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The Recovery Expert
with Sharie Stines, Psy.D.

Overcoming Social Anxiety

Definition:

Social anxiety disorder is also known as social phobia; it is a disorder involving discomfort in social situations, where a person feels a fear of being embarrassed and judged by others.  The anxiety can lead to isolation which can contribute to further deterioration of social skills and confidence, thus reinforcing the existing social anxiety (Porter, n.d.).

Diagnosis:

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) lists the following diagnostic criteria for social anxiety disorder:

  1. Has fear or anxiety specific to social settings, in which the person feels noticed, observed, or scrutinized.
  2. Typically, the individual fears they will display their anxiety and experience social rejection.
  3. Social interaction consistently provokes distress,
  4. Social interactions are either avoided, or painfully and reluctantly endured.
  5. The fear and anxiety will be disproportionate for the level appropriate to the actual situation.
  6. The fear, anxiety or other distress around social situations will persist for six months or long.
  7. The anxiety causes personal distress and impairment of functioning in one or more domains, such as interpersonal or occupational functioning.
  8. The fear or anxiety cannot be attributed to a medical disorder, substance use, or adverse medication effects or other mental disorder.

Triggers:

The following list is not exhaustive (Richards, n.d.):

  • Being introduced to other people
  • Being teased or criticized
  • Being the center of attention
  • Being watched or observed while doing something
  • Having to say something in a formal, public situation
  • Meeting people in authority (“important people/authority figures”)
  • Feeling insecure and out of place in social situations (“I don’t know what to say.”)
  • Embarrassing easily (e.g., blushing, shaking)
  • Meeting other peoples’ eyes
  • Swallowing, writing, talking, making phone calls if in public

Treatment:

Cognitive-behavioral therapy (CBT) for social anxiety is the therapy of choice for most experts on the topic. Thousands of research studies now indicate that, after the completion of social anxiety-specific CBT, people with social anxiety disorder have had successful outcomes.

Social anxiety specific CBT usually involves the following interventions:

  • Assessment: Identifying the individual’s personal triggers for anxiety are.
  • Cognitive restructuring: Identifying the maladaptive thoughts that contribute to the anxiety. Teaching the person how to challenge these thoughts and make changes (restructuring) to their thinking.
  • Mindfulness: Helping the person live in the present, rather than getting stuck in the realm of “what ifs” and other future-predicting thought processes.
  • Systematic exposure. This involves exposing the person to anxiety provoking situations while simultaneously using cognitive restructuring and mindfulness techniques during the process. The first part of systematic exposure would involve the least challenging form of exposure, such as “imagery” where the person just imagines the anxiety provoking event; followed by subsequently increased anxiety provoking exposures.

Group Therapy has been proven to have a high success rate for social anxiety individuals because it exposes them to social relationships with others struggling with the same concerns and helps people build a supportive environment in which to recover.

Exposure Therapy can reduce symptoms of social phobia. This involves gradually placing oneself in anxiety provoking situations, and associating the feared stimulus with a response of relaxation or indifference. This is also known as systematic desensitization, and is a very effective evidence-based treatment of phobia, including social phobia. (Porter, n.d.).

Eye Movement Desensitization Repossessing (EMDR) can help change the way your brain stores memories. An EMDR therapist can help you change the way you think about social situations through a process of targeting the negative memories while simultaneously utilizing bilateral stimulation techniques (such as eye movements, sound movements, or hand held devices.) This technique removes the negativity from your thinking with respect to social experiences, replacing it with more positive imagery.

Medication is a short-term treatment option for any type of anxiety, including social anxiety. Medication will not ameliorate social anxiety in the long term because it only addresses the symptoms of the disorder rather than the underlying issues.  The following types of medications have been used to treat social anxiety with relative successful outcomes:

Selective Serotonin Reuptake Inhibitors (SSRIs):

Fluoxetine (Prozac)

Paroxetine (Paxil)

Sertraline (Zoloft)

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs):

Duloxetine (Cymbalta)

Venlafaxine (Effexor)

Benzodiazepines:

Benzodiazepines can help with social anxiety disorder because they work rapidly. However, benzodiazepines can become physically addictive and will not eliminate the underlying causes of the anxiety disorder without being utilized in conjunction with psycho-therapy.

