Social anxiety

From Wikipedia, the free encyclopedia

Social anxiety is anxiety (emotional discomfort, fear, apprehension, or

worry) about social situations, interactions with others, and being
evaluated or scrutinized by other people.[1] It is the third most prevalent
psychiatric disorder according to the US National Comorbidity
Survey(American Psychiatric Association, 1994). It can occur at different
times of life, and for different reasons. Developmental social anxiety
occurs early in childhood as a normal part of the development of social
functioning, and is a stage that most children grow out of, but problem or
chronic social anxiety may persist (perhaps unnoticed) until adolescence
or may surface in adulthood.[2] People vary in how often they experience
social anxiety and in which kinds of situations. Overcoming social anxiety
depends on the person and the situation. In some cases it can be relatively
easy—just a matter of time passing for many individuals, and yet for some
people social anxiety can become a very difficult, painful and even
disabling problem that is chronic in nature. The reasons are unknown.
Social anxiety can be related to shyness or anxiety disorders or other
emotional or temperamental factors, but its exact nature is still the subject
of research and theory and the causes may vary depending on the
individual. Recovery from chronic social anxiety is possible in many
cases, but usually only with some kind of therapy or sustained self-help or
support group work.
A psychopathological (chronic and disabling) form of social anxiety is
called social phobia or social anxiety disorder, and is a chronic problem
that can result in a reduced quality of life. Overcoming social anxiety of this
type can be very difficult without getting assistance from therapists,
psychologists or support groups. Social anxiety can also be self-integrated
and persistent for people who suffer from obsessive-compulsive disorder,
which can also make the social anxiety harder to overcome, especially if
ignored.[1]
Some use the terms social anxiety and social phobia interchangeably.[3][4]

