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  • Bridget Friedman, LICSW

Help for Social Anxiety

Updated: Sep 19, 2021

Social anxiety….we all experience it at times. How many of us feel completely confident before giving a big presentation at work? (CONGRATULATIONS if you are one of the three percent who do!). And who hasn’t experienced a sleepless night or racing heart when pondering whether to ask a new romantic prospect out on a date? A certain level of social anxiety is a normal part of life. Welcome to humankind.

And yet, for some people, social anxiety can be a much more distressing problem. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, notes that about 7% of people in the United States will meet clinical criteria for social anxiety in a given 12-month period. I have a strong suspicion (although no concrete data) that the rise of social media over the last couple of decades has also contributed to an increase in social anxiety. It has become a daily ritual for many of us to scroll through social media, comparing our lives to the perfectly curated lives of others on display. Its not surprising that so many of us feel that we somehow don’t quite measure up or may have some hidden defect that we have to work hard to hide from others.

If we all experience some degree of social anxiety, how does one know if their symptoms might be problematic? The DM-5 lists specific criteria needed to make a diagnosis of social anxiety. The criteria include:

1) Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

2) The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing or will lead to rejection by others).

3) Th social situation almost always provokes fear or worry.

4) The social situations are avoided or endured with intense fear or anxiety.

5) The fear or anxiety is out of proportion to the actual threat posed.

6) The fear, anxiety, or avoidance is persistent (typically lasting six months or more).

7) The fear, anxiety or avoidance causes significant distress or impairment in social, occupational, or other important areas.

The last point is the most important point. The hallmark of social anxiety is social avoidance. The person with social anxiety begins to avoid social situations due to the fear the situations provoke. They may avoid speaking up at work, leading to lost opportunities and promotions. They may avoid social situations, leading to a gradual narrowing in their network of friends and community support. The anxiety may lead to missing out on new experiences or adventures (joining a sports team, going to a dance class, attending a church service, travelling to new places). It may start to feel like one is standing on the sidelines of life rather than participating in and enjoying life. The avoidance of social situations creates an immediate short-term payoff because it removes the discomfort of experiencing anxiety, but the long-term costs can be very high.

Fortunately, there are some very good treatment options available for social anxiety. Treatment typically involves several components:

Assessment: Identifying the specific situations that cause anxiety and noticing the symptoms that one experiences when encountering these situations.

Cognitive Restructuring: This approach involves learning to notice and change unhelpful thinking habits. All of us have certain “automatic thoughts” that routinely come into our heads. Often these thoughts are not accurate or helpful…and just because we think something doesn’t necessarily mean the thought is valid or true. Learning how to identify and question our thoughts can be pivotal in reducing anxiety.

Skills Training / Practice: It is often helpful to practice or rehearse feared situations in a safe place before trying them out in real life.

Exposure: This is the most important part of treatment for social anxiety. It basically means taking a deep breath, going out into the world, and seeing how it goes. Social anxiety grows over time because people have learned to avoid taking social risks. They never discover that the feared situation is actually NOT particularly dangerous and they are deprived of the opportunity to develop confidence in their social abilities. By starting to take small steps and exposures, the downward spiral becomes an upward spiral.

Admittedly, it can feel scary to make a deliberate choice to engage in “exposure” activities and venture out into the world. However, this is done in very small steps with lots of preparation. An individual usually creates a personalized hierarchy of feared situations. On a scale of 1 to 10, they would identify the least feared situation as a 1 (for example, saying good morning to the barista at Starbucks). The most feared situation might be a 10 (for example, publicly singing a karaoke song at an office party - this would probably be at least an 11 for me!). They would then identify additional anxiety provoking situations along the scale. Progress is made step by step up the hierarchy ladder, with lots of preparation and support at each rung on the ladder.

Who knows, you might even discover that you are actually pretty good at karaoke!

I am including some additional resources for people who might want to take a deeper dive into the treatment of social anxiety. I greatly enjoyed the following podcast and book (both by Ellen Hendriksen, PhD).

How to Be Yourself: Quiet Your Inner Critic and Rise Above Social Anxiety by Ellen Hendriksen PhD.

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