Most people have experienced some apprehension when faced with a social situation. Giving a speech may not come as naturally to some as to others, or some might feel butterflies in their stomach during a job interview. Sometimes, people may even feel a little nervous while speaking to a stranger or stumble over a few words while asking someone out on a date. Social anxiety, however, is more than just the shyness or discomfort someone would experience in those awkward situations. Social anxiety is such an intense fear of being embarrassed that people reluctantly endure those situations or they tend to avoid them all together. To people who suffer from social anxiety, staying away from social interaction is often the path of least resistance. But, no matter how intense the feelings of anxiety are, there is still hope. By understanding the causes including culture, society, neurological, or contextual conditioning, and by using one of the following treatments: social imagination, skills training, cognitive behavioral therapy, group therapy, or medication; people absolutely can overcome social anxiety.
The first step in treating social anxiety is to understand what causes it. Stefan G. Hofmann, PhD, and other contributors point out that the defining feature of social anxiety is the fear of negative evaluation of others (1117). Because of this, it is directly linked to social standards and role expectations, which are culturally dependent (Hoffmann et al. 1117). Social organizations that emphasize the interdependence of its members are referred to as collectivistic. Those that reward individual achievement and success over those of the group are individualistic. It should be apparent that collectivistic societies tend to have a lower occurrence of social anxiety because there is normally not as much evaluation of individuals. People living in Asia will be less likely to experience social anxiety, while people living in Russia and the United States will be more likely to experience social anxiety (Hoffman et al. 1124).
But what, specifically, causes the fear? Heidemarie Blumenthal and her colleagues at the University of Arkansas show us that as with most other psychological diagnoses, adolescence is a key period in the development of social anxiety (1134). During puberty, there is profound psychosocial development as youths experience extensive physical growth and developing of primary and secondary sexual characteristics (Blumenthal et al. 1134). Also, during this time, youths will reach skeletal maturity and attain reproductive capability (Blumenthal et al. 1134). These intense changes set the stage for the future vulnerability of social anxiety symptom manifestation (Blumenthal et al. 1134). As adolescents become more unfamiliar and more conscientious about their changing body and moods, a greater potential exists that their social interactions will be negative.
From this early negative social interaction, an exaggerated fear response will develop. Sabin G. Shah, a graduate student at Tufts University, and others illustrate how the brain structures of the amygdala and insula react to negative stimulus in patients suffering from a generalized social anxiety (296). From their experiment, it was found that the generalized social anxiety is normally associated with a negative affectivity in that negative facial expressions and negative images yielded more of a reaction to the brain structures than positive ones (Shah et al. 301). In other words, people suffering from social anxiety are much more aware and much more sensitive of the negative social interactions than the positive social interactions. This negative affectivity continuously feeds the social fear as they imagine the worst and try to avoid social interactions entirely.
Contextual conditioning is also at work. Joannie M. Schrof, an author for U.S. News & World Report, observes that a fear “marker” is attached to the details of a situation in which the trauma was experienced (e.g. place, time of day, background music) (50). If, for example, children get tongue-lashings from a teacher, they will feel nervous the next few times they step into the classroom (Schrof et al. 50). Unfortunately, the brain is sometimes too good at making associations and the anxiety “grows like a cancer”, attaching itself to the act of entering any classroom or talking to any teacher and thus generalizations are made (Schrof et al. 50). While this “weariness of other creatures” has contributed to the overall survival of the human race, it also plays a large role in the generalized social anxiety that people so often experience even though there is often no threat at all (Schrof et al. 50).
So, what can be done to reduce social anxiety to a manageable level or to eliminate it all together? First of all, the patient needs to be retrained or rewired. If they are expecting the worst when interacting with others, they have to, instead, be trained to expect something other than the worst. Remember, the goal is to fight the belief that others will pass negative judgment and unbearable humiliation will result (Schrof et al. 50). We can accomplish that through many different methods.
One method is called sociological imagination. This encourages patients to seek understanding as it relates to the larger historical picture. In “It’s Not My Fault: Overcoming Social Anxiety through Social Imagination”, the author takes us through a tour of his life and the things that may have contributed to the anxiety he struggles with (42). In understanding how society has contributed to his social anxiety, he can better cope with it. He walks us through his military life as a child and explains how being sent to many different military bases hurt him instead of helping with socialization skills (“Fault” 42). He took on different roles as a child and treated the world as a theatre, shying away from who he really was to avoid embarrassment (“Fault” 43). Eventually, not confronting his fears caused him to avoid all types of social contact (“Fault” 47). Later on in life, however, he became very capable of dealing with social anxiety (“Fault” 47). Looking inside one’s own thoughts and seeking understanding for the external forces that affect us can be a very important first step in conquering social anxiety.
