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Even if we’re fairly independent, we all worry about what others think of us from time to time. But with social anxiety, everyday interactions can feel overwhelming. We can become so concerned about what others think or how we might mess up that we can’t function to our fullest potential.
Unfortunately, this can make it even more challenging to get treatment and support for social anxiety. After all, how do you reach out to people for help when social interactions are the source of your stress? People with social phobia may worry about how they’ll be perceived if they reveal that they need help.
Although social anxiety is best diagnosed — and treated — by a licensed mental health provider, coaching can provide a wonderful source of support. Coaching relationships are inherently safe spaces where people can get an extra dose of unconditional positive regard, work out their worries about social interactions, and escape the stigma that often accompanies treatment for mental health.
Learn more about how social phobia impacts daily life — and how to get the support you need to overcome it.
What is social anxiety disorder?
Social anxiety disorder is when an individual experiences acute fear and stress when placed in social settings. While it’s common for people to feel nervous when they have to have an important conversation or speak in public, social anxiety is more than that. People with social anxiety disorder are so distressed by their symptoms that it impacts their daily lives.
Diagnosing social anxiety disorder
Social anxiety is an officially recognized mental health disorder. In order to receive a diagnosis, a person needs to meet with a licensed mental health professional for assessment. They’ll talk to you about your history and how social anxiety is affecting your life.
According to the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the diagnostic criteria for social anxiety disorder includes the following:
Symptoms of social anxiety disorder
- Fear or anxiety about social situations where you feel you may be watched, scrutinized, or open to the judgement of others
- Stress that’s not proportionate to the social situation
- Significant distress that causes either avoidance of social situations or getting through them only with intense anxiety
In children, this often shows up as temper tantrums, frustration, low self-esteem, freezing, and clinginess. The symptoms in adults, though, aren’t very different. As we get older, we tend to get better at hiding our urge to throw a tantrum. Instead, it comes out in other ways, like irritability, avoidance, quitting projects, “ghosting” people, or staying in unhealthy relationships.
If you meet these criteria, your doctor may determine that you have social anxiety disorder. They will either start treatment or refer you to another professional for help.
What triggers social anxiety?
Typically speaking, people with social anxiety can be triggered by any situation that involves interacting with other people. This could — and often does — include daily tasks like going to work, making a phone call, asking questions, or giving a presentation.
It’s worth noting that people with social anxiety aren’t necessarily introverts, nor do they “dislike” people. It’s not usually the people that trigger bouts of social anxiety. Most often, people with social anxiety disorder are concerned about being judged, humiliated, or scrutinized by others. In other words, it’s not so much the people as what the people may think — and the possible outcomes of losing their esteem.
How can social anxiety affect your life?
Most people know what it feels like to be nervous about social situations or public speaking. Social anxiety disorder, however, is more than just shyness. The intense fear can be debilitating. People with social anxiety will sometimes go to great lengths to avoid social events. Depending on the severity of the symptoms, they might be willing to lose money, time, relationships, or opportunities to avoid being in front of others.
Because most things in life, especially work, involve interpersonal interaction, those with social anxiety may have poor self-efficacy. They might feel that their symptoms — and therefore their lives — are out of their control. If they’ve tried and failed to gain control of their symptoms, it might feel like there’s no point in trying to talk to people or do anything differently.
What’s the treatment for social anxiety disorder?
There are many ways to treat anxiety disorders, including social anxiety. Typically, a mental health professional will help you decide on the best course of treatment.
Like most anxiety disorders, social anxiety is usually treated with a combination of medication and psychotherapy. However, since social anxiety has a specific set of triggers, the treatment generally includes slowly acclimating to and talking through various social situations.
Cognitive behavioral therapy (CBT) is one of the most common and effective interventions for treating social anxiety. Patients work with a clinician to identify unhelpful, distorted, and anxious thoughts. Once they identify these patterns of thinking, they can start challenging and replacing the negative thoughts.
Social anxiety disorder shares many traits with phobias. In this case, the "phobia" is the fear of social situations. Because of this, therapists often choose to pair CBT with exposure therapy. With exposure (or desensitization) therapy, practitioners gradually “expose” their patients to the triggers they are afraid of. For example, they may start with setting an appointment over the phone and progress to small talk with the receptionist.
