What is Social Anxiety?



Everyone, ok…well, almost everyone experiences fear or anxiety sometimes. Fear is a primary emotion and helps us prepare for danger. Therefore, we will never entirely rid ourselves of fear, nor should we want to.

Social Anxiety is about more than just being shy around others. “Many people are a little bit shy. If you’re shy, you might be somewhat uncomfortable in situations such as going to a party where you don’t know anyone, but you do it. You give yourself a push, you go to the party, after a while you relax and talk to people,” says Rudolf Hoehn-Saric, MD, who heads the Anxiety Disorders Clinic at Johns Hopkins University School of Medicine. “The social phobic person, at the prospect of the same party, would be overwhelmed by such anxiety that [he or she] would have a physical reaction — perhaps nausea, sweating, heart racing, dizziness — and would avoid it if at all possible.”

Shyness and introversion are not the same thing, either. As stated above, Shy people experience discomfort, while introverts simply prefer less social stimulation. While shyness is internally painful, introversion is not distressing.

The problem with social anxiety (formerly known as social phobia) is that we become fearful when no clear or reasonable threat is present. 

Social anxiety can keep people from things they want and/or need to do. At the heart of social anxiety is an intense fear of being judged by people around you. This fear is so intense for some that they are unable to engage strangers in conversation and some people are too fearful to leave their own homes. Some people are unable to eat in public or use public restrooms. 

This intense anxiety typically lasts for about six months or more for an official diagnosis. 

Social anxiety shows significant improvement using Cognitive-Behavioral Therapy (CBT). Cognitive therapy teaches us how to think differently while behavior therapy teaches us how to act differently. It is generally recommended that we first learn the facts regarding anxiety in preparation for CBT interventions. 

Some people opt for individual therapy while others benefit from group therapy. One of the benefits of group therapy is that socially anxious people are able to see that it is not just them who suffer with anxiety. So often people with social anxiety feel like they are the only ones who are suffering when nothing could be further from the truth.

CBT interventions for social anxiety include making a list of all the areas where one feels social fear or social discomfort. Then, the therapist helps the client arrange the things which makes them fearful from least fearful to most fearful. The therapist (and client) would benefit from practicing relaxation skills or coping skills at this point so that the client can learn to control their fear reaction. Once the client is able to use coping skills, the therapist would then assist the client in repeatedly engaging in the least scary thing on the client’s list while the client uses his or her coping skills. 

When the client no longer has a fear reaction to the least scary thing on their list, the client moves up the list until he or she is able to perform all actions on their list without excessive fear.

Another approach besides CBT is called Acceptance and Commitment Therapy (ACT) which is like a cross between CBT and Mindfulness. With ACT, the therapist suggests that the person may always have discomfort or feelings of anxiety and the client learns to not allow the feeling of fear to prevent them from going to a dinner party, or a public restroom.

Some individuals who struggle with ongoing anxiety choose to see a psychiatrist or their individual doctor regarding anti-anxiety medication as well as psychotherapy. Some people find medication helps them relax easier and get increased benefits from their individual or group therapy.



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