Another method to treat social anxiety is to develop certain skills. Robin F. Cappe and Lynn E. Alden, PhD, explain how important it is for patients to not have their attention focused on themselves (796). They believe that the majority of the anxiety comes from not being able to effectively interact with other people and emphasize four very important skills to help: active listening, empathetic responding, communicating respect, and self-disclosure (Cappe and Alden 796). These same skills are commonly taught in human relations training, but modified to apply to social interactions with friends.
One such skill is active listening. Lucetta B. Comer and Tanya Drollinger, with the Department of Consumer Sciences and Retailing at Purdue University, define active listening as a process in which the listener receives messages, processes them, and responds so as to encourage further communication (15). In active listening, we must include both verbal and non-verbal messages including body positioning, eye contact, facial expressions, and emotion (Comer and Drollinger 15). Being an active listener means that you provide verbal and nonverbal feedback to the speaker such as acknowledgements that you understand what is being said (Comer and Drollinger 15).
Empathetic responding, an advance method of acknowledgement, is another useful social skill. Empathy is defined as understanding another person’s thoughts and feelings with some degree of accuracy (Comer and Drollinger 15). It involves listening on an intuitive as well as literal level (Comer and Drollinger 15). To respond with empathy gives speakers a sense that you understand what they are saying. Once they feel that you “get them”, they are more encouraged to open up. Being able to empathize with someone takes the attention away from you and helps to relieve social anxiety.
A skill commonly overlooked would be communicating respect to someone in a social interaction. Kyu-Taik Sung, president of Elder-Respect, Inc., and Ruth E. Dunkle, Professor of Social Work at the University of Michigan, describe respect as a benevolent, altruistic, or sympathetic expression of regard for other persons (251). Respect calls for more than one’s attention (Sung and Dunkle 251). Communicating respect means using courteous manners, using respectful language, and treating others as you would want to be treated (Sung and Dunkle 253).
The last skill of self-disclosure is revealing more about oneself to others. Rimantas Koclunas, a Professor of Clinical Psychology at the University of Vilnius and Tatjan Dragan, a psychologist from the Psychology Section of the Lithuanian Police Department Personnel Board, describe self-disclosure using two aspects: the “here-and-now” and historical “there-and-then” (346). There are also two types of disclosure: disclosing personal information such as personal difficulties, unresolved problems, aims and wishes, strong and weak points of your personality, positive and negative experiences; and the ability to share reactions to the events occurring immediately in the conversation (Koclunas and Dragan 346). When you practice self-disclosure, you develop established conditions of trust, interpersonal warmth and support in your social interactions (Koclunas and Dragan 349).
Cognitive Behavioral Therapy is another method for controlling social anxiety. One psychologist will take patients to an elevator where she asks them to ride up and down and make small talk with fellow passengers (Schrof et al. 50). Sometimes it takes 10 or 15 rides, and sometimes it takes all day, but eventually, the patients’ hearts stop racing for fear of what the people in the elevator think of them (Schrof et al. 50). Putting patients in embarrassing situations or situations that would normally elicit social anxiety helps them confront their biggest fears and eventually deal with them. If they have enough experiences that are positive, they will eventually extinguish their fears of social anxiety. This social exercise of engaging others until it is second nature is much like our gym workouts to stay physically healthy (Schrof et al. 50).
This particular behavioral therapy is a form of in vivo exposure. Ronald M. Rapee, a professor in the Macquarie University Department of Psychology, describes in vivo exposure as a cognitive restructuring individually tailored to target the specific social fears of the patient. Patients start with tasks that cause little or no discomfort and eventually work up to more strenuous activities. Eventually, they are able to conquer their biggest social phobias (Rapee et al. 320).
Over the years, group therapy has been found to be a good treatment for a variety of disorders. It can, however, be especially helpful in treating social anxiety. The group setting itself encourages social interaction. Since others in the group share your anxiety, you are likely to receive less negative evaluations. In group settings, you are able to easily practice the skills that will make you more comfortable with social interaction. Diane Damer, a psychologist from the University of Texas at Austin, and colleagues explain that the cost benefits of group therapy are far greater than those of individual therapy. There also is mounting evidence in studies that group therapy can prove to be more effect (Damer et al. 10).
