Social Anxiety Disorder

OVERVIEW

People with Social Anxiety Disorder are extremely afraid of social situations or giving performances (speeches, recitals, acting, etc.). The belief that tends to sustain their anxiety is that they will be judged, rejected, scrutinized ridiculed and/or fear embarrassment and offending others. Individual who are shy may face "butterflies in the stomach" when faced with social situations, but this generally does not prevent shy individuals from participating in social situations. However, those with social anxiety tend to experience their fear to such a degree they may avoid social situations all together. Or if they cannot (e.g. performing a music or dance recital), they may postpone it until they can no longer do so.

As a result of this avoidance of social interactions, people with social anxiety disorder may find themselves experiencing feelings of loneliness, shame and guilt, and sadness. Disorders such as depression, other forms of anxiety, and substance use disorders co-occur in persons with social anxiety disorder as a result of the symptoms of social anxiety and isolation it often brings.

Social Anxiety Disorder symptoms include:

• Feeling highly anxious about being with other people and having a hard time talking to them
• Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others
• Being very afraid that other people will judge them
• Worrying for days or weeks before an event where other people will be
• Staying away from places where there are other people
• Having a hard time making friends and keeping friends
• Blushing, sweating, or trembling around other people
• Feeling nauseous or sick to your stomach when other people are around

Social Anxiety Disorder can manifest in many ways:

• Fear of defecation and/or urination in public bathrooms
• Fear of talking on telephones
• Fear of speaking in front of others (e.g. in classes)
• Fear of dating or romantic intimacy
• Fear of consuming food or beverages in public
• Fear of reading or writing in public spaces

Possible risk factors for Social Anxiety Disorder are:

• Inhibition in childhood
• Being female
• Being from any underrepresented or marginalized group.
• Experiencing a break-up
• Limited financial resources
• Exposure to stressful or traumatic events in childhood
• Anxiety disorders in other biological family members

TREATMENT

Several research studies show evidence that Cognitive Behavioral Therapy (CBT) is a more effective treatment for Social Anxiety Disorder longitudinally compared to other types of therapy or anti-anxiety medication alone. Within the context of treating Social Anxiety Disorder, CBT counselors look at patterns of thought that sustain or maintain social anxiety as well as behaviors an individual engages in to remain "safe" in social situations. The client and therapist will talk about the mechanism of how Social Anxiety is reinforced by "safety behaviors" (relief from avoiding triggering situations), consider ways to restructure anxious thoughts and belief systems around one's self-perception as a social being and also assumptions about how others perceive the socially anxious client. Clients and their CBT therapists also will make a list of situations that the client can put themselves into between sessions to face social anxiety. For instance, someone who worries about others' judgement and scrutiny for inconveniencing others may be assigned going out to dinner and sending their meal back to the kitchen to be heated up. Someone who worries that others will judge them as being weird may be encouraged to engage in a weird behavior, such as going to Pike Place Market while carrying a large stuffed animal with a diaper on it and asking for directions to the aquarium. In each circumstance the client will be encouraged to attend to the process and outcome of the situation and compare that to their initial worries.

It is hoped that through the process of thought restructuring one learns to talk to oneself with more self-compassion, and that through the exposure exercises the client becomes aware of how their anticipatory anxiety expectations are disproportionate to the actual experience. Over time this leads to "habituation", where one learns that there is little danger in social situations of being judged by others, or that one's social skills are not as lacking as previously assumed.