Social Anxiety Disorder- Psychiatry

Social anxiety disorder is a disorder where people have an irrational fear or anxiety when exposed to certain social situations.

Socially anxious individuals experience an excessive fear of being judged, embarrassed, rejected, or humiliated by others during a public performance or social interactions. Social phobia can interfere with a person’s ability to work, perform daily activities, and form or maintain relationships.

Different forms of psychotherapy can be used to treat social anxiety disorder including cognitive-behavioral therapy, exposure therapy, acceptance and commitment act therapy, and group therapy. Certain medications can also be prescribed to manage the symptoms of social anxiety.

Read on to learn more about what social anxiety disorder is, its symptoms, and the different therapy techniques used to treat it.

What Is Social Anxiety Disorder?

Social anxiety disorder, also known as social phobia, is a type of anxiety disorder that causes feelings of deep fear and worry in common social settings.

A socially anxious person has trouble making conversations, meeting new people, attending meetings, and making other everyday interactions because they feel:

• Self-conscious 
• Worried they will be humiliated or rejected
• Concerned they will be embarrassed in front of other people
• Afraid they will be scrutinized and judged negatively by others

Getting these unhelpful thoughts can make it very challenging for a person with social anxiety to perform regular day-to-day activities, including:

• Public speaking (giving a speech or a lecture)
• Going on job interviews
• Going on dates
• Attending social gatherings
• Answering or asking a question in class
• Asking for directions
• Eating or drinking in public
• Talking with a waiter or a cashier
• Performing on stage or in front of an audience

Social interactions or public performances can cause the following symptoms of social anxiety:

• Nausea
• Fast heartbeats
• Blushing
• Sweating
• Trembling
• Speaking with an overly soft or shaky voice
• Avoiding eye-contact
• Avoiding people or large groups

The apprehension and unease experienced by a person with social anxiety disorder can become debilitating and lead to the avoidance of social interactions and situations.

This avoidance usually negatively affects and compromises the person’s ability to work, attend school, and maintain healthy relationships and friendships.

Social Anxiety Disorder Treatment

Proper diagnosis is always the first step for any effective treatment. If you have a persistent and intense fear of normal social situations and tend to avoid them, contact your healthcare provider.

After making sure that your symptoms are not caused by a different physical problem, your healthcare professional may refer you to a mental health professional such as a psychiatrist, psychologist, or a clinical social worker.

The treatment of social phobia depends on how debilitating your anxiety is. The fear of social situations is commonly treated with psychotherapy, medication, or both.

Psychotherapy for social anxiety disorder

Psychotherapy, also known as psychological counseling or talk therapy, helps people with social anxiety to recognize the negative thoughts they have about themselves. Afterward, they’re taught:

• How to change negative self-criticizing thoughts
• Form positive reassuring thoughts about oneself
• Gain more confidence in social settings

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy is an evidence-based treatment of anxiety disorders. CBT is one of the most effective types of psychotherapy and is commonly used to treat the fear and anxiety people experience in social situations.

Cognitive-behavioral therapy sessions aim to identify irrational thoughts of social anxiousness and distress and replace them with more realistic ones. The goals of CBT for social anxiety disorder include:

• Identifying negative thoughts you might have about your image, capabilities, and self-worth
• Digging into residual feelings of guilt, shame, or resentment you may be carrying from past experiences
• Recognizing reasons why you might mistakenly believe that someone is judging you
• Learning how to be more assertive
• Getting rid of procrastination habits associated with social anxiety
• Working on maintaining eye contact during individual and group interactions

During your cognitive behavioral therapy for social anxiety, you are trained to think, behave, and react to situations in ways that make you feel less anxious or fearful.

CBT helps you learn how to control your social anxiety through:

• Relaxation exercises
• Breathing techniques
• Ways to replace your negative thoughts with more positive ones

Cognitive-behavioral therapy uses different techniques to treat a variety of other anxiety disorders. Therefore, it’s important to seek a mental health professional who is experienced with the CBT therapy techniques used specifically for social anxiety.

