What Is Social Anxiety Disorder?
Social anxiety disorder is where you are nervous or anxious of social situations or being around other people. Commonly feared situations include public speaking, meeting new people, being in coffee shops, bars and restaurants or public places generally, going to parties, asking for dates, eating in public, using public toilets, speaking to people in authority, and disagreeing with others.
People with social anxiety disorder worry that in social situations they might embarrass or humiliate themselves. They fear they will act in ways that will make other people think badly of them. They often worry that others will detect their anxiety symptoms (e.g. blushing, shaking or sweating). Often they will try to avoid situations that make them feel anxious. When they cannot avoid a situation, they tend to feel very anxious or embarrassed. They may even have panic attacks.
Social anxiety disorder is a severe form of shyness that can cause problems in people’s lives. Sometimes these problems are minor, such as not being able to speak up in class. Sometimes, however, the problems can be quite serious. In more serious cases, people with severe social anxiety disorder often have few friends, feel very lonely most of the time, and have trouble reaching their goals in school or at work.
How common is Social Anxiety Disorder?
Social anxiety disorder is actually very common. For every eight of us, one of us will suffer from social anxiety disorder at some point in our lives. Many more people have symptoms of shyness that are not severe enough to be called social anxiety disorder. This problem usually starts when people are in their early teens, but it can begin much earlier. If people do not get help, the problem can last for years and can become more serious.
What Causes Social Anxiety Disorder?
A number of factors have been suggested to contribute to the development and maintenance of social anxiety disorder:
Genetics: People with social anxiety disorder may often have relatives who are anxious or shy.
Prior experiences: Many people with social anxiety disorder remember having been embarrassed or
humiliated in the past or even bullied. This leads them to be afraid that the same thing will happen again. Negative experiences with other people may all contribute to social anxiety.
Why doesn’t the problem go away?
As shown in the vicious cycle below, certain factors contribute to maintaining this problem. Poor self esteem can result in people thinking they unlikeable or unable to perform well in social situations.
Prior to socialising, they may have negative thoughts such as “”I wont be able to cope”. People with social anxiety disorder often have negative expectations about what will happen in social situations. Common thoughts are “I won’t be able to think of anything to say,” “I’ll make a fool of myself,” and “People will see I’m anxious.” They also tend to have exceptionally high performance standards that are hard to meet, such as “I should NEVER be anxious,” “You have to be beautiful and smart to be liked,” or “its absolutely essential that I get everyone’s approval.” Typically they have negative beliefs about themselves, such as “I’m boring,” “I’m weird,” or “I’m different from other people.”
Returning back to our vicious cycle, these thoughts will make them feel anxious emotionally, and soon they become aware of the resultant physical symptoms of anxiety, e.g. dry throat, sweating, shaking, blushing. This may strengthen their negative belief that they are unable to cope.
During social situations themselves they are typically very self conscious and this will result in thoughts such as “I bet people can see how badly Im blushing” for example, or “Im sounding stupid” or “I bet others are noticing how quiet I am”. This serves only to increase anxiety levels and the symptoms this produces.
Sometimes people participate in social situations, but do certain things to try to avoid embarrassing themselves, such as not asking questions or holding a glass tightly so no one will see their hand shake. These “safety behaviours,” also prevent people from learning that they can do well in social situations. People with social anxiety disorder often avoid situations that make them afraid. This helps them feel less anxious in the short run. But in the long run, avoidance prevents them from learning that their social fears are exaggerated, which keeps them feeling anxious. Having less experience socially means that some people with social anxiety disorder never had the chance to learn social skills. This can cause them to have problems in social situations. Other people with this disorder have good social skills, but get so anxious that they have a hard time using them.
After socialising they might conduct post-mortems analysing their social performance in detail, and criticising themselves. This only serves to strengthen the negative beliefs they have about themselves, which will feed into how they think about themselves next time they face a social situation, thereby maintaining this problem in a vicious cycle.
Can Medication Help?
Medication can provide some relief, however this will not address the root cause of the problem. Cognitive behavioural therapy (CBT) has been found to be at least as effective as medication, if not more so, and because this addresses the root cause of the problem, is more likely to provide a better long-term outcome. Scientific research has demonstrated that CBT helps most people with social anxiety disorder to feel much less anxious. Furthermore, patients usually continue to feel better even after therapy has stopped.
How Does CBT for social anxiety disorder work?
CBT helps you change the beliefs that cause your fear. Your therapist will teach you how
to recognise your negative thoughts and to think more realistically about social situations and about yourself. He or she will also help you gradually face the situations you have been afraid of in the past. This allows you to discover that your fears usually do not come true, and that the consequences of any negative things