Social anxiety affects the same men and women, and patients with this disorder tend to be more disposed to develop drug addiction or alcoholism, as these substances can help inhibit the person and socialise better.
People with social anxiety are aware of the irrationality of their thoughts and fears, but it is difficult for them to stop anticipating adverse, irrational outcomes.
Symptoms
People with social anxiety suffer from anxiety and extreme shyness in social situations of daily life. The fear is persistent and chronic, and therefore, the anxiety can last days or even weeks.
This phobia can be focused on a specific social situation or can be broader and affect any type of social interaction with anyone who is not a member of the person’s family.
As the Anxiety and Depression Association of America (ADAA) explains, social anxiety can make patients decline a job opportunity that requires frequent interaction with new people or avoid going out to eat with friends due to a fear that their hands will shake when eating or drinking.
Some of the physical symptoms include:
- Blushing.
- Stumbling over words.
- Having a dry mouth.
- Difficulty speaking.
- Sweating intensely.
- Nausea.
- Rapid heart rate.
- Shaking and palpitations.
- Problems focusing that lead to forgetting information or ideas that the person wanted to share when speaking.
Social anxiety is not the same as shyness, as shy people can participate in social situations, whereas people with social anxiety are blocked and incapable of engaging, making them isolated. If the condition is very severe, the person with social anxiety can suffer from panic attacks.
Types
There are two types of social anxiety depending on the focus of the fear:
- General social anxiety: when the person fears any social situation.
- Specific social anxiety: the person develops a fear of specific moments or situations, such as speaking or eating in public.
Treatment
The purpose of the treatment is for the patient to have an everyday social life and lose intense fear under challenging circumstances.
The primary treatment for social anxiety is psychotherapy and medication. The type of therapy most beneficial for any anxiety disorder is Cognitive-Behavioural Therapy (CBT), where the therapist helps the person identify the irrational thoughts and cognitive distortions and challenge them, replacing them with other more productive and realistic thoughts.
CBT should include Exposure Response Therapy (ERP) as part of the therapy. This is a method that consists of exposure to the feared situations. The anxiety will rise, but it will start dropping with time, as the person will adapt to the feeling. If doing this multiple times, the anxiety will be less intense each time, as the brain will adapt and see that the most feared consequences won’t happen. Read more about therapy for social anxiety.
It is possible to use antidepressant medication, usually selective serotonin reuptake inhibitor (SSRI), such as escitalopram or sertraline. This can help reduce the symptoms and anxiety and make it easier for the person to engage with CBT and ERP.
More resources
- What is cognitive behavioural therapy (CBT)?
- What can parents of young people with social anxiety do?
- FAQ about social anxiety – Royal Collage of Psychiatrist
- Self-help guide – NHS
- More information about social anxiety treatments – Harvard Medical School
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