Exposure therapy

Exposure therapy is another therapy technique for social phobia which focuses on exposing the person to a feared social situation. It’s usually done within cognitive-behavioral therapy.

Exposure therapy helps you face a social concern that makes you anxious rather than avoid it. Gradual exposure to the source of your social anxiety can help you confront any unhelpful thoughts you might develop little by little until your anxiety decreases.

Social anxiety disorder treatment by exposure therapy can be done using different strategies:

• Real-world confrontation therapy: when it’s possible, you might be encouraged to speak in front of a large audience to address a dreaded public or social situation.
• Imaginal exposure therapy: this involves you vividly imagining a feared setting, object, or activity with the guidance of your mental health care professional. You may be asked to recall or describe a previous event during which you experienced symptoms of social phobia.
• Role-playing therapy: therapeutic role-playing helps you overcome your phobia of social interactions by practicing it with your therapist in a safe space with professional guidance.
• Virtual reality therapy: VR technology can help you engage in a situation that triggers your social anxiety without having to go through it in real life.
• Flooding therapy: this treatment for social anxiety works by continuously exposing you to a specific feared situation until it becomes less frightening.
• Systematic desensitization therapy: Similar to flooding, this type of exposure therapy helps you desensitize your social phobia by gradually exposing you to the source of your anxiety.

Being exposed to stressful situations or your negative thoughts during therapy can sometimes be too heavy or too difficult, especially at the beginning. That’s why it’s crucial to choose a trained therapist with extreme experience and skill that can help you slowly and safely treat your social phobia.

Acceptance and commitment therapy (ACT)

Acceptance and commitment therapy (ACT) is a newer type of psychotherapy that can be used to treat social anxiety. It uses an approach different from other cognitive behavioral therapy techniques.

ACT focuses on your normal everyday beliefs and thoughts that can be self-destructive. Rather than face your social anxiety symptoms, the goal of acceptance and commitment therapy is to:

• Help you come to terms with your thoughts, values, and beliefs
• Encourage you to live a meaningful life
• Help you accept that there will always be pain and suffering
• Motivate you to take action based on your own standards and morals

To achieve the mentioned goals, your ACT therapist will:

• Use vivid metaphors to deliver ideas and messages to you during therapy
• Clarify your individual values in life
• Use mindfulness skills to help you become more aware of the present moment

By changing your views on life, pain, and suffering in general, ACT therapy is expected to indirectly decrease your social fears and concerns.

Group therapy

Cognitive-behavioral therapy can also be done in groups. Group therapy for social anxiety brings together people with similar fears, worries, and concerns which makes them feel less alone.

Social anxiety group therapy is done to help people learn social and interaction techniques and then apply them through role-playing.

The goals of group therapy for the phobia of social situations are:

• Help you form new relationships with people in the same situation as you
• Help you learn from the experiences and views of other group members
• Improve your response to situations that increase your anxiety in social situations

ACT counselors will help you set problem-specific goals and guide you through your journey to achieve them.

Medication

Depending on the severity of your social anxiety and how much it interferes with your daily life, your healthcare professional may prescribe you medication, with or without therapy, to mitigate your symptoms.

Various types of medications can be effective in treating symptoms of social phobia, including:

• Performance anxiety medications such as beta-blockers
• Antianxiety drugs
• Antidepressants

Social anxiety disorder is more than shyness or timidness during social encounters. If left untreated, it can go on for a prolonged time and become debilitating. People with untreated social anxiety symptoms can struggle to form new relationships, maintain a job, and keep up with daily activities.

If you feel like you might be suffering from social phobia disorder, reach out to a qualified mental healthcare professional for diagnosis and effective treatment.

To learn more about Social Anxiety Disorder, please check our blog on DO YOU HAVE SOCIAL ANXIETY?.

Sources:

• NIMH » Social Anxiety Disorder: More Than Just Shyness
• Social Anxiety Disorder - StatPearls - NCBI Bookshelf
• Cognitive-behavioral therapy for social anxiety disorder: current status and future directions
• Enhancing Exposure Therapy for Anxiety Disorders, Obsessive Compulsive Disorder, and Posttraumatic Stress Disorder - PMC  
• The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial

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