by Thomas A. Richards, Ph.D. Google+
Psychologist/Director, Social Anxiety Institute
Social anxiety is the fear of interaction with other people that brings on self-consciousness, feelings of being negatively judged and evaluated, and, as a result, leads to avoidance.
Social anxiety is the fear of being judged and evaluated negatively by other people, leading to feelings of inadequacy, inferiority, embarrassment, humiliation, and depression.
If a person usually becomes (irrationally) anxious in social situations, but seems better when they are alone, then "social anxiety" may be the problem.
The Third Largest Mental Health Care Problem
Social anxiety disorder (formerly termed "social phobia") is a much more common problem than past estimates have led us to believe. Millions of people all over the world suffer from this devastating and traumatic condition every day, either from a specific social anxiety or from a more generalized social anxiety.
In the United States, epidemiological studies have recently pegged social anxiety disorder as the third largest psychological disorder in the country, after depression and alcoholism. It is estimated that about 7% of the population suffers from some form of social anxiety at the present time. The lifetime prevalence rate for developing social anxiety disorder is 13-14%.
Specific and Generalized Social Anxieties
A specific social anxiety would be the fear of speaking in front of groups (only), whereas people with generalized social anxiety are anxious, nervous, and uncomfortable in almost all social situations.
It is much more common for people with social anxiety to have a generalized type of this disorder. When anticipatory anxiety, worry, indecision, depression, embarrassment, feelings of inferiority, and self-blame are involved across most life situations, a generalized form of social anxiety is at work.
Symptoms of Social Anxiety Disorder
People with social anxiety disorder usually experience significant emotional distress in the following situations:
- Being introduced to other people
- Being teased or criticized
- Being the center of attention
- Being watched while doing something
- Meeting people in authority ("important people")
- Most social encounters, especially with strangers
- Going around the room (or table) in a circle and having to say something
- Interpersonal relationships, whether friendships or romantic
This list is certainly not a complete list of symptoms -- other feelings have been associated with social anxiety as well.
The physiological manifestations that accompany social anxiety may include intense fear, racing heart, turning red or blushing, excessive sweating, dry throat and mouth, trembling (fear of picking up a glass of water or using utensils to eat), swallowing with difficulty, and muscle twitches, particularly around the face and neck.
Constant, intense anxiety that does not go away is the most common feature.
People with social anxiety disorder know that their anxiety is irrational and does not make "head" (i.e., cognitive) sense. Nevertheless, "knowing" something is not the same thing as "believing" and "feeling" something.
Thus, for people with social anxiety, thoughts and feelings of anxiety persist and show no signs of going away -- despite the fact that socially-anxious people "face their fears" every day of their lives.
Only the appropriate treatment works to alleviate social anxiety disorder, the largest anxiety disorder, and the one that few people know anything about.
Effective Therapy for Social Anxiety Disorder1
The good news is that cognitive-behavioral therapy for social anxiety has been markedly successful. Research and clinical evidence alike indicate that cognitive-behavioral therapy, which should be comprehensive in nature, produces permanent changes in the lives of people.
Social anxiety disorder can be overcome, although it takes both consistency and persistence. But, barring cognitive problems (e.g., dementia, Alzheimer's Disease) everyone can make progress against social anxiety using the appropriate type of cognitive-behavioral therapy.
At The Social Anxiety Institute, we call cognitive-behavioral therapy for social anxiety disorder "comprehensive" cognitive-behavioral therapy, to differentiate it from the general idea that cognitive concepts are simplistic and can be addressed by using only a few strategies.
A successful therapy program for social anxiety disorder must address the dozens of cognitive methods, strategies, and concepts that will allow people's brains (i.e., their brain associations or neural pathways) to literally change. The brain is continually learning, and irrational thoughts and beliefs can change as a result of this cognitive process.
A good therapy program will supply the necessary and specific strategies as well as indicate to people how and why they need to practice, work on, and begin to accept rational thoughts, beliefs, emotions, and perceptions.
How To Find Help for Social Anxiety Disorder
Social anxiety, as well as the other anxiety disorders, can be successfully treated. In seeking support for this problem, search for a specialist -- someone who (a) understands this problem well and (b) knows from experience how to treat it.
Become an informed client and ask questions. For example, does the therapist understand that you feel very self-conscious and that others are watching and forming a negative evaluation about you? – or do they minimize what you’re saying and just say, "No, No, No, you’re fine ... you're just exaggerating...." or expect you to go out and do unreasonable "exposures"?
