Social Anxiety Disorder:
An Overview of Symptoms and Treatment
Social Anxiety Disorder is an anxiety disorder characterized by fear and avoidance of social situations causing significant distress and negatively affecting several areas of a person's life and functioning. Have you ever had to read in front of a group of people and become nervous or anxious? Maybe you started sweating or noticed your face turning red. Perhaps you noticed negative or critical thoughts about yourself swimming through your mind as you misread a line or heard the sound of your voice out loud. This is just a tiny glimpse into the experience of someone who manages Social Anxiety Disorder (SAD - not to be confused with Seasonal Affective Disorder which has been renamed Depressive Disorder with Seasonal Pattern in the DSM V) on a regular basis. For persons managing SAD, even seemingly minor interactions such as ordering a coffee at a coffee shop or asking for a substitution on a lunch order can cause great distress and even total avoidance of that situation, causing frequent isolation and difficulty forming and maintaining meaningful relationships with others.
1. Symptoms of Social Anxiety Disorder
People managing SAD can experience a number of different symptoms. Some of the most common symptoms include:
- Feeling highly anxious about being with other people and having a hard time talking to them or joining in on conversations
- Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others
- Being very afraid that other people will judge them
- Worrying for days or weeks before an event where other people will be or where socializing is a part of the event
- Avoiding places where there are other people
- Difficulty forming and maintaining friendships or romantic relationships
- Blushing, sweating, or trembling around other people
- Feeling nauseous or sick to your stomach when other people are around and even having serious stomach issues such as Irritable Bowel Syndrome (IBS) or frequent diarrhea
- In children - crying, having temper tantrums, clinging to parents or refusing to speak in social situations
2. Treatment for Social Anxiety Disorder
While the symptoms of SAD can be crippling for many people and disruptive for most, there are several treatments that have been shown to decrease symptoms of SAD and increase overall emotional well-being of those managing this disorder.
Cognitive Behavioral therapy (CBT)
CBT is a short-term, goal-oriented psychotherapy treatment that takes a practical approach to changing unwanted behaviors. The goal of CBT is to guide the person's thoughts in a more rational direction and help the person stop avoiding situations that once caused anxiety. CBT teaches people to react differently to the situations that trigger their anxiety symptoms and can be used to help treat a wide range of issues in a person’s life, from sleep difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression.
Two components of CBT used to treat Social Anxiety Disorder are cognitive therapy and exposure therapy. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying anxiety disorders.
Exposure therapy focuses on first identifying and then compiling a hierarchy of fears or situations which the person avoids due to anxiety and confronting those fears in order to help the person engage in activities that they have been avoiding. Exposure therapy is often used along with relaxation exercises and/or imagery. The person is gradually exposed to the feared object or context without any danger, in order to overcome their anxiety and/or distress.
An example of an exposure therapy exercise for someone diagnosed with social anxiety disorder might be to ask them to compile a list of 10 situations that they avoid or that cause them anxiety and have them rate these situations on a scale from 0-100 (100 being highest experience of anxiety). Starting with a situation that causes the person least distress, the therapist would have the person imagine situations that cause her or him anxiety and introduce relaxation skills such as deep breathing techniques or mindfulness exercises. The therapist might take a few sessions introducing imagined feared situations and then assign the person homework assignments to engage in real-life situations that have caused the client distress.
Several types of medications can be used to treat Social Anxiety Disorder; However, selective serotonin reuptake inhibitors (SSRIs) are often the first type of medication tried for persistent symptoms of social anxiety. Additional medications might include antidepressants, anti-anxiety medications, or Beta Blockers. It is important to note that the most effective way of treating SAD is to utilize psychotherapy treatments alone or in conjunction with medication.
Make sure to meet with your psychiatrist or physician regularly to monitor any possible physical side effects or negative psychological responses to taking psychotropic medication.
3. resources for social anxiety disorder
Dealing with SAD can be overwhelming and frustrating, whether you are seeking help for yourself or are seeking help for a loved one. Here are some basic resources for helping better manage you or a loved one's Social Anxiety Disorder.