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What is Social Anxiety Disorder (SAD)?
Social anxiety disorder (SAD), otherwise known as social phobia, is a chronic, intense and persistent fear of being negatively judged by others. People with SAD often experience an ongoing and deep, underlying fear of being rejected–and because it involves situations that are deemed as “normal” to other people, those with the disorder often feel guilty and ashamed of their anxiety.
It is estimated that SAD affects 7% of the adult population at some point in their lives. Situations which could cause fear in someone with SAD include:
- Meeting new people.
- Performing in front of people.
- Engaging in classes or meetings.
- Going to social events or participating in activities.
- Eating in front of people.
- Going in an interview.
- Making eye contact.
For some people, only specific social situations elicit fear (such as giving a talk in front of an audience), while others might experience fear in a range of social situations. Regardless of which type, social anxiety disorder manifests itself in terms of physical, emotional and behavioural symptoms, including:
Physical symptoms
- Racing heart rate
- Lightheadedness
- Upset stomach
- Rigid posture
- Sweating
- Inability to catch their breath
- Feeling like your mind is a blank
Emotional symptoms
- Intense fear of interacting with strangers
- Feelings of humiliation or embarrassment
- Over-analysing your performance
- Avoiding situations where you may be the centre of attention
- Fear of offending someone
Behavioural symptoms
- Being very self-conscious in front of other people
- Finding it scary and overwhelming to be around people, especially strangers
- Avoiding places where there are people
- Avoiding eye contact
- Feeling a persistent, intense and chronic fear of being judged and watched by others.
The role of the brain in social anxiety disorder
Many parts of our brain are involved with fear and anxiety; in particular, the amygdala. Social anxiety disorder is linked to having an overactive amygdala, which essentially triggers our “flight-or-fight” response.
A study found that those with SAD had increased blood flow in their amygdala whereas those without showed increased blood flow to their cerebral cortex (area of logical thinking and evaluation). Those with SAD know that their fear is irrational, but often feel powerless in overcoming them at the moment.
The good news is, our brains are extremely malleable and can be reprogrammed (with a little work) to form new neural circuits and learn how to accurately access a situation so that anxiety does not take over.
Avoidance and safety behaviours
One of the DSM-5 criteria for social anxiety disorder is that “social situations are avoided or endured with intense fear or anxiety.” In fact, avoidance is one of the key features of social anxiety disorder where individuals tend to completely avoid social situations in an attempt to prevent discomfort and feelings of anxiety.
Unfortunately, while turning down an invitation to a friend’s birthday party can make you feel relieved at that moment, social fears almost always become worse when you consistently avoid social events. Avoidance is a type of coping mechanism that can be maladaptive for someone with social phobia; for example, avoidance of a feared situation prevents a person from learning that it is harmless.
On top of missing the opportunity to challenge their negative thoughts, avoidance can strengthen them as they would be unable to collect any “evidence” to check how accurate their assumptions are.
People with SAD also often use “safety behaviours” as a means to cope with or avoid a perceived threat (in this case, it could be a job interview or making an order at Starbucks). Some examples of safety behaviours include staying quiet in social situations, planning out what to say ahead of time, limiting eye contact and wearing inconspicuous clothing.
Similar to avoidance behaviours, safety behaviours only provide short-term relief and can make individuals more anxious in the long run.
Main treatment options
One of the best and go-to treatment approaches for someone with social anxiety disorder is cognitive behavioural therapy (CBT). CBT is a modality that helps to combat the longstanding, negative and self-critical thoughts commonly seen in those with SAD.
During treatment, the therapist will likely ask you to think about your core beliefs or automatic negative thoughts about different social situations and challenge you in evaluating how accurate they are. They will then work closely with you to construct alternative thoughts that are much more constructive. Remember: Thoughts fuel behaviour patterns.
A therapist may also recommend exposure therapy, which is where you work on gradually facing the situations you fear the most to slowly develop your confidence in dealing with them. This might begin with some visual imagery and role-playing in the therapy room, followed by getting you “out there” to try out new behaviours (making small talk with the barista when ordering your coffee).
In more severe cases, or if CBT and exposure therapy do not work; antidepressant medicines, such as a selective serotonin reuptake inhibitor (SSRI), or anti-anxiety medications such as benzodiazepines and beta-blockers may be prescribed by a doctor for managing symptoms. Research suggests that counselling and psychotherapy and medication are equally effective, although psychotherapy may be a better option for longer-lasting benefits.
