Social Anxiety

Social Anxiety

By Tara Kearns

Most of us feel shy, anxious or nervous around others occasionally; particularly when meeting new people or when we have to speak in public. However, if this anxiety is so frequent and severe that it interferes with your relationships, work and everyday life, you may have Social Anxiety Disorder.

Social Anxiety is one of the most common anxiety disorders, with an estimated global prevalence of 4% (Stein et al, 2017).

Symptoms of Social Anxiety include:

• Worrying about routine activities such as starting conversations; speaking on the phone; going to the shop; ordering food or taking the bus

• Excessive worry or avoidance of social situations including dating; eating out; and parties

• Extreme self-consciousness around other people and worrying about doing something embarrassing such as shaking, sweating or blushing

• Finding it difficult to do something when someone else is watching

• Fearing criticism; judgement or scrutiny

• Feeling nauseous; sweating; shaking; feeling a ‘lump in the throat’ sensation; feeling breathless; and having palpitations in social situations

For people with Social Anxiety, meeting new people, group activities, presentations, meetings and dealing with authority figures are typical trigger situations (Corrie, Townend & Cockx, 2015). People with Social Anxiety worry about how others might perceive their appearance, words or actions and often avoid situations where they might be the focus of attention; have to act; or speak in front of others. This results in a negative reinforcement loop; where we avoid situations which make us anxious, but inadvertently feed our anxiety and remove any opportunities to unlearn it.

Unsurprisingly, the enforced social isolation during the Covid-19 lock downs led to a significant increase in the number of people presenting for therapy for Social Anxiety.

There is no single cause for Social Anxiety; like most psychological disorders it is multifactorial in nature. Evolutionary theories suggest that social anxiety evolved as an adaptive trait; to ensure survival via social acceptance and integration in prehistoric societies. Developmental models of Social Anxiety propose that cues in our childhood environment may act as risk factors for Social Anxiety in later life (Karasewich & Kuhlmeier, 2020).

Negative self-image, intense self-consciousness and avoidance of social situations are core features of Social Anxiety. Uncontrollable worrying prior to social events and post-morteming afterwards maintains and intensifies the associated anxiety. One-to-one CBT has been shown to be the most effective form of treatment for Social Anxiety (Warnock-Parkes at al., 2020).

CBT for Social Anxiety typically involves:

• Developing a personalised model of your Social Anxiety

• Correcting your negative self-perceptions and beliefs

• Reducing worry and post-morteming

• Processing socially traumatic experiences

Social anxiety can feel overwhelming and uncontrollable, but can be treated effectively with a range of evidence-based techniques and strategies that will help you cope with your anxious thoughts and feelings and ultimately feel more comfortable in social situations.

References

• Corrie, S., Townend, M., & Cockx, A. (Eds.). (2015). Assessment and case formulation in cognitive behavioural therapy. Sage.

• Karasewich, T. A., & Kuhlmeier, V. A. (2020). Trait social anxiety as a conditional adaptation: A developmental and evolutionary framework. Developmental Review, 55, 100886.

• Stein, D. J., Lim, C. C., Roest, A. M., De Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., & De Girolamo, G. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC medicine, 15(1), 143.

• Warnock-Parkes, E., Wild, J., Thew, G. R., Kerr, A., Grey, N., Stott, R., ... & Clark, D. M. (2020). Treating social anxiety disorder remotely with cognitive therapy. the Cognitive Behaviour Therapist, 13.