Social anxiety is painful and anguishing. It can interfere with social functioning, relationships and career. Social anxiety is characterized by:
- Marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.
- Exposure to the feared situation almost always provokes anxiety or panic.
- The person recognizes that the fear is excessive or unreasonable.
- The feared social or performance situation are avoided or endured with intense anxiety or distress
- The avoidance, anxious anticipation, or distress significantly interferes with the person’s normal routine, occupation or social functioning.
Social anxiety is a very prevalent psychological problem. Studies have found that approximately 40% of adults consider themselves shy to the point that it creates problems in their lives. 7 – 13% of people meet criteria for having social phobia.
Social anxiety consists of certain behaviors, thoughts, and physical reactions, combined with fear, anxiety or panic.
Thinking and Social Anxiety
When in a social situation (or thinking about going into a social; situation) people with social anxiety have thoughts (cognitions) that have to do with worry about being judged, scrutinized or looked at closely. Particular thoughts may include:
- “They will think negatively of me”
- “They will see that I’m nervous”
- “They will see that I’m blushing”
- “I won’t know what to say”
- “I’ll sound stupid”
- “They won’t like me
- “They will understand how incompetent I really am”
These thoughts have the theme of a social danger or threat and are often accompanied by avoidance of situations where one might be judged. Avoidance is the behavior most often associated with social anxiety. Most people would not willingly or easily put themselves in a situation where they believe they will be judged negatively.
Physical Reactions and Social Anxiety
The Physical reactions or symptoms associated with social anxiety are:
- Rapid Heart Beat
- Breathing Changes
These physical reactions are a “fight or flight” response. Millions of years of evolution have created a finely tuned response to perceived danger. In this situation the body is preparing to deal with the perceived social danger or threat. Sometimes these physical responses actually improve our performance. At other times the physical response is so overwhelming that it interferes with doing our best.
Moods and Social Anxiety
The mood associated with social anxiety is fear or panic. When people with social anxiety go into a social situation or think about going into a social situation they often are overwhelmed with fear or panic which can intensify as the social situation approaches.
Importantly, these four areas (thoughts, moods, behaviors and physical functioning) operate in tandem. We don’t know for sure, and it may not matter, which of these areas occurs first or causes the social anxiety. What we do know is that there is a reciprocal interaction between these areas. Changes in any one of the areas (thoughts, moods, behaviors, physical functioning) will result in changes in the other three areas.
Cognitive Behavioral Therapy of Social Anxiety
Cognitive-Behavior Therapy (CBT) is an active, structured goal directed form of psychotherapy that targets thoughts (cognitions) and behaviors (avoidance) associated with social anxiety. In the context of a warm and trusting therapy relationship CBT helps clients look at difficult and painful experiences. In understanding these experiences clients can learn new skills, methods and strategies that may enable them to overcome their social anxiety. CBT can help people identify and alter the thoughts and behaviors associated with social anxiety.
The goal of CBT for social anxiety is often increased social interaction with minimal anxiety. Successful treatment may result in the ability to interact in any group or social situation without anxiety and with little or no concern about being evaluated or judged. Successful treatment may result in the elimination of avoidance behaviors.
In CBT of social anxiety disorder clients learn to identify, evaluate and change the automatic thoughts associated with their anxiety. For many people this results in a reduction of their anxiety and a greater sense of comfort in group and social settings.
The behavioral component of CBT for social anxiety disorder includes overcoming the avoidance associated with the anxiety. This can be done gradually and systematically. Overcoming avoided situations begins by creating a list of all situations in which the anxiety is likely to occur. This may include situations that you participate in with anxiety, situations you avoid or situations that you feel anxious just thinking about. After the list is developed each item is given a value of how anxiety producing it is. The item on the list that creates the most anxiety is given a value of 100 while the item at the bottom of the list is given a value of 1. Every other item on the list is given a value somewhere in between 1 and 100.
Utilizing the cognitive therapy and anxiety management skills that have been previously developed the client then begins the process of gradually approaching and exposing oneself to increasingly difficult (anxiety producing) situations. In these situations, in a systematic way, clients learn to manage, control, minimize or accept their anxiety. Often, the new thinking and anxiety management skills become more developed and powerful as the client works their way up the list of feared situations. This process continues until the most difficult situations can be experienced with a lack of or minimal amount of anxiety and a sense of comfort and confidence.
Social anxiety disorder is very treatable. Psychotherapy research studies have shown that CBT is a highly effective treatment for anxiety disorders in general and social anxiety in particular. The beneficial results are often achieved in 20 CBT sessions or less and appear to be durable in that the results are usually maintained even after the discontinuation of treatment.