What Is Social Anxiety Disorder?

You’re supposed to attend a charity gala this weekend, and your stomach is in knots. What if your close friend bails? What if you have no one to talk to? What if you can’t think of anything interesting to say? What if everyone can tell you’re anxious? You consider canceling your RSVP. It’s possible you might struggle with social anxiety.

The DSM-5 defines social anxiety as:

“A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.”

Also, according to the DSM-5, in order to meet criteria for Social Anxiety Disorder, one must typically experience anxiety in these social/performance situations, recognize the fear is excessive, and either uncomfortably tolerate this distress when in these situations, or avoid them entirely. The fear and/or avoidance of such situations generally lasts six months or more and tends to interfere with overall functioning.

Those who struggle with Social Anxiety Disorder might fear social/performance situations in general or might have specific situational triggers, such as public speaking, appearing in front of crowds, meeting new people, socializing at parties, interacting with higher-ups at work, asking for help or favors, etc. Underlying most presentations is a fear of being judged or negatively evaluated and a concern that one’s anxiety will be apparent to others.

Treatment of Social Anxiety Disorder:

Treatment of Social Anxiety Disorder typically involves cognitive-behavioral therapy, the goal being to challenge some of the thoughts that lead to the experience of anxiety (e.g., “I have to be interesting at all times” or “If they see I’m anxious, they’ll think less of me”) and engaging in exposure exercises. Exposures exercises encourage us to engage in exactly what we fear. So, those who fear public speaking might sign up for Toastmasters, where they can practice public speaking. With exposure, we see acclimation and reduced anxiety over time. The teen who fears unstructured social situations might set up a series of graded, exposure exercises, perhaps starting with spending some time at a coffee shop, then saying hello to someone at the coffee shop, then striking up a conversation with a stranger, and then proceeding to more challenging exposures, such as attending parties and school dances.

Another effective treatment modality for Social Anxiety Disorder is group therapy.  By it’s nature, group therapy encourages social interactions (with strangers), and allows people to practice relating to others in a safe, therapeutic space.  Because of the exposure built into the treatment, those who struggle might see quicker, more sustainable gains with group. And in some cases, individuals with Social Anxiety Disorder may take medication in order to augment the effects of psychotherapy.

Gatewell Therapists Who Specialize in Treating Social Anxiety Disorder: