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Social Anxiety Disorder

What are the symptoms?

Social anxiety disorder, also known as ‘social phobia’, is defined as a fear of negative evaluation by others. It is a common form of anxiety that usually starts during adolescence and for some people it can go away on its own, however, for many people it can become an ongoing issue. Social anxiety disorder is diagnosed when the distress is so overwhelming that it affects an individual’s daily living, self-confidence, relationships and work or school life. Social anxiety is much more than shyness, it is an intense fear; and while many people will occasionally worry about social situations, someone with social anxiety disorder feels overly worried before, during and after them. This disorder is pervasive and causes distress most areas of a person’s life.

Those with social anxiety disorder may experience many different symptoms and use many different behaviors to try and ease the symptoms.  For example, people may:

Safety behaviors are things that a person will do to either make themselves feel more comfortable, reduce symptoms or avoid situation that may trigger social anxiety. Examples of safety behaviors are:

In addition to the behaviors mentioned, there will be other ones used that are specific to the individual. Although safety behaviors can give the person relief from the anxiety, it is not a long-term solution and does not give the person a chance to prove to themselves that they can cope in social situations and get better to the point where that can live daily life with more ease. By planning and using these safety behaviors reinforces that idea that these situations are dangerous, which will make the anxiety worse and worse over time.

Common triggers

There are two main types of triggers, which are: performance situations and interpersonal interactions.

Performance situations are situations where people feel they are being observed and judged by others. Examples of performance situations are: public speaking, answering questions in meetings or classes, eating in front of others, using public toilets, performing in public, and entering a room where everyone is already seated.

Interpersonal interactions are situations where people are interacting with others and developing relationships. Examples of interpersonal interactions are: meeting new people, talking to co-workers, inviting others to do things, going to social events, dating, being assertive, talking on the phone, expressing an opposing opinion, ordering food at a restaurant and returning something to a shop.

Myths about social anxiety

Like many other common mental health issues, social anxiety is often misunderstood; for example:

One myth is that people who have social anxiety disorder are mute: it is often assumed that those with social anxiety disorder have selective mutism, which means that they are not capable of speech in specific situations or with specific people. However, this is rarely the case, and although selective mutism can co-exist with social anxiety disorder, it is a separate disorder and does not affect most people with social anxiety disorder.

Another myth is that social anxiety and shyness are the same thing. Although characteristics of being shy are also true for social anxiety disorder, social anxiety is an intense fear, like any other phobia, those who have it experience a severe fear reaction to their triggers. Unlike shyness, those with social anxiety may experience panic attacks, depression and can negatively affect the individual long before, during and after the social situation.

Additionally, people may assume that social anxiety only refers to public speaking. This may be an assumption due to anxiety or nervousness being experienced by many people, not just those who have social anxiety or are shy, while speaking in front of a group of people. However, although people with social anxiety may experience symptoms of their disorder during this performance situation, they may also experience a similar level of anxiety by talking with someone on the phone.

The idea that alcohol and other substances can cure social anxiety is a common myth. Alcohol is often referred to as ‘liquid courage’, and although it may seem like it eases symptoms for a short time and increases confidence, people should not be fooled into thinking that drinking can cure social anxiety. Drinking may be used as a safety behaviour but can be a dangerous one. Drinking, like other forms of self-harm, swaps one pain out for another and can worsen the mental health disorder rather than help people cope with it.

It is also common for people to disassociate mental health disorder with physical issues, in the sense that mental health issues cannot physically hurt or kill you (this is not just specific to social anxiety disorder). However, this is not true; when people experience intense emotions as a result of their mental health it can have physiological effects such as: increased chances of heart disease, palpitations, sweating, dizziness, chest pain, skin irritation and rashes, fatigue and insomnia, nausea, weight loss, obesity, diarrhea, headaches, muscle aches, chills or hot flushes and for some, their mental health issues lead to suicide. There are many physical responses to mental health issues that are not mentioned here. 

It may be assumed that people will be able to get over their social anxiety on their own or that the fears are a phase that will fade over time. Although some people may be able to recover on their own, for the majority of people who experience mental health issues such as social anxiety, their disorders will not suddenly disappear, and if the disorder is ignored and untreated then it may worsen and become harder to cope with.

How to help

Accessing talking therapies is widely encouraged for any mental health issues; this can come in the form of one-to-one counselling, group counselling or peer support groups. Talking therapies gives people the opportunity to be able to discuss their problems, receive other view points on their situations, receive guidance through coping techniques, challenge negative thoughts in a safe environment, and it allows people to share their experiences. Mental health issues can be difficult to overcome on your own and so by receiving that extra support can make a difference in recovery.

However, due to the nature of social anxiety disorder, some people may find it too daunting to seek help. Therefore, there are some self-help strategies people can use before they seek help with their social anxiety disorder.

Learn about social anxiety – the more people know about their mental health issues, the more they will understand how to cope with them. There are many forms of information on the internet and in books that people can use to get more understanding of their disorder, if they feel too uncomfortable talking with someone about it.

Challenge negative thoughts – when a situation arises that causes the individual distress, it is important that they consider why they find it distressing. Negative thoughts can catastrophize and forecast negative outcomes of a situation that may not hold any truth but can still cause intense distress and anxiety.

These negative thoughts can cause people to avoid a situation or to experience it as negative because they had already decided in their head that that was going to happen. Challenging these thoughts can help the person have a rational and healthy outlook on the situation.

Be positive – thoughts can sometimes decide how a person will experience a situation. For example, if someone assumed that they would have a bad experience of a situation then they will have a bad experience of it.

Our thoughts influence our behaviours, so if we go assuming the worst, our behaviours will reflect that which will then reinforce the idea of the situation being a negative one. Whereas, if a person in the same situation went assuming they will have a positive experience, they will approach the situation feeling positive and their behaviours will follow.

Create a fear hierarchy – this is where someone writes a list of feared situations starting with least scary to most scary, then proceeding though each situation in their own time and as many times as needed until the familiarity with the situation helps to reduce the anxiety response.

Try to do more things that you would usually avoid – it is easy to get into a habit of avoiding challenging situations as it is the easier route. However, avoiding situations reinforces the idea that they are too much to cope with and does not allow you to prove to yourself that you can cope with situations. Additionally, much like the ‘list of fears’ technique, becoming familiar with situations can help ease the anxiety.

Breathe – breathing exercises can help with the physical responses to stress. Deep breaths can help control quick and rapid breaths, minimize shaking and by inhaling more oxygen can slow down heart rate.

Distraction techniques – when people experience intense emotions from their mental health that they cannot calm down from, it may be that taking their mind off their issues is what is best.

This is not to say that people should ignore their emotions, but distraction tasks can allow the individual to calm down which will put them in a better frame of mind to be able to confront the problem. Distraction tasks can include: walking, exercising, drawing, painting, reading, doing house work, watching something on television, doing puzzles or any activity that occupies the mind and shifts focus to something else that is enjoyable.

There are many other possible coping techniques that people can use, it is important that people find what works best for them so that they have their coping strategies at the ready when they are faced with a possible trigger.

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