In some cases of social anxiety, one might also turn to medication. As outlined in the article “Treating social anxiety disorder” from Harvard Mental Health Letter, selective serotonin reuptake inhibitors (SSRIs) and one serotonin and norepinephrine reuptake inhibitor (SNRI) are considered the best medical options for the generalized form of social anxiety disorder (1). However, if there is a specific social phobia, beta-blockers or benzodiazepines should first be considered (“Treating” 1).
Serotonin is a neurotransmitter used by your body to regulate mood, sleep, appetite, and pain sensation. Reduced serotonin transmission contributes to anxiety. SSRIs such as citalopram (Celexa), paroxetine (Paxil), and sertraline (Zoloft) increase the availability of serotonin thereby decreasing social anxiety (“Treating” 2). Venlafaxine (Effexor) is an SNRI that targets not only serotonin, but also norepinephrine. Norepinephrine is also known as adrenaline (“Treating” 2). Coincidentally, SSRIs are also used to treat depression. In comparison, only half the dosage used to treat depression is used in treating social anxiety (“Treating” 3).
To medically treat the specific phobia of public speaking, doctors will sometimes prescribe beta-blockers. Although, these are typically prescribed patients with heart disease, beta-blockers like propranolol (Inderal) can help to counter symptoms of social anxiety, such as sweating, rapid heartbeat, or shortness of breath (“Treating” 3). Several studies suggest that taking this type of drug about an hour before speaking, this can greatly reduce the effects of social anxiety (“Treating” 3).
Benzodiazepines are another medication used to treat specific social anxiety disorders. They work by boosting the activity of gamma-aminobutyric acid, which is an “inhibitory” neurotransmitter (“Treating” 3). In other words, it suppresses signals that are traveling down a neural pathway (“Treating” 3). This will have a calming effect on anxiety symptoms. Unfortunately, people taking benzodiazepines can become physically dependent upon them and there is some potential for abuse.
When it comes to social anxiety, there are many treatment options available. In a world of computers and smart phones, social interactions are not as common as they once were. Where there used to be a natural “overcoming of shyness”, people are more inclined to take the easier path and avoid these situations. That’s why it’s so important to recognize the causes of social anxiety as well as the treatments available. Whether someone uses social imagination, skills training, cognitive behavioral therapy, group therapy, or medication, there should be no reason for anybody to suffer; overcoming social anxiety is absolutely possible.
Blumenthal, Heidemarie, et al. “Elevated Social Anxiety among Early Maturing Girls” Developmental Psychology 47.4 (2011): 1133-1140. Print
Cappe, Robin F., and Alden, Lynn E. “A comparison of treatment strategies for clients functionally impaired by extreme shyness and social avoidance” Journal of Consulting and Clinical Psychology 54.6 (1986): 796-801. Print
Comer, Lucetta B., and Drollinger, Tanya “Active Empathetic Listening and Selling Success: A Conceptual Framework” Journal of Personal Selling & Sales Management 19.1 (1999): 15-29. Print
Damer, Diana E. et al. “Build Your Social Confidence: A Social Anxiety Group for College Students” Journal for Specialists in Group Work 35.1 (2010): 7-22. Print
“It’s Not My Fault: Overcoming Social Anxiety through Sociological Imagination” Journal of the Sociology of Knowledge 2.1 (2003): 42-49. Print
Hoffman, Stefan G., et al. “Cultural aspects in social anxiety and social anxiety disorder.” Depression & Anxiety 27.12 (2010): 1117-1127. Print
Koclunas, Rimantas, and Dragan, Tatjan “The Phenomenon of Self-Disclosure in a Psychotherapy Group” Journal of the Society of Existential Analysis 19.2 (2008): 345-363. Print
Rapee, Ronald M., et al. “Testing the efficacy of theoretically derived improvements in the treatment of social phobia” Journal of Consulting and Clinical Psychology 77.2 (2009): 317-327. Print
Schrof, Joannie M., et al. “Social Anxiety” U.S. News & World Report 126.24 (1999): 50. Print
Shan, Sabin G., et al. “Amygdala and insula response to emotional images in patients with generalized social anxiety disorder” Journal of Psychiatry & Neuroscience 34.4 (2009): 296-302. Print
Sung, Kyu-Taik, and Dunkle, Ruth E. “How Social Workers Demonstrate Respect for Elderly Clients” Journal of Gerontological Social Work 52.3 (2009): 250-260. Print
“Treating social anxiety disorder” Harvard Mental Health Letter 26.9 (2010): 1-3. Print