Treating Social Anxiety Disorder

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‘Treating Social anxiety disorder’ (SAD) is a type of anxiety which is driven by one’s fear of being embarrassed, humiliated, rejected or looked down on in social interactions. In social anxiety disorder, the fear triggered anxiety will usually lead to active avoidance of social occasions thus disrupting one’s daily and life’s routines, including work, school and social interactions which can lead to social isolation.

Social anxiety disorder

Of course, it’s normal to feel nervous in some social situations. For example, going on a date or giving a presentation may give you that feeling of butterflies in your stomach. Indeed, meeting new people is a key trigger for anxieties even in non-anxious people. But in social anxiety disorder, also called ‘social phobia’, everyday interactions cause significant and uncontrollable anxiety potentially resulting in a chronic social debilitating condition, for example ‘Agoraphobia’*.

Social anxiety disorder is a chronic mental health condition, but learning coping skills in psychotherapy can help you gain confidence and improve your ability to interact with others*. Our understanding of social anxiety disorder (also known as social phobia) has moved from rudimentary awareness that it is not merely shyness to a much more sophisticated appreciation of its prevalence, its chronic and pernicious nature, and its neurobiological underpinnings.

Social anxiety disorder is the most common anxiety disorder and is distinct from ‘Generalised anxiety disorder’ (GAD) which, as the term states, is a generalised anxiety disorder which is being in a constant state, or almost constant state, of excessive worrying, whereas social anxiety only occurs in or is triggered by having to perform in social situations.

Social anxiety disorder occurs in children, adolescents, and adults, but its manifestation and treatment differ depending on developmental factors. Indeed, Social anxiety disorder is the most common anxiety disorder; it can have an early age of onset—by age 11 years in about 50% and by age 20 years in about 80% of individuals—and it is a risk factor for subsequent depressive illness and substance abuse*.

The most well-researched psychosocial treatments for social anxiety disorder are Cognitive-Behavioural Therapies (CBTs) which in most forms appear likely to provide some benefit for sufferers of social anxiety disorder.

Symptoms of Social Anxiety Disorder can include

Symptoms of Social Anxiety Disorder

Feelings of shyness or discomfort in certain situations aren’t necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on personality traits and life experiences. Some people are naturally reserved and others are more outgoing.

In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interfere with daily routine, work, school or other activities. Social anxiety disorder typically begins in the early to mid-teens, though it can sometimes start in younger children or in adults.

Emotional and behavioural symptoms

Signs and symptoms of social anxiety disorder can include persistent:

  • Fear of situations in which you may be judged;
  • Worrying about embarrassing or humiliating yourself;
  • Intense fear of interacting or talking with strangers;
  • Fear that others will notice that you look anxious;
  • Fear of physical symptoms that may cause you embarrassment i.e., blushing, sweating, trembling or having a shaky voice;
  • Avoiding doing things or speaking to people out of fear of embarrassment;
  • Avoiding situations where you might be the centre of attention;
  • Having anxiety in anticipation of a feared activity or event;
  • Enduring a social situation with intense fear or anxiety;
  • Spending time after a social situation analysing your performance and identifying flaws in your interactions;
  • Expecting the worst possible consequences from a negative experience during a social situation;

For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.

Performance type of social anxiety disorder is when you experience intense fear and anxiety only during speaking or performing in public, but not in other types of social situations.

Physical symptoms

Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:

  • Blushing;
  • Fast heartbeat;
  • Trembling;
  • Sweating;
  • Upset stomach or nausea;
  • Trouble catching your breath;
  • Dizziness or light-headedness;
  • Feeling that your mind has gone blank;
  • Muscle tension;

Avoiding common social situations

Common, everyday experiences that may be hard to endure when you have social anxiety disorder include, for example:

  • Interacting with unfamiliar people or strangers;
  • Attending parties or social gatherings;
  • Going to work or school;
  • Starting conversations;
  • Making eye contact;
  • Dating – including online dating;
  • Entering a room in which people are already seated;
  • Returning items to a store;
  • Eating in front of others;
  • Using a public restroom.

Social anxiety disorder symptoms can change over time. They may flare up if you’re facing a lot of stress or demands. Although avoiding situations that produce anxiety may make you feel better in the short term, your anxiety is likely to continue over the long term if you don’t get treatment:

Causes of Social Anxiety Disorder can include

Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of biological and environmental factors. Possible causes include –

Inherited traits: Anxiety disorders tend to run in families. However, it isn’t entirely clear how much of this may be due to genetics and how much is due to learned behaviour.

Brain structure: A structure in the brain called the amygdala (uh-MIG-duh-luh) may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.

Environment: Social anxiety disorder may be a learned behaviour — some people may develop the condition after an unpleasant or embarrassing social situation. Also, there may be an association between social anxiety disorder and parents who either model anxious behaviour in social situations or are more controlling or overprotective of their children.

Risks Factors

Several factors can increase the risk of developing social anxiety disorder, including:

Family history: You’re more likely to develop social anxiety disorder if your biological parents or siblings have the condition.

Negative experiences: Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder. In addition, other negative events in life, such as family conflict, trauma or abuse, may be associated with social anxiety disorder.

Temperament: Children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk.

New social or work demands: Social anxiety disorder symptoms typically start in the teenage years, but meeting new people, giving a speech in public or making an important work presentation may trigger symptoms for the first time.

Having an appearance or condition that draws attention. For example, facial disfigurement, stuttering or tremors due to Parkinson’s disease can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.


Left untreated, social anxiety disorder can run your life. Anxieties can interfere with work, school, relationships or enjoyment of life. Social anxiety disorder can cause:

  • Low self-esteem;
  • Trouble being assertive;
  • Negative self-talk;
  • Hypersensitivity to criticism;
  • Poor social skills;
  • Isolation and difficult social relationships;
  • Low academic and employment achievement;
  • Substance abuse, such as drinking too much alcohol;
  • Suicide or suicide attempts.

Other anxiety disorders and certain other mental health disorders, particularly major depressive disorder and substance abuse problems, often occur with social anxiety disorder.

There’s no way to predict what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you’re anxious. While it is never too late to seek out couples counselling, the sooner you do the better the possibility of assisting you identify and alleviate the problems affecting your relation.

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Agoraphobia is an extreme or irrational fear of entering open or crowded places, of leaving one’s own home, or of being in places from which escape is difficult. Agoraphobia involves a severe fear of being in certain situations and having panic attacks or other similar panic-like symptoms, such as fainting, feeling dizzy or lightheaded, vomiting, or experiencing a migraine headache.

In some more severe cases of ‘social anxiety disorder’ a Psychiatrist or other qualified medical practitioner may consider it necessary to prescribe medication. Some types of antidepressant medication can help people to manage anxiety.

Functional neuroimaging studies point to increased activity in amygdala and insula in patients with social anxiety disorder, and genetic studies are increasingly focusing on this and other (eg, personality trait neuroticism) core phenotypes to identify risk loci. A range of effective cognitive behavioural and pharmacological treatments for children and adults now exists; the challenges lie in optimum integration and dissemination of these treatments, and learning how to help the 30–40% of patients for whom treatment does not work.

Charles Pratten Principal CBT Counselling & Psychotherapy Sydney

Author: Charles Pratten

Principal CBT Counselling & Psychotherapy

Title: Treating Social Anxiety Disorder

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