Treatment for Social Anxiety Disorder

Social Anxiety Disorder

It is not unusual to be nervous or self-conscious from time to time. Perhaps you have to give an important presentation at work, or are meeting your partner’s parents for the first time. To be anxious in these kinds of situations is natural and does not affect the overall quality of your life. In fact, anxiety may even serve a useful purpose in these situations. People suffering from social anxiety disorder (aka social phobia or SAD), however, suffer intense fear of social situations. These fears tend to revolve around concerns of being scrutinized or evaluated negatively by others. Sufferers may believe that they will be judged as crazy, weak, boring, stupid, unlikable, etc. People with social anxiety disorder may also fear appearing anxious, specifically if others observe them blushing, shaking, trembling, sweating, or stumbling to find words.

The sufferer fears that the perceptions of others will result in a negative evaluations and ultimately rejection. Some sufferers experience a pronounced fear response, believing they are causing offense simply by being in the presence of others. This fear may be especially pronounced in cultures which prioritize collectivity over individuality. Ultimately, individuals suffering from social phobia work to avoid situations where a negative evaluation might occur. This avoidance can lead to significant effects on a SAD sufferers’ quality of life. 

Diagnosis

The following criteria and characteristics are used to identify social anxiety disorder:

  • The individual exhibits significant fear or anxiety about being scrutinized by others in one or more social situations. For example, they may be anxious about meeting new people or eating and drinking in front of others.
  • The individual is afraid of negative evaluation by others due to displaying symptoms of their anxiety. The person fears humiliation, embarrassment, and potential rejection.
  • Social situations almost always provoke fear and anxiety.
  • Sufferers avoid social situations or endure them with intense fear or anxiety.
  • The sufferer’s fear or anxiety is out of proportion to the actual threat posed by the social situation.
  • The fear and anxiety cause significant distress that interferes with the person’s quality of life. Areas of impairment may include their job and other activities of daily living.
  • The sufferer’s fear is not the result of substance use, medication, or another medical condition.
  • The causes of fear are not better explained by diagnoses of panic disorder, body dysmorphic disorder, or autism spectrum disorder.
  • Performance-only specifier: Individuals with performance-only SAD do not fear or avoid non-performance social situations.

Signs and symptoms

Our thinking changes when we become anxious. When we are anxious, we are primed to be vigilant: our brains begin to selectively abstract, allocating resources towards reacting to danger to avoid being caught unprepared. A person with SAD may become hyper-vigilant and self-conscious. Individuals may worry for days, weeks, or longer over an imagined misstep from a previous conversation. They may spend excessive amounts of time preparing for a minor presentation to a group. The list of potential triggers is long, and unique to each sufferer.

Our nervous system is tremendously complex and very effective in maximizing our chance for survival. Most often, our sympathetic nervous system responds to our perception of danger. It does not make a distinction between the perception of danger and experiential evidence of danger. If we are conditioned to or think there is a danger, our nervous system will engage in order to protect us. When our nervous system perceives a social situation as dangerous, we often resort to behavioral avoidance. Avoidance significantly disrupts daily life and a person’s ability to build a life that is preferred and is worth living. Avoiding social situations can severely limit our ability to build intimate connections, rewarding relationships, and careers.

Some physical symptoms a person with social anxiety may experience include:

  • racing heart
  • tightness in the chest
  • feeling dizzy or faint
  • shortness of breath
  • sweating
  • nausea
  • hollowness or butterflies in the stomach
  • blushing
  • shaking or trembling
  • shaky voice

Onset & Prevalence

The median age of onset for social anxiety disorder is age 13. Sometimes the disorder emerges from an individual with a temperament that includes behavioral inhibition and fear of negative evaluation. SAD can follow people throughout their entire life, presenting problems at any age.

The onset of social anxiety disorder may follow a stressful or humiliating event, including being bullied or publicly shamed. However, it also may also develop slowly over time. It is relatively rare for an initial onset to occur as an adult. If so, it is more likely to occur after a stressful or humiliating event, or following life changes that require new, unfamiliar social roles. Furthermore, people who suffer from SAD are at a higher risk of dropping out of school. It may also lead to decreased overall well-being, employment and workplace productivity, socioeconomic status, and quality of life. 

Roughly 7% of the population of the U.S, about 15 million people, suffer from social anxiety disorder. However, only about half of those who suffer from SAD seek treatment, and it generally takes 15-20 years of experiencing symptoms before many sufferers seek help. Social anxiety disorder is more frequently diagnosed in women than in men across the entire population; however, the rates of diagnosis are roughly equal or even slightly more pronounced for men in adolescent and young adult ages. 

The exact causes of SAD are unknown, though research suggests a combination of environmental factors and genetics influences the onset of social anxiety. In addition to adverse experiences, an individual’s temperament and environmental risk factors (such as childhood maltreatment and adversity) affect the likelihood of developing social phobia. Social anxiety is also known to run in families, both in terms of genetic and learned factors. Genetic factors may predispose children to behavioral inhibition, and children who exhibit behavioral inhibition are more susceptible to learning socially anxious behaviors from an anxious parent.

Treatment for SAD

Cognitive Behavioral Therapy (CBT) and psychopharmacology have been shown to be effective in treating social anxiety disorder. There are four general approaches taken to treating SAD:

  1. Exposure-based strategies help sufferers confront anxiety-producing situations in a gradual way, repeatedly exposing the individual to their trigger in manageable doses until they no longer produce unjustified, overwhelming fear.
  2. Strategies to develop and adjust interpersonal skills are used help a suffer learn new approaches to social situations.
  3. Cognitive strategies are used to identify and change unhelpful and distorted thoughts and beliefs which maintain and strengthen an individual’s social anxiety.
  4. Mindfulness strategies are designed to help accept those factors which are beyond a sufferer’s ability to control, reducing the pain of resistance to reality.

In combination with these approaches, medication may be helpful in some cases. There are are differing opinions in the medical community regarding medication strategies for SAD. Antidepressants are the most frequently prescribed medications for social anxiety. Other types of medication used to manage symptoms include anti-anxiety medications, anticonvulsants, antipsychotics, and/or beta-adrenergic blockers. Please consult a medical professional prior to taking any medication for social anxiety.

Consult an expert

Having social anxiety disorder can significantly impede an individual’s potential and growth. While it can be difficult to take your first step toward treatment, making a call to ask questions can be a good place to start.

Contact Harold Kirby at 610-517-3127 to schedule a consultation, make an appointment, or learn more about treatment for social anxiety. Harold provides telehealth treatment for clients in Philadelphia and the surrounding areas of Pennsylvania and New Jersey (Main Line, Montgomery County, Camden, Cherry Hill), as well as in the South Carolina Lowcountry (Hilton Head, Bluffton, Beaufort, Colleston County, Dorchester County, Berkeley County, Charleston).