Contents [hide]
1 Forms and
degrees
1.1
Child
development
1.2
Ordinary
adult form
1.3
Disorder
2
Communication
Issues
3 See also
4 References
5 External
links
[edit]
Forms and degrees
[edit]
Child development
Social anxiety first occurs in infancy and is said to be a normal and
necessary emotion for effective social functioning and developmental
growth. Cognitive advances and increased pressures in late childhood and
early adolescence result in repeated social anxiety. Adolescents have
identified their most common anxieties as focused on relationships with
peers to whom they are attracted, peer rejection, public speaking,
blushing, self-consciousness, and past behavior. Most adolescents
progress through their fears and meet the developmental demands placed
on them.[2]
[edit]
Ordinary adult form
Common adult forms of social anxiety include shyness,[5] performance
anxiety, public speaking anxiety, stage fright, timidness, etc. All of these
may also assume clinical forms, i.e., become anxiety disorders (see
below).[1]
The term social anxiety is also commonly used in reference to experiences
such as embarrassment and shame. However some psychologists draw
distinctions among various types of social discomfort, with the criterion for
anxiety being anticipation. For example, the anticipation of an
embarrassment is a form of social anxiety, while embarrassment itself is
not.[6]
Criteria that distinguish between clinical and nonclinical forms of social
anxiety include the intensity and level of behavioral and psychosomatic
disruption (discomfort) in addition to the anticipatory nature of the fear.[1]
Social anxieties may also be classified according to the broadness of
triggering social situations. For example, fear of eating in public has a very
narrow situational scope (eating in public), while shyness may have a wide
scope (a person may be shy of doing many things in various
circumstances).[1] The clinical (disorder) forms are also divided into
general social phobia (i.e., social anxiety disorder) and specific social
phobia.
[edit]
Disorder
Main articles: social anxiety disorder and specific social phobia
Extreme, persistent and disabling social anxiety may be diagnosed as
social anxiety disorder. The experience is commonly described as having
physiological components (e.g., sweating, blushing), cognitive/perceptual
components (e.g., belief that one may be judged negatively or looking for
signs of disapproval), and behavioral components (e.g. avoiding a
situation).
The essence of social anxiety has been said to be an irrational or
unreasonable expectation of negative evaluation by others.[1] One theory
is that social anxiety occurs when there is motivation to make a desired
impression along with doubt about having the ability to do so.[7] Although
the "official" clinical name for the disorder, as listed in the DSM and ICD, is
Social Phobia or Social Anxiety Disorder, support groups for people who
have the disorder (whether through clinical diagnosis or self-diagnosis)
often refer to it as simply "social anxiety" or even "SA".[3][4]
Criteria in the DSM and ICD attempt to distinguish clinical versus
nonclinical forms of social anxiety, including by intensity and levels
of behavioral and psychosomatic disruption:[1] The validity of the
"disorder" diagnosis has been challenged, however, on scientific and
political grounds; people satisfying DSM social phobia criteria may simply
be temperamentally high in social anxiety rather than suffering from a
disorder, although such problems in living in society may still deserve
attention as a matter of social justice.[8]
Clinicians and researchers continue to struggle with definitional problems
regarding the constructs of shyness, social anxiety, and social anxiety
disorder. Each shares similarities, yet each has been used to define
distinct aspects of psychological life as it relates to interpersonal
functioning and how easy or difficult different cases of social anxiety are to
overcome. A continuum describes some of the distinctions yet there is no
absolute consensus yet as to where one disorder begins and another
ends, although it is widely agreed that there are differences.[9]
Social anxiety disorder may sometimes be symptomatic of an underlying
medical disorder, such as hyperthyroidism.
[edit]
Communication Issues
Social Anxiety causes something called Communication Apprehension,
this can be thought of as an‘‘internally experienced feeling of discomfort’’
(McCsroskey, 1983, p. 16) that causes ineffective communication when in
a social or public situation. “Communication apprehension is the level of
fear or anxiety associated with either real or anticipated communication
with another person” McCrosky 1984. Early communication researchers
described physiological sensations experienced while giving a public
speech as "profound discomfort" (Lomas, 1944, p. 479), patients with
social anxiety typically experience embarrassment, distressing panic
attacks, and self conciousness impairing their speech. According to a
study done by Robin and Mills children experiencing social anxiety show
issues in social perspective-taking ability, fewer successful problem solving
skills, and use less interpersonal problem solutions. This brings up a
problem with people who experience social anxiety getting help for their
problems. The feelings of embarrassment, inferiority, and shame that
social anxiety causes inhibits the ability to seek help. Basically, avoiding
social situations because of their fear eliminates the opportunities for social
growth which reinforces their fears which will of course lead to more
avoiding,creating a pattern thats hard to break.

Mental health professionals often distinguish between generalized social

phobia and specific social phobia.[1] People with generalized social
phobia have great distress in a wide range of social situations. Those with
specific social phobia may experience anxiety only in a few situations.[1]
The term "specific social phobia" may also refer to specific forms of non-
clinical social anxiety.
The most common symptoms of specific social phobia are glossophobia,
the fear of public speaking and the fear of performance, known as stage
fright. Other examples of specific social phobia include fears of writing or
eating in public, using public restrooms (paruresis), attending social
gatherings, and dealing with authority figures.
Specific social phobia may be classified into performance fears and
interaction fears, i.e., fears of acting in social setting and interacting with
other people, respectively. The cause of social phobia is not definite.
Symptoms of social phobia can occur in late adolescence when youths
highly value the impressions they give off to their peers. Clinical
experience of the prognosis of social phobia shows that it can prolong for
many years but that it improves by mid life. Treatment of social phobia
includes antidepressant medication. Selective serotonin reuptake inhibitors
(SSRIs) such as sertraline, fluvoxamine and paroxetine are common
medications which alleviate social phobia successfully in the short term but
it is not certain if they are useful in the long-term. Also the MAOI
moclobemide works well on treating social phobia in the short term.
Patients who have avoided certain situations should make a big effort to
become exposed to these situations while at the same time taking
antidepressant medication. Anxiolytic medication aids a patient to handle
social or professional situations before more lasting treatment has had an
effect and therefore it is a provider of short term relief . The risk of
dependence of anxiolytics should be noted and consequently they should
not be used regularly. Beta-adrenergic antagonists help to control
palpitations and tremors unresponsive to the treatment of anxiolytic
medication. One must read the precautions of these drugs outlined in the
manufacturer's literature and be careful to watch out for the
contraindications of these drugs.[2]
[edit]
Prevalence and distribution
In the past, when the prevalence was estimated by sampling the
psychiatric clinical cases, social phobia was thought to be a rare disorder.
It is now recognized that this way of estimating is inappropriate, because
people with social phobia rarely seek psychiatric help by the very nature of
their disorder. A more reliable source used now is community surveys.[3]
Various surveys show that the syndrome of glossophobia is the most
prevalent type. An article based on a National Comorbidity Survey reported
that 1/3 people with lifetime social phobia suffered from glossophobia[4]
Another survey of a community sample from a Canadian city reported that
of people who believed being anxious in one or several social situations
55% feared speaking to a large audience, 25% feared speaking to a small
group of familiar people, 23% feared dealing with authority, 14.5% feared
social gatherings, 14% feared speaking to strangers, 7% feared eating and
5% feared writing in public.[5]

