Overcoming Social Anxiety

In this post, I’ll define and describe social anxiety, list its triggers and risk factors, and discuss treatment options as well as coping strategies for overcoming social anxiety disorder.

Alternatively, you can watch the YouTube version below:

Anxiety’s Adventures in Social-land

With social anxiety, every social interaction is an adventure of sorts; you’re in “flight-or-fight” mode, prepped to face the danger that lies ahead… which is telling the waiter what you’ll have for dinner. Once again, your sneaky brain has tricked your body into preparing for a battle when you only need to answer the question, “Would you like fries with that?”

This article is written from both a professional and personal point of view, as I was extremely shy as a child and struggled with social anxiety in adolescence and as a young adult.

What Is Social Anxiety?

People with social anxiety disorder (SAD) experience a persistent fear of social situations in which they fear they’ll be scrutinized and humiliated. This fear leads to avoidance, impacting their ability to make friends, go to school, get a job, and be successful at work.

Examples of anxiety-provoking triggers include:

• Walking into an unfamiliar place such as a gas station or store
• Using a public bathroom when someone else is there
• Being asked to self-introduce in front of a group
• Entering a room full of people
• Eating in public
• Having to ask for directions or help
• Speaking with an authority figure
• Giving a presentation
• Going on a date
• Using public transportation
• Being the center of attention

It convinces you that every situation will have a terrible outcome. It convinces you that everyone sees you in the worst light.

Kelly Jean (Blogger)

A distinguishing characteristic of social anxiety is that the anxiety response is disproportionate to the trigger or event. For example, while it’s normal to feel somewhat anxious before making a speech or meeting your significant other’s parents for the first time, it’s not normal to experience intense fear or distress.

The following are signs of social anxiety:

• Blushing
• Sweating
• Stuttering
• Rapid heartrate
• Avoiding eating and/or drinking in public
• Avoiding using public restrooms
• Limiting eye contact
• Submissiveness
• Speaking in a soft or slow voice
• Rigid body posture
• Self-medicating with alcohol or other substances (e.g., drinking before a party to alleviate anxiety symptoms)
• Diverting attention to others
• Coming off as arrogant or aloof
• Being highly controlling of the conversation
• Hoarseness or vocal changes when speaking
• Feeling restless or irritable
• Fidgeting
• Presenting with extreme poise
• Increased empathy

---

Social anxiety is often misunderstood and underrecognized. SAD is different from simply preferring to avoid social events. People with social anxiety may enjoy social gatherings where they feel comfortable and safe, such as with close friends or family members. However, they may avoid other enjoyable social events due to their anxiety.

Social anxiety disorder can feel like being under a spotlight. The spotlight is uncomfortable and the person with SAD may go to great lengths to avoid it and not “get caught.” A person with social anxiety feels embarrassed about being embarrassed.

Nobody realizes that some people expend tremendous energy merely to be normal.

Albert Camus

Additionally, people with SAD may not seem anxious, even to those who know them well. This is because they have learned to hide their anxiety or disguise it as something else, such as disinterest or aloofness. They may become withdrawn or overcompensate for their anxiety by being overly talkative and dominating the conversation. They may seem the opposite of anxious, completely poised or arrogant even, having trained themselves to not appear anxious.

Who Is at Risk for Developing Social Anxiety?

In the United States, social anxiety disorder affects approximately 7% of the population, with higher rates in women and younger adults. Rates of SAD decrease with age.

The typical onset of social anxiety disorder is in childhood between the ages of 11 and 13. It often starts as shyness but can also develop in response to a significant humiliating event, such as being bullied or having an accident in public. Although less common, SAD can develop in adulthood, usually in response to stress or a major life change.

There are a number of risk factors that contribute to the development of SAD including:

• Genetics: People with a family history of SAD or other anxiety disorders are more likely to develop the condition themselves.
• Environmental factors: Parents who act anxious or nervous are modeling this for their children.
• Personality: Children who tend to be nervous or shy in new situations as well as children who fear rejection or punishment are more likely to develop social anxiety. A tendency to experience negative emotions, poor self-concept, and introversion are also associated with SAD.
• Perfectionism: There is an association between perfectionism and SAD. Some people with SAD attempt to hide their symptoms by presenting as perfectly as they can.

How Is Social Anxiety Treated?

Treatment interventions for social anxiety disorder include medication and psychotherapy.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line pharmacological treatments for SAD. Another type of medication, beta-blockers (e.g., propranolol), can be prescribed to treat the physical symptoms of anxiety. They work by blocking adrenaline, which reduces a person’s heartrate and helps with tremors.

Cognitive behavioral therapy (CBT) and exposure therapy are effective therapeutic approaches for managing SAD, especially when combined with medication.

