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Abby Penson, Phd Social Anxiety


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Social Anxiety
Anxiety Disorders >> Social Anxiety And Social Phobia

Social anxiety disorder (or social phobia) is an irrational, disabling fear of humiliation in everyday social situations.

People with social phobia fear that their behavior will lead to negative judgment by others, even though they recognize this fear is illogical. UNDERSTANDING SOCIAL ANXIETY DISORDER
What is a social anxiety disorder (social phobia)? Social anxiety disorder, also called social phobia, is defined as an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in everyday social situations which leads to avoidance of potentially pleasurable and meaningful activities. Most people experience some shyness or nervousness in certain social or work situations, but for someone with social anxiety disorder, the anxiety is so extreme that it can become debilitating.

Social anxiety disorder is common, affecting from 7 to 13 percent of American adults in any given year, making it the third most common psychiatric disorder in the United States after depression and alcohol abuse. Unlike other anxiety disorders, which affect women more than men, social anxiety disorder is an equal problem for both men and women. Adolescents and young adults, who often are unsure of themselves around others and concerned with image and conformity, are especially susceptible to social anxiety. However, social anxiety disorder is sometimes seen in children under twelve.

You may have social anxiety disorder if your feelings keep you from your work or isolate you from activities with others.
Warning signs of social phobia include:
  • Intense worry for days or even weeks before an upcoming social situation.
  • Extreme fear of being judged by others, especially people you don’t know.
  • Excessive self-consciousness and anxiety in everyday social situations.
  • Fear that you’ll act in ways that that will embarrass or humiliate yourself.
  • Avoidance of social situations to a degree that limits your activities and causes disruptions to your daily life.
Is social anxiety disorder the same as shyness? The short answer is “No, it’s much worse.” Social anxiety disorder is a kind of extreme shyness: extreme to the point of avoiding social situations and causing disruption to social and professional relationships.

For example, if you get the jitters before making a speech or presentation, that’s considered pretty normal. If you call in sick to avoid making the presentation, that’s a clue that your anxiety exceeds normal levels. The shy guy might be too nervous to ask someone to dance at a party, but the person with social anxiety disorder, sure that everyone will decide his clothes are uncool and that he’ll spill a drink on himself, will skip the party altogether.

A person with social phobia might fail to attend the first meeting of a class or conference because she knows she’ll be asked to introduce herself. Another might worry all week about a weekly team meeting at work, deathly afraid that he’ll be required to describe what he’s working on or even answer a question. Some people with social anxiety disorder find it difficult to pick up a phone and call the cable company (what if the person on the other end thinks her request is stupid?), stand in line at the supermarket (he knows people aren’t really staring at him, but he feels as if they are), or simply walk down the street (what if she has to talk to someone?).

Social Phobia Triggers
According to the Social Phobia/Social Anxiety Association (SP/SAA), people with social phobia usually find their anxiety triggered by situations such as:

  • Being introduced to other people
  • Being teased or criticized
  • Being the center of attention
  • Being watched or observed while doing something
  • Having to speak in public
  • Meeting people in authority
  • Attending parties or other social gatherings
  • Becoming embarrassed
  • Meeting other people’s eyes
  • Eating, talking, or making phone calls in public

People with social anxiety disorder usually recognize that their fears are irrational, but they can’t help feeling fearful and allowing their fears to affect the way they conduct their lives. Social anxiety sufferers often experience negative thought patterns that contribute to and prolong their anxiety. If you have social phobia, you may find yourself overwhelmed by thoughts like:
  • “I'll act uncomfortable or awkward.”
  • “I'll look stupid or incompetent.”
  • “I'll seem weird or strange.”
  • “I'll feel embarrassed.”
  • “I'll be boring.”
How are children affected by social phobia? In children, the extreme shyness, timidity, and fear of embarrassing themselves that are hallmarks of social anxiety disorder are especially distressing because children are less able to understand that their fears aren’t based on reality. Again, there’s nothing abnormal about a child being shy, but children with social phobia often avoid everyday activities and situations such as playing with other kids, reading in class, speaking to adults, or ordering food in restaurants.

