Social Anxiety

Have you ever been called shy? It’s a label that parents, teachers, siblings and peers slap on us from a very early age for simply being quieter than others in social situations. What starts as an innocent remark can lead to more self-doubt and self-consciousness, which can begin a cycle of fear and avoidance of social situations as we develop into our teenage and adult years. Over time, the more we avoid social situations, the more frightening they become and the harder they are to engage in. We become hyper fixated on how we appear to others and become paralyzed in situations where we feel we could be judged or watched by others. The very acknowledgment of our own social fears and struggles can add a layer of shame and embarrassment, which only intensifies the cycle. It’s important to keep in mind that social anxiety is one of the most common forms of anxiety in the world. Somewhere between 7-12% of US citizens are diagnosed with this disorder at some point in their lives. So, although it often starts early in childhood, social anxiety can develop at any age in life.

Social Anxiety Symptoms

Social anxiety may look a bit different for each individual person. Below is a list of a variety of different types of symptoms (Cognitive/Emotional, Behavioral and Physical) that you may experience if you struggle with social anxiety.

Cognitive and Emotional Symptoms:

• Replaying conversations over and over again (both real and imaginary)
• Fear of humiliating or embarrassing yourself in front of others
• Scripting conversation before you have them
• Fear of others judging you (for appearance, personality, body posture, etc.)
• Worry that others may think you are strange, weird, uncool, boring, etc.)
• Worry others will notice that you are anxious around them (such as blushing or shaky voice)
• Catastrophizing everyday social interactions

Behavioral Symptoms

• Avoiding social interactions (parties, public speaking, dating, shopping, going to the gym, etc.)
• Positioning yourself in a way that makes you small or hard to notice (wearing bland clothing, sitting in the back of a class or meeting,etc).
• Avoiding eye contact
• Canceling events last minute due to anxiety about the event
• Walking with your head down to avoid being noticed
• Talking more to fill gaps of silence, rambling
• Talking very little to avoid attention

Physical

• Heart Racing
• Excessive sweating
• Shaking voice
• Touching your face or other parts of body due to restlessness
• Trembling Legs
• Trouble sleeping due to rumination

The symptoms of social anxiety vary, but a general sense of fear of being judged by others is the common thread here. But as you can see, you may have more of one group of symptoms and less of another. But you may also be able to see the cycle that these symptoms can creates: Our thoughts can influence our physical body, which can influence our behavior and vice a versa. Let’s imagine you are about to give a speech. You may begin thinking of all the ways it could go wrong. These thoughts make you anxious and your heart starts racing and you begin sweating. The idea of sweating during a speech freaks you out, so you decide to call out sick and cancel the speech all together. This is the pernicious cycle of social anxiety.

Stigma

Like most mental illnesses, social anxiety also comes with a stigma. Sometimes people in our lives won’t understand what we’re going through even if we spell it out for them. That judgment from others can rub off on ourselves, and we can become our own harshest critics. But the reality is, most people have a fear. For some people it’s spiders or snakes, for you it’s socializing. Fortunately for most people, they do not have to deal with their fear every day. In modern society we can avoid most of these things if we want to and it won’t impact our life much. People on the other hand, are much harder to avoid. They are everywhere. And even when they are not in front of us, they are on our minds, on the internet, or on our weekly virtual work meetings. We can’t avoid them no matter how hard we try. So be kind to yourself; you did not ask for this. No one in their right mind would. This is a fear like anyone else’s; the only difference is it makes a huge impact on our life.

Impact and Comorbidity

It’s often overlooked just how impactful social anxiety can be, and it’s quite common that those that struggle with it also struggle with other mental health conditions. Depression is very common for social anxiety suffers. One, because people who struggle with social anxiety often struggle making friends, which can lead to loneliness and isolation – two of the biggest predictors of depression. And two, because social anxiety often goes hand-in-hand with low self-esteem; which is another common trait of depression sufferers. It may seem difficult to see a positive road ahead, but if you can begin to address the social anxiety, it can open up pathways in your life that you thought were shut off for good.

Social anxiety also has a high comorbidity rate with substance use, particularly alcohol. This is because alcohol can (in small doses), be effective in calming our nerves and making us more outgoing. The problem with using alcohol to mask social anxiety is it doesn’t teach you how to socialize when you are sober, so you become dependent on it to function. This can lead to a dangerous cycle of overusing to get through your day-to-day social interactions. Alcohol obviously can also cause you to do things you later regret, which perpetuates obsessing about negative social interactions.

How Do We Overcome Social Anxiety?

Despite the myriad of ways social anxiety can wreak havoc on your life, there are ways to overcome this debilitating disease. The most common treatment for social anxiety is exposure therapy, which encourages us to slowly confront the things we are afraid of. Now, you may be thinking “I confront this every day. I go to work, I go shopping, I see friends, and it still won’t go away.” And this is true, partly. Most of us are forced to engage with people even when we try not to, the difference here is that when we are forced to socialize and we are still anxious, we revert back to our old habits. We don’t speak up, we edit ourselves, we avoid being front and center, and we just try to get by until we can go back home. In exposure therapy we test our limits to do and say things we would otherwise be too afraid to say.

Along with making behavioral changes and gradually exposing you to your fears, we will also work on challenging that pesky inner dialogue. Social anxiety can lead to catastrophizing situations and being overly harsh on ourselves when we make a very human social error. We will work together to explore where some of those beliefs came from and begin to dismantle these long-held ideas. As you simultaneously challenge your limits socially, we will start to develop a new sense of identity and confidence in yourself in social environments. We will also begin to practice embracing negative experiences and emotions, so instead of running away from doing something embarrassing, we learn to accept it as a normal part of our growth. When we learn to accept these negative experiences, we will begin to no longer fear them or avoid them.

If you are someone who has very intense physical sensations when you are anxious, we may also work on learning how to regulate your nervous system. Finding new ways to slow your heart rate and relax your muscles so you do not feel as overwhelmed in social situations. As I’m sure you are aware, the physical symptoms can be devastating and are often the biggest contributor to avoidance behaviors. After all, who would want to have a near panic attack if they don’t have to. When you start to learn how to slow your nervous system down, the thought of being around others will seem more and more manageable.

While I tend to be more of a “here and now” therapist, we will also be exploring some of your past, as these initial experiences shape our early understanding of ourselves and our place in the world. This can also help us uncover unhealthy behaviors and thoughts processes that have been instilled over the years, which keep you locked in a state of fear and avoidance.

I am not a medical doctor, but we can certainly explore the possibility of finding a psychiatrist if necessary. Medication can help give you the boost you may need to assist in overcoming this fear. Medication also does not always need to be a lifelong commitment, but can play a significant role in making those initial difficult changes when starting therapy. I can offer referrals if you are interested.

If this description of social anxiety resonates with you and you are looking to find freedom in your personal, social and professional life, please contact me for a free consultation.