It is true that we who have lived through social anxiety do realize our mind is many times irrational and we over-exaggerate, but it still FEELS like others are watching and judging us. Our self-consciousness is a feeling and it is very real.
If your psychologist/mental health care worker does not understand this, you know more than they do about social anxiety. Under these circumstances, it is very doubtful they will be able to help you.
Also, remember that the professional should always welcome your questions. If someone seems unfriendly or too clinical, they should not be your choice of a therapist.
Those of us who have (or have had) social anxiety need support, encouragement, and a relatively stress-free environment while we are in therapy, so that our brain can absorb all the changes that are occurring without being damaged by external factors (i.e., negative environments, negative people). If our environment is relatively peaceful when undergoing treatment for social anxiety, then it is easier to learn new habits that will permanently change our thoughts, beliefs, feelings, and our lives.
Does your therapist say, "Face your fears and they’ll go away?"
Sorry, but this therapist does not understand the dynamics of social anxiety. We, as people with social anxiety, have constantly faced our fears ever since birth – we’ve had to – and we feel more fearful now than we did in the past.
In this case, seek another therapist. It is imperative you find a psychologist who understands social anxiety disorder completely – because if they don’t even know what it is – how will they know what to do to help you overcome it?
Getting over social anxiety disorder is not an easy task, nor is it a difficult one. Many thousands of people have already done it.
While you’re in the middle of the social anxiety syndrome, it feels hopeless – it feels that you’ll never get any better. Life is just one gut-wrenching anxiety problem after another.
But this can be stopped, quenched, and killed in a relatively short period of time – by finding a cognitive-behavioral therapist who understands and specializes in the treatment of social anxiety.
The most important elements in overcoming social anxiety
1. An understanding and awareness of the problem,
2. A commitment to carry through with cognitive-behavioral therapy even when it is repetitious and seems difficult,
3. Practice, practice, practice to get that information (i.e., cognitive methods, strategies, and concepts) deep down into your brain - so that these cognitive methods become habitual and automatic,
4. Participation in a social anxiety therapy group in which you can slowly and gradually work on problems that cause you anxiety in the real world.
That is, the person who feels anxious while reading in public uses specific strategies to meet his goal, whereas the person who wants to learn how to make introductions and engage in small talk during social activities slowly works toward her goals. We use role-plays, acting, the tape recorder and video camera, question and answer periods, mock job interviews, and doing foolish things deliberately as part of our behavioral therapy group for people with social anxiety.
Note: A ladder or "hierarchy" should be used as a flexible guide in planning. We want to practice, meet our goals, move up our expectations, meet our goals, move up our expectations, until our goal is finally met.
Social anxiety behavioral therapy groups should not pressure, push, or cajole people to do things. No negative tactic should be employed because the individual must choose to participate at her own pace. If she wants to sit there in group and not say a word, that’s O.K. No one should be made to do anything.
You may be asking, "won't people never make progress if they choose to do nothing each group?" Here’s the secret: This has never happened. People in the group understand why they are there and, despite an amount of anxiety that is naturally present, they voluntarily choose to work on their specific anxieties. This is much more practical and real-life than being forced to do something.
Therapy groups for social anxiety should always be encouraging, positive, and supportive. If the right atmosphere is set, people can make (and continue to make) progress up their "hierarchy" of social anxieties.
It is impossible to stop a motivated person who refuses to give up. The role of the therapist is to know specifically what to do and how quickly to do it. This sounds easy, but it is not. You must be practicing the right material and you must proceed at the correct pace for your own anxieties. You are more in control of this process than you think.
Today, cognitive-behavioral therapy is used to treat both forms of social anxiety. With cognitive-behavioral therapy, we do not wallow in the past and continually bring it up --- because it doesn’t do us any good. Instead, we focus on present-day problems and symptoms and use many small techniques and methods to eradicate anxiety thinking, feelings, beliefs, and belief systems.
1. Goldin, P.R., Ziv, M., Jazaieri, H., Hahn K., Heimberg, R. (2013, October). Impact of Cognitive-Behavioral Therapy for Social Anxiety Disorder on the Neural Dynamics of Cognitive Reappraisal of Negative Self-beliefs, JAMA Psychiatry, 2013;70(10):1048-1056.