Many people get nervous or self-conscious on occasion, like when

giving a speech or interviewing for a new job. But social anxiety
disorder is more than just shyness or occasional nerves. If you have
social anxiety disorder, your fear of embarrassing yourself is intense —
so intense, in fact, that you may go to great lengths to avoid situations
that would trigger it. The good news is that many effective treatments
and self-help strategies can help you overcome the symptoms of social
anxiety and reclaim your life.
IN THIS ARTICLE:
Social anxiety disorder
Signs and symptoms
Getting help
Reducing physical symptoms
Challenging negative thoughts
Facing your fears
Related links
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What is social anxiety disorder (social phobia)?

Matthew’s story
Matthew skipped class today. It’s the first day of the new semester,
and he’s afraid that the professor will go around the class and have the
students introduce themselves. He knows it shouldn’t be a big deal,
but it really stresses him out. Whenever he has to speak in front of
more than just a few people, his voice starts shaking and his face gets
red. He always feels so humiliated afterwards.

Since public speaking is Matthew’s worst nightmare, he’s been

avoiding a speech class he has to take in order to graduate. He’s also
dreading his brother’s wedding, even though it’s over six months
away. As the best man, he’ll have to give a toast at the reception and
he’s already nervous about it.

Social anxiety disorder, also known as social phobia, involves intense

fear of certain social situations — especially situations that are
unfamiliar or in which you’ll be watched or evaluated by others. These
social situations may be so frightening that you get anxious just
thinking about them or go to great lengths to avoid them.
Underlying social anxiety disorder is the fear of being scrutinized,
judged, or embarrassed in public. You may be afraid that people will
think badly of you or that you won’t measure up in comparison to
others. And even though you probably realize that your fears of being
judged are at least somewhat irrational and overblown, you still can’t
help feeling anxious.

Although it may feel like you’re the only one with this problem, social
anxiety disorder is actually quite common. Many people struggle with
these fears. But the situations that trigger the symptoms of social
phobia can be different.

Some people experience anxiety in most social and performance

situations, a condition known as generalized social anxiety disorder.
For other people with social phobia, anxiety is connected with specific
social situations, such as speaking to strangers, eating at restaurants,
or going to parties. The most common specific social phobia is fear of
public speaking or performing in front of an audience.