The Cincinnati Children’s Hospital Medical Center reports that social anxiety disorder in children is triggered by situations such as speaking in front of the class, talking with unfamiliar children, writing on the board, performing in front of others, taking tests, and interacting with strangers. Typical thoughts among such children are:
  • “I hope the teacher doesn’t call on me.”
  • “I’m going to make a mistake.”
  • “Everybody’s staring at me.”
  • “Nobody likes me.”
Children showing symptoms of social anxiety disorder may avoid eye contact, speak inaudibly, or fidget and tremble. They may be sweaty or clammy and complain of dizziness, headaches, or stomach aches. Often, children with social phobia don’t want to go to school.

Children with social anxiety are often lonely, have fewer friends than other children their age, and report symptoms of depression. The center also warns that children who develop social anxiety before the age of twelve are not likely to outgrow the disorder. Left untreated, many children with social anxiety disorder grow up to be socially anxious adults and continue to have problems in interpersonal situations.

What are the symptoms of social anxiety disorder? Almost everyone experiences symptoms of social anxiety from time to time. But if you’re suffering from social anxiety disorder, these emotional and physical symptoms are severe and disruptive to your life. If your lifestyle is consistently limited by your fear of negative evaluation and your distress over the anxiety you suffer when socializing, it is likely that you have social anxiety
Symptoms of Social Anxiety Disorder
Emotional Symptoms
  • Disabling fear of one or more social situations.
  • Fear of being watched or judged by others.
  • Fear that others will notice your physical symptoms of anxiety.
  • Fear of embarrassing yourself in public.
Physical Symptoms
  • Racing heart or palpitations
  • Blushing
  • Excessive sweating
  • Dry throat and mouth
  • Trembling
  • Muscle tension
  • Trouble talking
  • Nausea
  • Stomach upset
  • Diarrhea

The Anxiety Disorders Association of America has a brief social phobia self-test that you can complete, print out, and share with a mental health professional if you are experiencing symptoms of social anxiety disorder.

