What to do about social anxiety

What To Do About Social Anxiety?

Social anxiety disorder is estimated to affect around 15 million adults in the US, which is around 7% of the total adult population. In fact, social anxiety disorder is today, the third largest mental health problem in the world. So, if you suspect yourself of suffering from social anxiety disorder—or social phobia—, know that you are definitely not alone.

While social anxiety disorder is certainly a serious condition that can be detrimental in affecting our day to day activities, the good news is that there are ways we can use to manage the disorder: short term (to manage the symptoms), and long term (to permanently recover from the condition).Below, we will learn about what to do about social anxiety disorder, starting with the actionable tips we can use to manage the symptoms.

5 Effective Tips For Dealing With Social Anxiety

1. Always have an escape plan

The main trigger of social anxiety disorder is social interaction—and especially unfamiliar social settings—, and it might be surprising that just knowing that you can leave a certain social setting and even social commitment at any time can significantly improve how you feel.

Think of this as a similar plan to having a friend that is willing to fake text or fake call to get you out of a bad date. Simply knowing you have a viable escape plan can relieve symptoms of SAD because you don’t feel trapped in a (potentially) triggering social situation.

Integrating this escape plan to certain social situations might be more difficult than the others. For example, setting up an emergency escape route when you have a responsibility for a public speaking commitment is more difficult than, say, leaving a boring high-school reunion.

However, always try to plan ahead and find a possible escape route—if possible, more than one— for any social commitment that might trigger your social anxiety.

2. Have a specific strategy for specific social situation

As mentioned above, not all social situations can have a proper exit route. Also, our aim is to be successful in facing these social situations, and the escape route is always a contingency plan.

So, some preparation and strategizing will significantly help to ensure the success of the specific social activity.

One of the most important parts of this strategy’ is to identify people and locations that can help in creating the most comfortable situation as possible, and thus can help suppress and relieve SAD symptoms.

Planning as many details as you can, can either make or break the activity. Knowing that you are in control’ by having a proper strategy can help build confidence and thus avoid you from anxiety attacks.

For example, if you know you are going to visit a busy party, find a calm area where you can make a temporary escape. Have a close friend prepare’ you by having a small chat before you jump into the full party, and if possible have some trustworthy friends accompany you throughout the night.

The idea is to have somewhere or someone to retreat to when the situation starts to become overwhelming, and as before, knowing that you have these as viable options can significantly help in overcoming anxiety

3. Slow breathing as a coping technique

Breathing exercises have been known as one of the most effective ways to create calmness, reduce stress , and as a technique to better control our emotions.

However, when we are anxious or afraid, the control over our breath is often the first thing we lost. As a part of our fight or flight response, breathing rate can rapidly increase as a symptom of social anxiety disorder, so learning how we can slow down this breathing rate is important:

  • Breathe through your nose (avoid using your mouth), and use your diaphragm—lower stomach—rather than your chest muscles.
  • Relax your stomach throughout the inhalation and exhalation
  • Inhale slowly for 3 seconds and exhale slowly for 3 seconds, do this for at least five minutes

The average person has around 12 breaths per minute (in a relaxed situation), and people with social anxiety disorder tend to breath faster than average. Practice to slow down your breath at least 4 to 5 times a day.

4. Be more active and healthy

It’s very important to ensure that your physical health condition doesn’t contribute to your fears or anxiety. For example, feeling ashamed of your body—i.e., because you are afraid to be called fat— might be a trigger for social phobia.

Exercise can effectively reduce anxiety and increase happiness, and when you exercise with other people—for example by joining a gym—, it can help in practicing your social skills in a relatively safe’ environment.

So, if you haven’t already, plan a regular exercise for yourself (including weight training and cardio exercises, and maintain a healthy diet. Avoid tobacco consumption and excessive alcohol intake.

Even if you don’t want to join a gym or participate in a regular class, you can exercise at home, run regularly in the park, and so on.
Also, before a threatening’ social interactions,

What to do about social anxiety

5. Challenge your cognitive distortion

Cognitive distortions—or distorted thinking—, simply ways our brain tell us that something is really true. “People are going to mock you at the party!”, “You are the ugliest people here!”, and so on.

Sounds familiar? Because cognitive distortion is the main culprit causing your anxiety and fears

So, one of the key ways to manage symptoms of social anxiety is to challenge these thoughts. For each of these thoughts, answer the questions:

  • Are my thoughts 100% true?
  • What is the worst that could happen?
  • Could I handle the worst outcome?

Write down the answers, and compile it into a few coping sentences that you can read before you face the challenging social interaction.

In short, embrace the distorted thought, explore it, and use it to your advantage instead.

Professional Treatment for Social Anxiety Disorder

Now, we are going to talk about your long-term solution.

If you suspect yourself—or closed ones— of suffering from social anxiety disorder or social phobia, it’s very important to seek professional help, which may not be easy at first since one of the core symptoms is the fear of speaking to strangers. Remember that as with many other mental health conditions, the longer you wait, it can be harder to treat your social anxiety.

As we have discussed above, having a plan and knowing what to expect can help significantly, so here we will discuss all you might need to know in getting professional treatment for SAD.

SAD Diagnosis

Here, the primary focus of your doctor or mental health specialist is to:

  1. Determine whether you (or the patient) are indeed suffering from social anxiety disorder
  2. Determine the root cause, that is, whether other physical and mental conditions might cause the disorder.

