Social Anxiety Disorder in Adults
It's the adult who has never dated because he's too shy to talk to members of the opposite sex. It's the quiet employee who is underappreciated by his co-workers and underpaid by his company. It's that great, funny person that you know, but who suffers from loneliness because s/he is too shy unless around close friends and relatives...
It is normal for everyone to be shy at certain times. For example, many people would have some nervousness about doing a big presentation, or about meeting a new boss for the first time. Having "just enough" shyness is good because it helps prevent people from doing things that might get them embarrassed or into trouble. But if you are feeling so shy that it causes you problems at school, work or relationships, then it may be social anxiety disorder...
Social anxiety (aka social phobia, or social anxiety disorder) is a condition where people get extremely anxious in social situations, especially when they are around unfamiliar people or situations, or where they are worried they might be judged by others.
People with social anxiety worry about showing symptoms of anxiety, or doing something wrong that will result in humiliation or embarrassment.
The anxiety is so severe, that people with social anxiety end up avoiding a variety of situations, and in this way, they withdraw from life and are unable to function to their full potential.
Because of the avoidance of social situations, people with untreated social anxiety report a lower quality of life, including a higher risk of being either unemployed, or being paid less if they are employed. Ultimately, untreated social anxiety may contribute to other problems such as depression, substance abuse and other mental health problems.
People with social phobia have usually been shy all their life, but it becomes more noticeable around the teenage years, as social demands increase.
It affects people of all ages, and it is believed that 8% of Canadians have had symptoms of it at some point in their lives (Stats Can, 2002).
People with social anxiety may feel many of these symptoms before or during social situations:
- Blushing, sweating, feeling hot
- Trembling, shaking
- Difficulty talking or making eye contact
According to the DSM-IV (a manual of mental health conditions used by professionals) there are two main types of Social Anxiety Disorder:
a) Social Anxiety Disorder, Generalized:
People with Generalized Social Anxiety Disorder tend to avoid (or endure with distress) a wide variety of social situations: starting up conversation with others (who aren't close friends); talking to strangers; talking on the phone; expressing personal opinions; talking to those in authority (e.g., teacher, employer).
b) Social Anxiety Disorder, Non-Generalized:
People with Non-Generalized Social Anxiety have difficulties mainly in performance situations, such as: public speaking; talking in classes or meetings; performing music or acting on stage; eating or drinking in front of others; using public restrooms when other people are nearby; making mistakes in front of others.
There are many factors which may contribute to social anxiety:
- Genetic: if there is a family history of anxiety, there you may be at higher risk.
- Life experiences can also lead to the social fear that "I'll be humiliated or embarrassed". For example:
- a) If one has had traumatic or negative events such as being teased about one's appearance
- b) If one has grown up in an environment with others with social anxiety, or where there is excessive concern about the opinions of others.
Do you have any of the following?
- Significant and persistent fears of social or performance situations in which embarrassment, rejection, or scrutiny are possible.
- You either avoid such situations, or endure them with distress (e.g. having symptoms of anxiety)
- The fear is unreasonable and/or causes problems in your life
If you answer positive to any of these screening questions, then speak with a health professional.
If you are concerned that you may have problems with social anxiety, then go see a health professional, such as your doctor. Your doctor can help make sure that there are no medical conditions contributing to the anxiety, such as hormone problems. Your doctor can then help with any referrals to more specialized mental health services or professionals in the community, such as a psychologist.
Beware that the social anxiety may trick you into thinking that your concerns are groundless, that its just shyness, or that you won't be taken seriously. That's the social anxiety talking. Help is out there, and you deserve it.
The bad news is that you may have social anxiety. But the good news is that there are many effective treatments for social anxiety.
1. Cognitive Behavioural Therapy (CBT)
CBT is a type of talk therapy (psychotherapy), usually given by psychologists, psychiatrists or other trained professionals, that helps people overcome social anxiety through a variety of cognitive and behavioral techniques. Social events lead to worry thoughts, which leads feelings of social anxiety, which leads to behaviours such as avoiding situations. By changing either the thoughts or behaviours, social anxiety can be overcome.
Techniques used in CBT include:
a. Changing the worry thoughts into more helpful thoughts (cognitive restructuring)
Common fears in social anxiety include:
- Fears about other people: "Everyone's going to laugh", "They're all watching me"
- Fears about oneself: "I'm going to make a fool of myself", "I'll be humiliated".