What are the effects of social anxiety disorder? Social anxiety disorder can have a severe and negative impact on your life, interfering with your school, social, and professional relationships. The dread of a feared event can begin weeks in advance and be quite debilitating. You may experience some or all of the following effects, leading to further discomfort and an overall dissatisfaction with the quality of your life:
  • Avoidance – You often go to great lengths to avoid socializing with people for fear that you will be perceived adversely or will be humiliated. Left untreated, avoidance can develop into another anxiety disorder, such as agoraphobia.
  • Low Self-Esteem – Most people with social anxiety disorder also experience low self-esteem. The longer you stay in the same self-defeating cycle of fear and avoidance, the harder it is on your sense of self-worth.
  • Depression – If you have social anxiety disorder, your feelings of extreme anxiety and lack of control over your life may lead to depression, a common co-existing condition.
  • Alcohol Abuse or Drug Abuse – About one-fourth of all people with social anxiety disorder abuse alcohol. If you experience severe anxiety, you might turn to alcohol or drugs to alleviate your pain, although eventually the substance abuse becomes another problem in your life and makes treatment and healing increasingly difficult.
  • Academic and Occupational Difficulties – Social phobia can interfere with your functioning both at school and at work. Social anxiety disorder may be an obstacle to finishing school and advancing on the career front.
  • Interpersonal Difficulties – People with social anxiety disorder are less likely to marry than others and may have fewer friends and social support.
  • Other Anxiety Disorders – Over half of people with social anxiety disorder have or will develop another anxiety disorder at some point in their life.
What are different types of social anxiety disorder? Social anxiety disorder is often classified into three different types or levels:
  • Generalized social phobia – This is the most common type of social anxiety disorder. Generalized social phobia affects a person in most social and performance situations. A person with this type of social anxiety disorder experiences anxiety in the majority of interactions with others.
  • Specific social phobia - In some cases, social anxiety is connected with specific social situations, such as meeting new people, using public restrooms, or eating in front of others. Fear of public speaking is the most common specific social phobia. Fear of public speaking is a type of performance anxiety. Performance anxiety, or stagefright, involves intense fear over performing in front of an audience, whether it be playing a piece of music at a recital or giving a presentation to your boss. For tips on coping with performance anxiety, visit Overcoming Stagefright.
  • Avoidant personality disorder – Avoidant personality disorder is considered by many mental health professionals to be the most severe form of social anxiety. The disorder is characterized by a lifelong pattern of extreme shyness to the point of self-isolation. If you have avoidant personality disorder, loss and rejection may be so painful for you that you choose a solitary life and avoid connecting with others.
What causes social phobia? Many social, psychological, and biological factors are believed to contribute to the development of social anxiety disorder or social phobia. These factors are interrelated and interact with each other, so it is impossible to pinpoint exact causes. For example, although social phobia tends to run in families, it is unknown whether this is because of genetics or social learning from family members.
Social Phobia Causes
Social & Environmental Causes
Learning from your environment Some researchers and professionals assert that social anxiety disorder is a learned behavior; that is, it can be developed from observing and interacting with others who experience similar anxiety. There may be association between parents who are controlling and overprotective and the development of social phobia. Parents often are not able to acknowledge the disorder in their children because they experience the anxiety themselves and think of it as normal.
Previous negative social experiences Some individuals may develop social phobia after a particularly negative social experience. For children, such experiences can include teasing, bullying, or a particularly embarrassing incident in public. Problems in speech or language, disfigurement, sexual or physical abuse, family conflict, and neglect can also contribute to social phobia.
Psychological Causes
Emotional or psychological trauma Researchers have turned an increased focus to the relationship between early-life emotional trauma and the development of social anxiety disorder. Your current social anxiety symptoms may be a result of unresolved trauma that you experienced earlier in life, regardless of whether you recall any traumatic circumstances. For more information, see Emotional and Psychological Trauma: Causes, Symptoms, Effects, and Treatments.
Poor attachment with primary caretaker during stages of early-life development If you were unable to develop an adequate bond with your primary caretaker as a child, you may lack self-regulatory skills to calm, focus, and soothe yourself in situations you perceive as stressful or chaotic. Attachment specialists point to this as a possible cause of social anxiety disorder and other anxiety, depression, and stress-related disorders. For more information, see Helpguide's Parenting: Attachment, Bonding and Reactive Attachment Disorder.
Biological Causes
Genetics/Heredity Many research studies suggest a modest genetic component to social phobia. Behavioral inhibition is believed to be the biggest inherited risk factor. Behaviorally inhibited infants are upset easily by things that are unfamiliar and are likely to develop into fearful children. By adolescence, they show an increased risk for social anxiety disorder.
Brain Structure The amygdala is the part of the brain that controls your fear response. Recent brain-imaging research has indicated that people who frequently experience social anxiety have an overactive amygdala and an underactive prefrontal cortex.
Biochemistry Other research studies have focused on the notion of a biochemical basis for social anxiety disorder. An imbalance in the brain chemical serotonin may be a factor. Other neurotransmitters that may be involved include dopamine and GABA.

How is social anxiety disorder treated? Cognitive behavioral therapy (CBT) and exposure therapy are both very effective in the treatment of social anxiety disorder. Certain medications can also be helpful for social anxiety disorder. Sometimes, CBT or other behavior therapies are combined with medication. But regardless of the treatment approach, you will need a qualified therapist to oversee the process.

Cognitive Behavioral Therapy
The most frequently used form of psychotherapy for the treatment of social anxiety disorder, or social phobia, is cognitive behavioral therapy (CBT). This type of therapy is based on the premise that your own thoughts — not other people or situations — determine how you behave or react. Even if an unwanted situation doesn’t change — you still have to make that presentation at work; your sister still expects you at her wedding — you can change the way you think and behave in a positive way. CBT teaches you how to quell the anxiety you feel in social situations so you can face such situations, rather than avoiding them.