For the former, the diagnosis is based on DSM-5 criteria for social anxiety disorder, which include but not limited to:

  • Intense and persistent anxiety and/or fear about specific social interactions and situations, mainly due to the fear of being humiliated or judged.
  • Excessive fear that is not proportionate with the social situation—and the patient might realize that the anxiety excessive and irrational—
  • Strong determination to avoid anxiety-triggering social situations, or if they decide to endure it, it will cause very intense fear and anxiet
  • The fear and/or anxiety is not caused by a substance or medication abuse, or other known medical condition.
  • The distress created by fear and/or anxiety obstructs day-to-day living

For the latter, here are the common ways the mental-health specialist can determine a diagnosis:

  • Interview and in-depth discussion of your symptoms, like in what situations they typically occur, how often and for how long
  • Physical examinations, to figure out whether any medication/substance or (physical) medical condition might trigger the social anxiety disorder symptoms
  • Reviewing a list of situations—which might show whether they can make you afraid or anxious—
  • Questionnaires and surveys about social anxiety symptoms

Possible Treatments for Social Anxiety Disorder

Different treatments might be performed depending on the severity of your social phobia symptoms—that is, how much the anxiety or fear affects your daily functions—.

In general, we can divide potential treatments into two different types: psychotherapy or medication—or a combination of both—.

Psychotherapy for SAD

Also called talk therapy or psychological counseling, the purpose of psychotherapy is for the patient to learn to recognize their anxiety, fear, and negative thoughts, to change the internal mindset, and to develop the required social skills to build confidence in social interactions.

Cognitive-Behavioral Therapy (CBT) is currently the treatment of choice for social anxiety disorder and generally claimed as the most effective psychotherapy for social phobia.

The main concept of cognitive-behavioral therapy, as the name suggests, is to change the way you think (cognitive level) and how you behave (behavioral level) in social commitments.

Cognitive Behavioral Therapy (CBT) for Social Phobia

Typically a CBT procedure will include:

  • Assessment of the patient’s current level of social anxiety
  • Informing the patient about anxiety and their symptoms, custom-tailored according to the individual’s condition. Again, the purpose is so that the patient can better understand their condition, recognize the symptoms, and change.
  • Learning about strategies and methods to manage anxiety symptoms—some we have discussed above—, like mindfulness meditation, breathing techniques, and especially building a mindset for the patients to regularly practice these strategies
  • Cognitive intervention training. A core aspect of CBT is to treat the cognitive process—how a specific person acquires knowledge—, to identify, recognize, and challenge their anxiety triggers. Here, the patient will be taught to monitor their thinking patterns, and identify any cognitive distortions that might be triggered by specific situations in their day-to-day activities.
  • Behavioral intervention training. In this aspect of the therapy, the patient is trained to prevent or stop misbehavior, which in this case, is behaviors related to social anxiety. This is typically done by exposing the patient to anxiety triggers (feared social situations) in a graded manner, for example:
  • The patient practice public speaking to an empty room (imaginary audience)
  • The patient practice delivering a speech to two of their close friends or trusted family members
  • The patient practice public speaking to a group of 3-5 people
  • We increase the number of listeners little by little until the patient can deliver a speech in front of the desired number of audience
  • Cognitive-behavioral therapy can also include situations where the patient is deliberately exposed to embarrassing situations—that might be very uncomfortable—. The main idea here is to challenge the patient to face the worst-case situations, often with a graded approach as explained above. On the other hand, patients suffering from SAD might use safety behaviors’ as their defense
  • On the other hand, patients suffering from SAD might use safety behaviors’ as their defense mechanism, for example avoiding looking at other people’s eyes, stuttering or mumbling, extensively planning all the details of social encounters, and more (as we have discussed further above). One of the purposes of CBT is so that the patients can let go of these safety behaviors and not rely on them.

Medications for CBT

Several medication options are available to treat social anxiety disorder, and might be prescribed to assist psychotherapy—or CBT):

  • Selective serotonin reuptake inhibitors (SSRI): increasing the levels of serotonin—one of the neurotransmitters in the brain that is responsible for happiness—, for example, Zoloft or Paxil
  • Norepinephrine reuptake inhibitors (NRI): often called Noradrenaline reuptake inhibitor (NRI) or Adrenegic reuptake inhibitor (AR) for example, Effexor X
  • Other antidepressants like tricyclic antidepressants, monoamine oxidase inhibitors, doxepin, etc.
  • Anti-anxiety medications especially benzodiazepine. Benzodiazepines, however, tend to form addictions, so is usually prescribed only for short-term usage.
  • Beta-blockers, blocking adrenaline or epinephrine, reducing blood pressure and heart rate—common symptoms for social anxiety—. Tend to be used to control symptoms for specific situations, for example when the patient is expected to deliver a speech. Not recommended for general, long-term treatment.

End Words

Social anxiety disorder (SAD) is a very serious condition that can significantly affect your day-to-day lives, social interactions, and in a lot of cases, professional success. On the one hand, it is important to learn about the short-term ways we can use to manage the symptoms. On the other hand, seeking professional help as a long-term solution is very important so you can get an effective treatment plan to overcome the condition.

 

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