Beta Blockers:

Used for short term relief of social anxiety symptoms, such as rapid heart rate and excessive perspiration. Helps stop stage fright which often occurs with public speaking.

Self Help:

There are many things you can do if you suffer with social anxiety. Here is a list of helpful and personal interventions you can employ on your journey of self-healing:

  1. Change the self-talk inside your head. That is to say, eliminate the inner critic, the mind reader, the negative voice, replacing it with an inner compassionate voice and encourager. Tell yourself positive and compassionate statements rather than scary, negative ones.
  2. Implement positive mantras that you can use in the moment. Following are some examples, utilize the ones that fit your personality.
    • I can heal from anxiety.
    • I am becoming whole again.
    • I choose to live with courage.
    • I am calm.
    • I am in control of myself.
  3. Use imagery. That means to use your imagination to visualize yourself being successfully social. The same part of your brain that actually does things operates when you imagine yourself doing things. So, practice seeing yourself having successful encounters with others in social situations.
  4. Practice deep breathing. One approach to anxiety that works in the moment is to take one to three deep breaths. This will help calm your brain down by putting oxygen in your amygdalae – the part of your brain responsible for regulating your anxiety levels.
  5. Take positive action. Rather than continuing to allow yourself to avoid those situations that cause you anxiety, make a concerted effort to get out of your comfort zone on a daily basis. For example, if you are in a rut of isolating in your room each day, make the decision to move out in to the kitchen instead. After you have mastered that, take yourself to the library or to a Star Bucks and do there what you used to do in your room. Whatever you do, take baby steps to do one more challenging act each day.
  6. Implement mindfulness exercises. These include meditation and focusing on the hear and now in the present. For instance, when you notice your mind starting to venture off into the land of the “what ifs” pull it back to the room. Count the number of words you can notice, or identify everything of a specific color. Notice what you hear. Notice what you feel. Take time and focus on each one of your five senses until you calm yourself down.
  7. Never give up. Keep pursuing success and pat yourself on the back with each positive change you make in your recovery from your fears. Remind yourself that no one is perfect and you can conquer this.

References:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.

Davidson, J.R. (2004). Use of benzodiazepines in social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder. J Clin Psychiatry. 2004;65 Suppl 5:29-33.

Porter, D. (n.d.) Social Anxiety Disorder (Social Phobia) DSM-5 300.23 (F40.10). Retrieved from: https://www.theravive.com/therapedia/social-anxiety-disorder-(social-phobia)-dsm–5-300.23-(f40.10)

Richards, T. (n.d.) What is Social Anxiety Disorder? Symptoms, Treatment, Prevalence, Medications, Insight, Prognosis. Retrieved from: https://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis.

WebMD (n.d.)  What Are the Treatments for Social Anxiety Disorder? Retrieved from:  https://www.webmd.com/anxiety-panic/treatments-social-anxiety-disorder

Overcoming Social Anxiety


Sharie Stines, Psy.D

Sharie Stines, Psy.D. is a recovery expert specializing in personality disorders, complex trauma and helping people overcome damage caused to their lives by addictions, abuse, trauma and dysfunctional relationships. Sharie is a counselor at LIfeline Counseling & Education Inc., in Southern California (www.lifelinecounselingservices.org). Lifeline Counseling is a non-profit organization 501(c)(3) corporation. Sharie is also an abusive relationship recovery coach - therecoveryexpert.com

 


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APA Reference
Stines, S. (2020). Overcoming Social Anxiety. Psych Central. Retrieved on February 22, 2020, from https://pro.psychcentral.com/recovery-expert/2020/02/overcoming-social-anxiety/