I often get asked about social anxiety and thought it would be helpful to put together a primer, so to speak. If you are a parent of a teenager who refuses to go to school, isolates themselves and is exhibiting other forms of anxiety, feel free to give me a call at Doorways, 602-997-2880.
Dr. David Yee, Psy.D., Psychologist, Doorways.
Getting to Know Social Anxiety
Because social anxiety can often seem unwieldy or even overwhelming to understand, it is often helpful to view it in terms of three separate components that are interrelated and can strengthen one another, leading to a cycle of anxiety:
Anxious sensations in our bodies, such as:
- Racing heart
- Shaking or tremor
- Dry mouth
- Shortness of breath
- Feeling faint
Anxious thoughts about ourselves, others, and the situation:
- “Everyone is staring at me.”
- “They’ll think I’m a loser.”
- “I don’t belong here.”
- “I won’t have anything to say.”
- “People will see how nervous I am.”
- “They won’t want to talk to me again.”
- “I will keep looking more and more foolish.”
Anxious behaviors, which can be triggered by anxiety, but can also make the anxiety worse over the long term:
- Avoiding entering social situations
- Leaving situations
- Only entering “safe” places or with “safe” people
- Using mobile phones, MP3 players, or other devices to avoid
- being in conversations
- Apologizing excessively
- Asking for reassurance from others
- Preparing excessively (memorizing what to say, extreme grooming)
- Trying to direct people’s attention away from one’s performance (e.g., by making jokes, dressing in a particular way, etc.)
- Watching for signs that people are judging us
Social anxiety can emerge in a wide range of situations – essentially, whenever we are in contact with other people or believe we may become a focus of others’ attention. While the possibilities are infinite, the following list outlines some of the more common situations in which people experience social anxiety:
- Going on a date
- Starting a conversation with a stranger
- Asking for directions
- Starting a conversation
- Keeping a conversation going
- Attending a party
- Being interviewed for a job
- Holding eye contact
- Performance situations – our anxiety is triggered by potentially or actually being the focus of attention.
- Public speaking
- Public singing
- Eating at a restaurant alone
- Dropping something in a public place
- Spilling a drink
- Reading in front of others
- Voicing an opinion during a class or meeting
Is Social Anxiety Always a Bad Thing?
No! Anxiety is a normal and healthy part of being human. It mobilizes our bodies and minds to take action in dangerous or unhealthy situations. Without anxiety, we would probably not be alive – it is what tells us to get out of the way of the bus heading right toward us or to get that 3-week-old cough looked at. Social anxiety is no different. Social anxiety helps us to remain sensitive to the feelings and needs of others, which is a core foundation of cooperation and building relationships. Even strong social anxiety can occasionally be useful; for that job interview, we’ll likely do better if we’re extra careful in choosing our words and our outfits.
When Does Social Anxiety Become a Problem?
Social anxiety becomes a problem only when it is so severe that it is excessive or outside the “norm,” and when it causes major problems in our quality of life. When our social anxiety leads us to consistently avoid social situations, to be very distressed when exposed to them, to have excessive fears of being negatively judged by others, or to miss out on things that we otherwise strongly want or need to do, mental health professionals may consider a diagnosis of Social Phobia (also known as Social Anxiety Disorder).
How Common is Social Anxiety?
Quite common. While the exact prevalence of social anxiet remains to be determined, approximately 12% of the general public will experience social anxiety at some point during their lives.
Do I have Social Anxiety
Maybe…or maybe not. If you find that your social anxiety is above and beyond what you would consider “normal” or appropriate and it significantly interferes with your quality of life, you may have Social Phobia.
The next page contains a list of several common symptoms of social anxiety. Please take the next few minutes look through the lists on the next page and mark each item for how that situation affects you. Each item should have two scores, first rate how much anxiety that situation causes you and second mark how often you avoid that situation. Later, one of the therapists will review your list with you.
Depression and Anxiety
While this group specifically focuses on treating OCD and Social Anxiety, people who experience one or both of these conditions often suffer from difficulty in other areas of life as well. For example, your feelings of anxiety may not be limited to only OCD or social situations. It might feel like everything leaves you feeling anxious. Other times our conditions can cause us to miss out on important parts of our lives. It can impact our family relationships, our friendships, or it can halt our progress in school or our hobbies. It is very normal for people who experience this much difficulty to feel down or sad. Sadness, frustration and anxiety are all normal experiences that we should not feel embarrassed about. Sometimes, however, our feelings can become so strong and last so long that they become their own problem.
Taking your life back
Now that we have a better idea of how your symptoms affect you, it is time to get started fighting back. The good news is that OCD and Social Anxiety can be effectively treated. While there is no such thing as being “cured” from anxiety, this treatment program can help to eliminate some problems, reduce others and learn to effectively live with the rest.
How are OCD and Social Anxiety treated?
The best treatment for most people should include one or more of the following three things: A type of therapy called Exposure and Response Prevention (ERP), medicine, and family support.
Most studies show that, on average, about 70% of patients with OCD will benefit from either medicine or therapy. Patients who respond to medicine usually show a 40 to 60% reduction in OCD symptoms, while those who respond to therapy often report a 60 to 80% reduction in OCD symptoms.
However, medicines have to be taken on a regular basis and patients must actively participate in CBT for the treatments to work. Unfortunately, studies show that at least 25% of OCD patients refuse CBT, and as many as half of OCD patients don’t take their medication as directed.
What are CBT and ERP?
There are many types of therapy out there that use different techniques to help people find relief from their mental suffering. One type of therapy is Cognitive Behavioral Therapy (CBT). CBT focuses on changing the way people think in order to change emotional and behavioral responses to those thoughts. There are many types of CBT. The most important strategy in CBT for people with OCD is called “Exposure and Response Prevention” (ERP).
“Exposure” refers to confronting the thoughts, images, objects and situations that make you anxious. At first glance, this sounds backwards. You have probably confronted these things many times only to feel bad over and over again. It is important to keep in mind that you have to do the second part of the treatment as well – Response Prevention. Once you have come in contact with the things that make you anxious, you make a choice to not do the compulsive behavior. Again, this might not seem correct to you. You may have tried many times to stop compulsive behavior only to see your anxiety skyrocket. The last point is key – you have to continue to make the commitment to not give in to the compulsive behavior until you notice a drop in your anxiety. In fact, it is best if you stay committed to not doing the compulsive behavior at all.
When you stay “exposed” and “prevent” the compulsive “response” you will start to notice a drop in the feeling of anxiety. This might be a new idea for you – your anxiety will start to decrease if you stay in engaged with the things you fear and resist the compulsive behavior.
A False Alarm
When you feel anxiety, what is your brain trying to tell you? That you are in danger – or more accurately, that you might be in danger. “Might be” in danger is important to consider here. The experience of anxiety does not feel like a “might”, it feels like a fact: “I am in danger.” It has taken over your alarm system, a system that is there to protect you.
When you are facing an actual danger, like crossing a street and seeing a truck speeding toward you, your brain puts out information that you are in danger by making you feel anxious. The anxiety creates motivation to do something to protect yourself. The behaviors you do to protect yourself can actually save your life (getting out of the way of the oncoming truck!).
Unfortunately, your brain tells you that you are in danger a lot! Even in situations where you “know” that there is a very small likelihood that something bad might happen. Now consider your compulsive behaviors as your attempts to keep yourself safe when you “might be” in danger. What are you telling your brain when you try to protect yourself: that you must be in danger. In other words, your compulsive behavior fuels that part of your brain that sends the false alarm signals. In order to reduce your anxiety and your obsessions, you have to stop the behavior.