Social Anxiety

Social Anxiety 

 

Social anxiety, also called social phobia, is a disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social anxiety have a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their own actions. Their fear may be so severe that it interferes with work or school - and other ordinary activities. While many people with social anxiety recognize that their fear of being around people may be excessive or unreasonable, they are unable to overcome it. They often worry for days or weeks in advance of a dreaded situation.

Social anxiety can be limited to only one type of situation - such as a fear of speaking in formal or informal situations, or eating or drinking in front of others - or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people. Social anxiety can be very debilitating - it may even keep people from going to work or school on some days. Many people with this illness have a hard time making and keeping friends.

Physical symptoms often accompany the intense anxiety of social anxiety and include blushing, profuse sweating, trembling, and other symptoms of anxiety, including difficulty talking and nausea or other stomach discomfort. These visible symptoms heighten the fear of disapproval and the symptoms themselves can become an additional focus of fear. Fear of symptoms can create a vicious cycle: as people with social anxiety worry about experiencing the symptoms, the greater their chances of developing the symptoms.. Social anxiety often runs in families and may be accompanied by depression or alcohol dependence.

How Common Is Social Anxiety?

  • About 3.7% of the U.S. population ages 18 to 54 - approximately 5.3 million Americans - has social anxiety in any given year.
  • Social anxiety occurs in women twice as often as in men, although a higher proportion of men seeks help for this disorder.
  • The disorder typically begins in childhood or early adolescence and rarely develops after age 25.

What Causes Social Anxiety?

Research to define causes of social anxiety is ongoing.

  • Some investigations implicate a small structure in the brain called the amygdala in the symptoms of social anxiety. The amygdala is believed to be a central site in the brain that controls fear responses.
  • Animal studies are adding to the evidence that suggests social anxiety can be inherited. In fact, researchers supported by the National Institute of Mental Health (NIMH) recently identified the site of a gene in mice that affects learned fearfulness.
  • One line of research is investigating a biochemical basis for the disorder. Scientists are exploring the idea that heightened sensitivity to disapproval may be physiologically or hormonally based.
  • Other researchers are investigating the environment's influence on the development of social anxiety. People with social anxiety may acquire their fear from observing the behavior and consequences of others, a process called observational learning or social modeling.

What Treatments Are Available for Social Anxiety?

Research supported by NIMH and by industry has shown that there are two effective forms of treatment available for social anxiety: certain medications and a specific form of short-term psychotherapy called cognitive-behavioral therapy. Medications include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as drugs known as high-potency benzodiazepenes. Some people with a form of social anxiety called performance anxiety have been helped by beta-blockers, which are more commonly used to control high blood pressure.

Cognitive-behavior therapy is also very useful in treating social anxiety. The central component of this treatment is exposure therapy, which involves helping patients gradually become more comfortable with situations that frighten them. The exposure process often involves three stages. The first involves introducing people to the feared situation. The second level is to increase the risk for disapproval in that situation so people build confidence that they can handle rejection or criticism. The third stage involves teaching people techniques to cope with disapproval. In this stage, people imagine their worst fear and are encouraged to develop constructive responses to their fear and perceived disapproval.

Cognitive-behavior therapy for social anxiety also includes anxiety management training - for example, teaching people techniques such as deep breathing to control their levels of anxiety. Another important aspect of treatment is called cognitive restructuring, which involves helping individuals identify their misjudgments and develop more realistic expectations of the likelihood of danger in social situations.

Supportive therapy such as group therapy, or couples or family therapy to educate significant others about the disorder, is also helpful. Sometimes people with social anxiety also benefit from social skills training.

What Other Illnesses Co-Occur With Social Anxiety?

Social anxiety can cause lowered self-esteem and depression. To try to reduce their anxiety and alleviate depression, people with social anxiety may use alcohol or other drugs, which can lead to addiction. Some people with social anxiety may also have other anxiety disorders, such as panic disorder and obsessive-compulsive disorder.

 

Made available to ACT by Freedom From Fear

What Is Social Phobia?

by Robert L. Leahy, Ph.D. and Stephen J. Holland, Ph.D., Founding Fellows, ACT
 
Social phobia is the fear of one or more social situations. Commonly feared situations include public
speaking, meeting new people, being at parties, asking for dates, eating in public, using public
restrooms, speaking to people in authority, and disagreeing with others.
 
People with social phobia are afraid they will act in ways that will make other people think badly
of them. They often fear that others will see some sign of anxiety, such as blushing, trembling, or
sweating. People with social phobia usually try to stay away from the situations that make them anxious. When they cannot, they tend to feel very anxious or embarrassed.
 
Sometimes they may have
panic attacks. Social phobia is a severe, disabling form of shyness and can cause problems in people’s
lives. Sometimes the problems are minor, such as not being able to speak up in class. Sometimes,
however, the problems can be very serious. People with severe social phobia often have few friends,

feel lonely, and have trouble reaching their goals in school or at work. (Read more...)

Reprinted from Treatment Plans and Interventions for Depression and Anxiety Disorders by Robert L. Leahy and Stephen J. Holland. (C) Copyright 2000. This excerpt is posted with permission of Guilford Publications, Inc. and is subject to copyright law and restricted from further use. No part of this excerpt may be reproduced, stored in a retrieval system or transmitted in any form or by any means (electronic, photocopying, recording or otherwise) without prior written permission of the publisher. To obtain permission please contact Guilford Publications, Inc. at the address below or e-mail: permissions@guilford.com. This book may be ordered directly from Guilford Publishing at www.Guilford.com

Please visit Dr. Leahy's website at www.cognitivetherapynyc.com