Social anxiety disorder VS being shy
Anyone can experience shyness from time to time, or experience nervousness before a presentation, but people with social anxiety disorder often find that it interferes with everyday activities and functioning. While it is true that being shy increases your risk of developing social anxiety disorder, not everyone who is shy will have the disorder. A study conducted revealed that shyness and social anxiety both exist on the same continuum, but there are distinct differences between the two.
Essentially, the three main factors that distinguish social anxiety from shyness are:
- How intense the fear and anxiety is.
- How much avoidance is involved.
- How much it interferes with daily life.
Social anxiety disorder is the more intense, distressing and disruptive end which often requires intervention and treatment.
Ways to support a loved one with social anxiety disorder
The problems faced by someone with SAD may not make any sense to you, but they feel very real (and scary) to the person dealing with them. For such individuals, SAD is a constant presence that can make them feel isolated from the rest of the world.
Here are some tips to support someone with SAD:
- Learn about the disorder: Every individual’s experience of the disorder is different, so don’t be quick to assume you know what they are going through. Educate yourself as much as possible about the disorder!
- Be empathetic: Don’t downplay or dismiss their feelings and experiences. Let them know that you’re there to listen and support them. Someone who has social anxiety is likely already really critical of themselves and needs someone around who is non-judgemental and whom they trust.
- Be patient: Overcoming social anxiety does not happen overnight. Be ready to reassure them of your love, care and support during this time.
Having a strong support system is critical for not just people with social anxiety disorder but any mental health condition.
Things to practice to overcome social anxiety
If you have been diagnosed with social anxiety disorder, know that it isn’t over. In fact, the path towards your greatest potential is right in front of you, as soon as you are ready to face your fears, challenge your thought processes, and focus on what makes you, you.
- Rename your emotions. Symptoms of anxiety and excitement are almost identical. Instead of saying “I am nervous”, try relabelling your emotions as to something of excitement. It’s likely you’ll feel much more confident and prepared to enter a social situation. Or consider having a mantra or positive affirmations on hand that you can use before you go for a meeting or an important phone call.
- Role-play with people you trust. Ask a trusted friend or family member to role-play specific situations with you (and do practice both best and worst-case scenarios!) Ask your role-play partner to offer a range of reactions and emotions so you can practice and build your confidence for when the actual situation happens.
- Focus on kindness. Research has shown that there’s a link between kindness and social anxiety. As mentioned earlier, at the root of most people’s anxiety lives a fear of rejection. Instead of focusing your attention inward, focus on doing random acts of kindness–by doing something nice for others, you will likely receive a positive reaction in return, which will help reduce your intense fear of being rejected in social settings.
- Be willing to experience discomfort. Realise that some things are worth doing, even if you’re anxious, even when you are experiencing discomfort and unpleasant emotions. Either way, being an active participant when it comes to your recovery will help you feel better about yourself.
Taking baby steps
A 2021 paper argues that people who suffer from social anxiety actually get a lot of pleasure from meeting new people and spending time with others (contrary to what they, and many others believe!)
At the end of the day, anxiety is a normal and healthy response to danger. Even if your anxiety meter needs a little adjustment for the time being, know that it is not a character flaw, sign of weakness, or even a personal failure. Anxiety says nothing about you.
If you are currently struggling with social anxiety disorder, finding a therapist can help you to identify your triggers, reframe your negative thoughts, teach you social and coping skills, and collaborate with you on a personalised action plan that will allow you to overcome your anxiety.
Take courage, my dear friend!
Sources
https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
https://pubmed.ncbi.nlm.nih.gov/11481154/
https://rd.springer.com/article/10.1007/s11031-015-9499-5
https://www.sciencedirect.com/science/article/abs/pii/S0191886917300211
A dreamer whose go-to motto is “Follow Your Heart”, Charmaine is currently embarking on obtaining her Masters’ of Counselling, hoping to eventually make a full-time career in supporting others in their mental health journey. She has always been awed by the beauty of the human psyche and writing remains to be her favourite form of expression. She enjoys reading and writing about trauma, and would like to encapsulate the silver linings of what it means to be an imperfectly perfect human being in all her pieces.
