What Is Social Anxiety?
Do you get anxious when you have to give a talk? How about before work meetings or parties or other types of events? Do you notice apprehension, worry, or even dread? How about the physical manifestations of anxiety, such as a sweating, an increased heart rate, or stomach trouble? If these symptoms happen frequently and intensely enough, it could be that you struggle with social anxiety disorder.
The DSM-5-TR describes the core criterion of social anxiety to be:
“Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).”
Also known as social phobia, social anxiety disorder is one of the most common psychiatric disorders in the U.S., impacting over five million Americans. It tends to begin in the teen years, when social approval and rejection are paramount, and can linger long into adulthood. Still, even younger children can be diagnosed with social anxiety. Those who struggle with this condition may develop a pattern of habitual avoidance, avoiding the social situations and behaviors that lead them to experience anxiety. They might avoid public speaking, dating, going to parties or events, using public restrooms, or eating in front of others. Avoidance is designed to reduce the likelihood of being judged, rejected, or humiliated by others. Unfortunately, with avoidance, the fear is maintained and often strengthened over time.
Coping with Social Anxiety
Luckily, there are some tried and true strategies for coping with social anxiety. As with most anxiety disorders, the key is to target avoidance. The more you can expose yourself to anxiety-provoking situations, the more likely it is that you’ll experience symptom reduction over time. With avoidance, we shy away from certain situations, feel more comfortable, and then we convince ourselves that it’s the avoidance that’s responsible for any reductions in anxiety we might notice. But if we expose ourselves to our feared situations (and don’t escape), what we learn through experience is that our anxiety will naturally decrease over time. In scientific terms, we call this process “habituation.” It means that as we become accustomed to a feared stimulus, we learn that we can tolerate the anxiety it creates and we also learn that the anxiety will naturally decrease over time. All of this leads to less fear and anticipation over time.
Here are some strategies, many of which draw from DBT, that might be useful if you’d like to focus on coping with social anxiety.:
1 .Targeted exposure: As stated above, exposure to people and social situations is key in coping with social anxiety. This means doing the things that bring you fear over and over again until they’re not as daunting. You might sign up for a public speaking class (many cite Toastmasters as a helpful option), join a social group, start conversations with strangers, eat out more in public spaces – whatever it is that causes you fear, the assignment would be to do more of this. A number of people with social anxiety attend our DBT groups, and we think participation here serves double duty. First, folks learn crucial coping skills for managing their anxiety. But the group itself, since there are other people involved, can serve as an exposure. That said, our groups are intentionally supportive and non-judgmental spaces, so they can be a helpful stepping stone to participating in other social situations.
2. Opposite action: This is a DBT skill that involves doing the opposite of what our emotions “want” us to do. We’ve already covered exposure, which is the hallmark of opposite action for social anxiety. But it’s important to mention that opposite action works best when it’s done “all the way.” This means exposing yourself to the feared situation with a calm and confident body and a calm and confident mind. In social situations, you might stand tall and proud, adopting a soft, but secure, facial expression. Maybe you experiment with some other body-based DBT skills, such as half smile or willing hands when you’re with others. You tell yourself you’re okay and feed yourself encouraging versus critical self-talk. Doing exposures while your body is tense and while you’re mentally attacking yourself doesn’t really work; doing opposite action “all the way” is much more likely to lead to success when coping with social anxiety.
3. Preparation: In anticipation of social events, it can be helpful to cope ahead. What will you talk about? It’s often helpful to observe others who seem to have a bit more social ease. What kinds of things do they talk about? What kinds of questions do they ask? Is there anything you can model? Then think about some potential questions to ask or topics to broach before a party or event. Some sample conversational topics might include travel/vacations, how you know the host, work, leisure/hobbies, and anything else that feels tolerable for you to address. And it’s helpful to get skilled at small talk. While many of us shy away from small talk, it’s an integral part to forming connections and eventually going deeper. More ideas for conversational topics are listed here.
4. Participation: When you’re engaging with others, really engage. We call this “participating” in DBT, and it means throwing yourself into the moment, the conversation or interaction, moving away from analyses or critiques of yourself. It also means letting go of trying to control an interaction or situation and instead, “going with the flow.” People who are able to participate – rather than staying stuck on the sidelines or self-consciously in their own heads, monitoring or evaluating their own performance as they interact – are more likely to feel less social anxiety and therefore more positivity as a result of their interactions.
5. Medication: If you’ve tried these techniques and are still struggling with the symptoms of social anxiety, it might be helpful to seek out consultation regarding adding psychiatric medication. Two classes of medication that are often used for social anxiety are beta-blockers and SSRIs. Beta-blockers interfere with the release of stress hormones and slow the heart rate and lower blood pressure. This “slowing” of the body can contribute to a decreased experience of anxiety. An example of a beta-blocker is propranolol, which many use episodically for stage fright. The other class, SSRIs (selective serotonin reuptake inhibitors) are prescribed for anxiety and depression, taken over time, and effective at addressing social anxiety. Three SSRIs have been FDA-approved for social anxiety disorder (Zoloft, Paxil, and Luvox), though other SSRIs may be used too.
At Gatewell Therapy Center, we offer DBT skills in individual and group settings and can create a treatment plan specifically to address your struggles with social anxiety. Treatment often involves exposure to challenging situations along a graded hierarchy, from easier to more difficult over time. Remember, when coping with social anxiety, exposure is key. Continuing to expose yourself to social situations, seeking out opportunities to speak, interact, eat, and just be among other people, is what we know to be most effective in addressing this difficult, but treatable, condition.