Complementary treatment interventions include exercise and mindfulness-based interventions.

In-the-Moment Coping Strategies for Social Anxiety Disorder

If you have social anxiety, there are a number of in-the-moment coping strategies that can help you manage your anxiety. Here are a few examples:

• Self-talk: Talk to yourself in a positive and reassuring way. Tell yourself that whatever you’re facing can’t hurt you. (And you won’t die from embarrassment.) You can also try repeating a mantra to yourself, such as “This is nothing I can’t handle” or “I’ve been through worse and survived” to get yourself through the situation.
• Remind yourself that everyone makes mistakes: When you feel embarrassed about something you said or did, remember that everyone makes mistakes or experiences social awkwardness from time to time. And don’t forget how quickly people forget. Hours or even minutes from now they’re not going to be thinking about you, so don’t dwell on it or let it ruin your day.
• Learn to laugh at yourself: Laughing at yourself can help you to take yourself less seriously and to see the humor in the situation. This can help to reduce your anxiety by making you feel more relaxed.
• Talk about it: Although it may seem counterproductive, some people find it helpful to purposely bring attention to their symptoms and/or condition. This takes the power away from your anxiety. For example, before a presentation lead with, “Bear with me, public speaking makes me anxious” or if you’re worried about blushing say, “I’m little anxious right now so I might blush.” You’ll find that most people are sympathetic.
• Play the “so what” game: This is a helpful strategy for challenging your negative and/or distorted thoughts. When you’re feeling anxious, ask yourself, “So what?” What’s the worst that could happen? Once you’ve identified the worst-case scenario, you’ll realize that it’s not as bad as you thought it was.
• “Dim” the spotlight: This is an avoidance strategy, not a long-term solution, but it can help you survive when you’re overwhelmed. Try to find ways to make yourself less noticeable. This could mean standing behind a podium, sitting instead of standing, or (literally) dimming the lights. You may actually build confidence this way to the point where you no longer need to make yourself less noticeable.
• Bring a buddy: Sometimes it can be helpful to have someone with you for moral support. If you’re going to be in a social situation where you’re feeling anxious, have a friend or family member tag along. This can help you to feel more confident and less alone.

There is no one-size-fits-all approach, so experiment until you find what helps you the most.

---

To conclude, social anxiety disorder can be debilitating, but there are effective treatments for SAD as well as coping strategies for managing symptoms. You may have SAD, but that doesn’t mean you are SAD.

Be kind to yourself. Have self-compassion. Forgive yourself for mistakes and forgive your brain for betraying your body. You have social anxiety. So what? With time and effort, you can remake yourself and overcome.

References

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
• Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
• Evans, R., Chiu, K., Clark, D. M., Waite, P., & Leigh, E. (2021). Safety behaviours in social anxiety: An examination across adolescence. Behaviour Research and Therapy, 144, 103931. https://doi.org/10.1016/j.brat.2021.103931
• Gilboa-Schechtman, E., & Shachar-Lavie, I. (2013). More than a face: a unified theoretical perspective on nonverbal social cue processing in social anxiety. Frontiers in Human Neuroscience, 7, 904. https://doi.org/10.3389/fnhum.2013.00904
• Li, J., Cai, Z., Li, X., Du, R., Shi, Z., Hua, Q., Zhang, M., Zhu, C., Zhang, L., & Zhan, X. (2021). Mindfulness-based therapy versus cognitive behavioral therapy for people with anxiety symptoms: A systematic review and meta-analysis of random controlled trials. Annals of Palliative Medicine, 10(7), 7596–7612. https://doi.org/10.21037/apm-21-1212
• National Collaborating Centre for Mental Health (UK). Social Anxiety Disorder: Recognition, Assessment and Treatment. Leicester (UK): British Psychological Society (UK); 2013. (NICE Clinical Guidelines, No. 159.) 6, INTERVENTIONS FOR ADULTS. https://www.ncbi.nlm.nih.gov/books/NBK327654/
• Pelissolo, A., Abou Kassm, S., & Delhay, L. (2019). Therapeutic strategies for social anxiety disorder: Where are we now? Expert Rev Neurother, 19(12), 1179-1189. doi: 10.1080/14737175.2019.1666713
• Pittelkow, M. M., Aan Het Rot, M., Seidel, L. J., Feyel, N., & Roest, A. M. (2021). Social Anxiety and Empathy: A Systematic Review and Meta-analysis. Journal of Anxiety Disorders, 78, 102357. https://doi.org/10.1016/j.janxdis.2021.102357
• Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A. (2015). Exercise as treatment for anxiety: Systematic review and analysis. Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine, 49(4), 542–556. https://doi.org/10.1007/s12160-014-9685-9

---