Replacing those thoughts with more helpful thoughts such as:
- "Nobody's going to laugh, and even if they did, so what? They'll forget it by the next day anyways!" "They are not all watching me - its not like I'm some big celebrity or something!"
- "I'm not going to make a fool of myself - after all, what I'm going to do isn't half as bad as what everyone else has done so far!" "I'm not going to be humiliated - I've survived worse!"
b. Exposure: gradually and repeatedly exposing the person to the feared situation, until the person is no longer afraid of the situation. For example, someone who is afraid to talk to teachers might start by talking to the teacher after class, privately, and then work up to being able to talk to the teacher during class with others around. Exposure is done using a ‘hierarchy', a step-by-step approach starting with easy behaviours and working up to more challenging behaviours.
c. Role plays: where a person practices new ways of responding to situations that are scary. For example, an adult who is anxious about what to say when meeting new people might practice that situation with a therapist.
d. Social skills training: where a person is explicitly taught the steps and rules of effective social interaction. Learning about social skills is something that we expect most people to simply learn, or pick up on their own. At school, most people don't get any "course" on how to talk to others, how to make friends, or other key life skills. But because people with social anxiety tend to avoid social situations, they end up having fewer chances to learn social skills. Thus, it can be helpful to provide direct teaching about social and interpersonal skills.
e. Problem-solving: working together with the person to figure out what problems are causing stress and then deal with them. The person is taught how to solve problems systematically by brainstorming, estimating the advantages and disadvantages of various possible solutions to a problem, and planning the steps involved in implementing the best solution. It is important for the person to learn how to go through this process whenever he or she faces a problem, not simply to learn how to solve one immediate problem.
Social anxiety tends to trick people into avoiding problems (and situations), and so one of the key strategies in cognitive behaviour therapy (or any therapy, for that matter) is to simply help people to gradually face their problems (and situations) gradually more and more.
Medications are prescribed by physicians (such as family doctors, pediatricians or psychiatrists) and are generally reserved for situations where social anxiety has not responded to other types of counseling or therapy, or where the anxiety is so severe that counseling/therapy is not possible. Evidence shows that when appropriately used, medication is safe and effective (Bridge, JAMA, Apr 18, 2007). Interestingly, there is also newer evidence that suggests medications in combination with psychotherapy may be more effective than using medications alone, or psychotherapy alone (Walkup et al., 2008).
Although treatments such as CBT are classically given by mental health professionals (such as psychologists), many of these techniques can be easily learned by people with social anxiety themselves.
Help the person get help.
- Offer to accompany drive your friend or relative to the appointment
Support the person with any treatments recommended, whether it be talking therapy or medications or other treatments.
Acknowledge your friend or relative's distress in having social anxiety.
- Don't tell them to just snap out of it
- Don't intentionally put them on the spot, or make them the focus of attention, unless you have their permission... E.g. don't plan big surprise parties without asking them ahead of time in general how they'd feel about a big surprise party...
Specific Things to Help with Social Anxiety
Help your friend come up with positive coping thoughts to fight the worry thoughts of social anxiety
- In order to fight the social anxiety thoughts such as "You'll make a fool of yourself", gently state that there are other possibilities, "You'll do fine", "Its going to be fun", etc..
- Be flexible and help your friend/relative build an ‘exposure hierarchy'.
Statistics Canada. (2002). 2002 Canadian Community Health Survey (CCHS): Mental Health and Well-being.
Canadian Psychiatric Association. (2006). Clinical Practice Guidelines on the Management of Social Anxiety Disorder, retrieved Nov 6, 2008 from http://publications.cpa-apc.org/media.php?mid=448&xwm=true.
Websites and Organizations
Information from the Anxiety Treatment and Research Centre. http://www.anxietytreatment.ca/socialphobia.htm
Information from the National Institutes of Mental Health
Anxiety Disorders Association of Canada
Painfully Shy: How to Overcome Social Anxiety & Reclaim Your Life (2003), by
Barbara Markway and Gregory Markway.
The Shyness and Social Anxiety Workbook (2000) by Martin Anthony and Richard P. Swinson.
Overcoming Shyness & Social Phobia: A Step-by-Step Guide (1998) by Ronald M. Rapee.
Beyond Shyness: How to Conquer Social Anxieties (1994) by Jonathon Berent.
Written by the eMentalHealth Team, with help from psychologist Dr. Barry Schneider and colleagues at the Department of Psychology at the University of Ottawa.
Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.
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Date of Last Revision: Oct 8, 2016