People with social anxiety disorders are often prescribed medication to manage the symptoms of their anxiety. Anti-anxiety medications include SSRIs, beta blockers, and benzodiazepines.
SSRIs, or selective serotonin reuptake inhibitors, work by helping the brain keep serotonin from being reabsorbed as quickly. Often, SSRIs are prescribed as antidepressants, but they are also used to treat generalized anxiety disorder and other mental health conditions. SSRIs usually take a couple of weeks to start working, but can be very effective for both depression and anxiety.
Beta blockers and benzodiazepines are usually prescribed to treat acute (immediate) symptoms of anxiety, like heart palpitations, sweating, and dizziness. However, benzodiazepines can be dangerous due to their highly addictive nature.
Because of the fear of interacting with and being judged by others, support groups for those with social anxiety can be especially healing. People can share their experiences, practice social skills, and talk openly in a way that they may not feel comfortable doing outside of group therapy.
Ways to manage social anxiety
In addition to therapy, there are several other things you can do to help calm yourself down when you’re feeling anxious. Although none of these should be a substitute for medical advice from a qualified professional, being proactive about your mental fitness can significantly boost the effectiveness of therapy.
1. Get some sleep
It may be hard to nod off when you’re feeling anxious, but getting enough sleep is the number one thing you can do to keep your emotions well-regulated. Lack of sleep can exacerbate symptoms of anxiety and depression. When you aren’t well-rested, it also makes it difficult to keep up with other healthy habits, like exercise, eating mindfully, and staying connected to others.
2. Be aware of what you eat and drink
If you have anxiety, you should try to avoid foods and beverages that contain caffeine. Consuming caffeine often makes certain physical symptoms (like an elevated heart rate or upset stomach) worse. Drinking enough water can help prevent symptoms of dehydration — several of which mimic the symptoms of a panic attack.
You also want to be mindful of your alcohol intake. Some people with social phobia rely on alcohol’s reputation as a “social lubricant” to make them feel less self-conscious. However, since alcohol is a depressant, it can leave you feeling worse. Drinking alcohol can also be habit-forming, so it’s not advisable to use it to “treat” chronic anxiety.
3. Be intentional about your downtime
When you deal with chronic stress, you feel like you’re always in overdrive. For those with social anxiety, you might feel “peopled out” relatively quickly — and often. When you have time to yourself, prioritize your self-care. Do things that make you feel at ease, good about yourself, and help you recover.
4. Give yourself an advantage
Often, people with social phobia are more triggered by certain situations and interactions than others. As you work through your stress, try seeing if there’s anything you can do to shift necessary social interactions so they’re more comfortable for you. Try meeting a friend for a birthday lunch instead of a party, or practice your presentation with a coach until you feel at ease.
5. Challenge your thoughts
If you’re working with a therapist, you’ll likely spend time working on CBT techniques to identify intrusive thoughts. Like any other new skills, CBT is the most effective when you practice it consistently. If you notice yourself worrying about what others are thinking of you, take your thoughts to trial. Ask yourself “Is this true? Do I have evidence? What’s more likely?”
Therapists often recommend keeping a journal of your intrusive thoughts. You can discuss them in your next session.
Remind yourself that you’re safe
Ultimately, we can’t get rid of our anxiety completely — nor would we want to. Anxiety is a natural emotion, and it serves a very important function in our lives. Anxiety is meant to keep us safe. When we feel fearful, it’s because somewhere in our environment, there is a perceived threat.
What makes anxiety hard to deal with is that our response is out of proportion to the threat. We get an email from work and we flip into high gear. This emotional roller-coaster can make us feel like we don’t have any control. And with social anxiety, the threat can feel like it’s everywhere.
By working with your therapist, a coach, and prioritizing your self-care, you can help increase your sense of safety. When you start to feel more at ease and build your self-efficacy in social situations, you won’t be as overwhelmed by your social anxiety. Like any other phobia, it can be treated and overcome.
BetterUp Staff Writer