Triggers for social anxiety disorder (social phobia)

The following situations are often stressful for people with social
anxiety disorder:
▪ Meeting new people ▪ Being called on in class
▪ Being the center of attention ▪ Going on a date
▪ Being watched while doing something ▪ Making phone calls
▪ Making small talk ▪ Using public bathrooms
▪ Public speaking ▪ Taking exams.
▪ Performing on stage ▪ Eating or drinking in public
▪ Being teased or criticized ▪ Speaking up in a meeting
▪ Talking with “important” people or authority ▪ Attending parties or other socia
figures
Signs and symptoms of social anxiety disorder (social
phobia)
Just because you occasionally get nervous in social situations doesn’t
mean you have social anxiety disorder, or social phobia. Many people
are shy or self-conscious — at least from time to time — yet it doesn’t
get in the way of their everyday functioning. Social anxiety disorder,
on the other hand, does interfere with your normal routine and causes
tremendous distress.

For example, it’s perfectly normal to get the jitters before giving a
speech. But if you have social anxiety disorder, you might worry for
weeks ahead of time, call in sick to get out of it, or start shaking so
bad during the speech that you can hardly speak.

Psychological symptoms of social anxiety disorder (social

phobia)
▪ Intense worry for days, weeks, or even months before an upcoming
social situation.
▪ Extreme fear of being watched or judged by others, especially people
you don’t know.
▪ Excessive self-consciousness and anxiety in everyday social
situations.
▪ Fear that you’ll act in ways that that will embarrass or humiliate
yourself.
▪ Fear that others will notice that you’re nervous.
▪ Avoidance of social situations to a degree that limits your activities
or disrupts your life.
Physical symptoms of social anxiety disorder (social
phobia)
▪ Pounding heart or tight chest ▪ Trembling or shaking
▪ Shaky voice ▪ Muscle tension
▪ Rapid breathing ▪ Blushing
▪ Sweating or hot flashes ▪ Dizziness, feeling faint
▪ Upset stomach, nausea ▪ Clammy hands
▪ Dry mouth ▪ Twitching
Social anxiety disorder (social phobia) in children
There’s nothing abnormal about a child being shy, but children with
social anxiety disorder (social phobia) experience extreme distress
over everyday activities and situations such as playing with other kids,
reading in class, speaking to adults, taking tests, or performing in
front of others. Often, children with social phobia don’t want to go to
school.

Getting help for social anxiety disorder (social phobia)

While it may seem like there’s nothing you can do about the symptoms
of social anxiety disorder (social phobia), in reality, there are many
things that can help. The best treatment approach for social anxiety
disorder varies from person to person. You may find that self-help
strategies are enough to ease your anxiety symptoms, or you may
need professional help as well, such as therapy or medication. But
whatever your approach, you can overcome your social anxiety if seek
the help you need and make a commitment to treatment.

Lifestyle changes for social anxiety disorder (social

phobia)
While lifestyle changes alone aren’t enough to overcome social anxiety
disorder, they can support your overall treatment progress. The
following lifestyle tips will help you reduce your overall anxiety levels
and set the stage for successful treatment:

▪ Avoid or limit caffeine. Coffee, tea, caffeinated soda, energy

drinks, and chocolate act as stimulants that increase anxiety
symptoms.
▪ Drink only in moderation. You may be tempted to drink before a
party or other social situation in order to calm your nerves, but
alcohol increases your risk of having an anxiety attack.
▪ Quit smoking. Nicotine is a powerful stimulant. Smoking leads to
higher, not lower, levels of anxiety.
▪ Get adequate sleep. When you’re sleep deprived, you’re more
vulnerable to anxiety. Being well rested will help you stay calm
in social situations.
Medication for social anxiety disorder (social phobia)
Medication is sometimes used to relieve the symptoms of social
anxiety, but it’s not a cure for social anxiety disorder or social phobia.
If you stop taking medication, your symptoms will probably return full
force. Medication is considered most helpful when used in addition to
therapy and other self-help techniques that address the root cause of
social anxiety disorder.