In CBT for social phobia, a therapist will first help you identify the automatic negative thoughts that underlie your fear of social situations. These negative assumptions might include thoughts such as “I don’t have anything interesting to say” or “I’m going to look stupid.” Once you’ve identified these negative thoughts, you and your therapist will analyze and challenge them. For example, you may ask yourself questions about the negative thoughts: “Do I know for sure that I won’t think of anything interesting to say?” or “Even if I’m nervous, will people necessarily think I look stupid?” Through this logical evaluation of your negative thoughts, you can gradually change them into more realistic and positive ways of perceiving anxiety-triggering situations. Other CBT techniques for social anxiety disorder might include role-playing and social skills training. As you act out and prepare for situations you are afraid of, you will become more and more comfortable and confident in your social abilities.

Exposure Therapy
In exposure therapy for social anxiety disorder, you are exposed in a safe and controlled way to the social situation you fear. Just as it is used in the treatment of other types of phobias, exposure therapy for social phobia involves gradual, repeated encounters with the situation you fear. If you’re uncomfortable in large social gatherings, your therapist may first have you imagine being at a large party. Using relaxation techniques, you will imagine this anxiety-producing party until the fear begins to subside. Once you are able to imagine going to a party without fear, you may expose yourself to a party in real life. With each successful exposure experience, you feel an increasing sense of control over your social phobia and you become desensitized to your fear.

What lifestyle changes or self-help tips can help me cope with social phobia? Just learning about social anxiety disorder and knowing that it is highly treatable can relieve some of your pain and discomfort. There are also a number of coping techniques that you can use to relieve anxiety when you find yourself in a social situation.

For example, one doctor suggests that when you think “Everyone is watching me,” you look around the room or the street and take an actual count of the people who truly are watching you (You’ll find that few will even be looking in your direction.). He also suggests that rather than leave a social situation, you wait 15 minutes and see if your anxiety symptoms lessen. If they get even a little bit better, wait 15 minutes more.

Other coping techniques include:
  • Slow, shallow breathing.
  • Consciously trying to heighten or exaggerate your anxiety or symptoms. Paradoxically, this usually has the effect of decreasing anxiety or its symptoms.
  • Positive self-talk can reduce anxiety. It includes telling yourself that your symptoms and anxiety will diminish if you wait them out, and that other people in the room are probably anxious too.
  • Breaking some of the tension by verbalizing your feelings in a humorous way (“Boy, I sure am a nervous wreck.”).
  • Carrying supportive statements, such as “I’ve handled this before, and I can handle it now,” on index cards and looking at them when necessary.
Steps to Overcome your Social Anxiety
In its section on self-care for social anxiety disorder, the Mayo Clinic suggests the following ideas for you to try when taking steps to overcome your social anxiety:
  • Imagine a stressful situation happening in a comfortable place.
  • Focus on personal qualities you like about yourself.
  • Eat with a close relative, friend or acquaintance (someone with whom you feel safe) in a public setting — a picnic or a restaurant.
  • Make eye contact and return greetings from others, or say hello first.
  • Prepare for conversation. For instance, read the newspaper to identify an interesting story you can talk about.
  • Give someone a compliment.
  • Show an interest in others. Ask about their homes, children and grandchildren, hobbies or travels.
  • Ask a retail clerk to help you find an item.
  • Get directions from a stranger.
Actively seeking out and joining supportive social environments is another effective way of tackling and overcoming social phobia. The following suggestions are good ways to start interacting with others in positive ways:
  • Take a social skills class or an assertiveness training class. These classes are often offered at local adult education or community colleges.
  • Join a support group. The Anxiety Disorders Association of America has a directory of anxiety support groups . You can also join a virtual support group such as Social Anxiety Support , an online forum dedicated to social phobia sufferers.
  • Volunteer doing something you enjoy, such as walking dogs in a shelter, or stuffing envelopes for a campaign – anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people. See Helpguide's Volunteering and Civic Engagement: Finding Your Best Opportunities for tips on becoming involved.
Ellen Jaffe-Gill, M.A, Melinda Smith, Heather Larson, and Jeanne Segal, Ph.D. contributed to this article. Last modified on 9/30/06.

Reprinted with permission from http://www.helpguide.org/. C 2008 Helpguide.org. All rights reserved.

You can find the original article at

SOURCE: www.helpguide.org

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