Three types of medication are used in the treatment of social anxiety

disorder (social phobia):

▪ Beta blockers – Beta blockers are used for relieving performance

 anxiety. They work by blocking the flow of adrenaline that occurs
when you’re anxious. While beta blockers don’t affect the
emotional symptoms of anxiety, they can control physical
symptoms such as shaking hands or voice, sweating, and rapid
heartbeat.
▪ Antidepressants – Antidepressants can be helpful when social
anxiety disorder is severe and debilitating. Three specific
antidepressants—Paxil, Effexor, and Zoloft—have been approved
by the U.S. Food and Drug Administration for the treatment of
social phobia.
▪ Benzodiazepines – Benzodiazepines are fast-acting anti-anxiety
medications. However, they are sedating and addictive, so they
are typically prescribed only when other medications for social
phobia have not worked.
For more about the medications used to treat social anxiety
disorder, see:
▪ Anxiety Medication: What You Need to Know About Drugs for Anxiety
▪ Antidepressants: What You Need to Know About Depression
Medications
Therapy for social anxiety disorder (social phobia)
Of all the treatments available, cognitive-behavioral therapy (CBT) has
been shown to work the best for treating social anxiety disorder, or
social phobia. Cognitive-behavioral therapy is based on the premise
that what you think affects how you feel, and your feelings affect your
behavior. So if you change the way you think about social situations
that give you anxiety, you’ll feel and function better.

Cognitive-behavioral therapy for social phobia typically involves:

▪ Learning how to control the physical symptoms of anxiety through

relaxation techniques and breathing exercises.
▪ Challenging negative, unhelpful thoughts that trigger and fuel social
anxiety, replacing them with more balanced views.
▪ Facing the social situations you fear in a gradual, systematic way,
rather than avoiding them.
Other cognitive-behavioral techniques for social anxiety disorder
include role-playing and social skills training, often as part of a therapy
group.
Group therapy for social anxiety disorder uses acting, videotaping and
observing, mock interviews, and other exercises to work on situations
that make you anxious in the real world. As you practice and prepare
for situations you’re afraid of, you will become more and more
comfortable and confident in your social abilities, and your anxiety will
lessen.

Learning more about therapy for social phobia

The length of therapy treatment for social anxiety disorder will differ
from person to person. However, many anxiety therapies are relatively
short-term. And many of the techniques you learn can be practiced at
home and put into daily use.

To learn more about the types of therapy that help anxiety, see
Therapy for Anxiety Disorders.

Social anxiety disorder treatment #1: Reducing

physical symptoms of anxiety
Many changes happen in your body when you become anxious. One of
the first changes is that you begin to breathe quickly. Overbreathing
throws off the balance of oxygen and carbon dioxide in your body —
triggering additional physical anxiety symptoms such as dizziness, a
feeling of suffocation, increased heart rate, and muscle tension.
Learning to slow your breathing down can help you bring your physical
symptoms of anxiety back under control.

Practicing the following breathing exercise will help you decrease the
physical symptoms of anxiety and stay calm:

▪ Sit comfortably with your back straight and your shoulders relaxed.
Put one hand on your chest and the other on your stomach.
▪ Inhale slowly and deeply through your nose for 4 seconds. The hand
on your stomach should rise, while the hand on your chest
should move very little.
▪ Hold the breath for 2 seconds.
▪ Exhale slowly through your mouth for 6 seconds, pushing out as
much air as you can. The hand on your stomach should move in
as you exhale, but your other hand should move very little.
▪ Continue to breathe in through your nose and out through your
mouth. Focus on keeping a slow and steady breathing pattern of
4-in, 2-hold, and 6-out.

Relaxation techniques for anxiety relief

In addition to deep breathing exercises, regular practice of relaxation
techniques such as meditation, yoga, and progressive muscle
relaxation will also help you get control over the physical symptoms of
anxiety.

For step-by-step advice on getting started, see Stress Relief: Yoga,

Meditation, and other Relaxation Techniques.

Social anxiety disorder treatment #2: Challenging

negative thoughts
Social anxiety sufferers have negative thoughts and beliefs that
contribute to their anxiety. If you have social anxiety disorder, or
social phobia, you may find yourself overwhelmed by thoughts like:

▪ “I know I’ll end up looking like a fool.” ▪ “People will think I’m stupid.”
▪ “My voice will start shaking and I’ll humiliate ▪ “I won’t have anything to say
myself.”
Challenging these negative thoughts, either through therapy or on
your own, is one effective way to reduce the symptoms of social
anxiety disorder.

The first step is to identify the automatic negative thoughts that

underlie your fear of social situations. For example, if you‘re worried
about an upcoming work presentation, the underlying negative
thought might be: “I’m going to blow it. Everyone will think I’m
completely incompetent.”

The next step is to analyze and challenge them. It helps to ask

yourself questions about the negative thoughts: “Do I know for sure
that I’m going to blow the presentation?” or “Even if I’m nervous, will
people necessarily think I’m incompetent?” Through this logical
evaluation of your negative thoughts, you can gradually replace them
with more realistic and positive ways of looking at social situations that
trigger your anxiety.

Unhelpful thinking styles involved in social phobia

In particular, ask yourself if you’re engaging in any of the following
unhelpful thinking styles:

▪ Mind reading – Assuming you know what other people are thinking,
and that they see you in the same negative way that you see
yourself.
▪ Fortune telling – Predicting the future, usually while assuming the
worst will happen. You just “know” that things will go horribly, so
you’re already anxious before you’re even in the situation.
▪ Catastrophizing – Blowing things out of proportion. If people notice
that you’re nervous, it will be “awful,” “terrible,” or “disastrous.”
▪ Personalizing – Assuming that people are focusing on you in a
negative way or that what’s going on with other people has to do
with you.
How can I stop thinking that everyone is looking at me?
In order to reduce self-focus, pay attention to what is happening
around you, rather than monitoring yourself or focusing on symptoms
of anxiety in your body:
▪ Look at other people and the surroundings.
▪ Really listen to what is being said (not to your own negative
thoughts).
▪ Don't take all the responsibility for keeping conversations going—
silence is okay, other people will contribute.
Adapted from: Moodjuice
Social anxiety disorder treatment #3: Gradually facing
your fears
One of the most helpful things you can do to overcome social anxiety
disorder, or social phobia, is to face the social situations you fear
rather than avoid them. Avoidance keeps social anxiety disorder going.
It prevents you from becoming more comfortable in social situations
and learning how to cope. In fact, the more you avoid a feared social
situation, the more frightening it becomes.

While it may seem impossible to overcome a feared social situation,

you can do it by taking it one small step at a time. The key is to start
with a situation that you can handle and gradually work your way up
to more challenging situations, building your confidence and coping
skills as you move up the “anxiety ladder.”

For example, if socializing with strangers makes you anxious, you

might start by accompanying an outgoing friend to a party. Once
you’re comfortable with that step, you might try introducing yourself
to one new person, and so on.

Working your way up the social phobia “anxiety ladder”

▪ Don’t try to face your biggest fear right away. It’s never a good
idea to move too fast, take on too much, or force things. This
will backfire and reinforce your anxiety.
▪ Be patient. Overcoming social anxiety takes time and practice. It’s
a gradual step-by-step progress.
▪ Use the skills you’ve learned to stay calm, such as focusing on
your breathing and challenging negative assumptions.
Beating social phobia by building better relationships
Actively seeking out and joining supportive social environments is
another effective way of tackling and overcoming social phobia. The
following suggestions are good ways to start interacting with others in
positive ways:
▪
▪ Take a social skills class or an assertiveness training class.
These classes are often offered at local adult education centers
or community colleges.
▪ Volunteer doing something you enjoy, such as walking dogs in a
shelter, or stuffing envelopes for a campaign — anything that
will give you an activity to focus on while you are also engaging
with a small number of like-minded people.
▪ Work on your communication skills. Good relationships depend
on clear, emotionally-intelligent communication. If you find that
you have trouble connecting to others, learning the basic skills of
emotional intelligence can help.
For more on how to build these skills, see Relationship Help:
Building Great Relationships with Emotional Intelligence Tools.
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