Social anxiety disorder (SAD) or social phobia is more than just shyness (most people feel a little uncomfortable at first in social settings). A diagnosis of social anxiety disorder is typically given when a person experiences panicky feelings when around other people in a social setting (or when attempting to enter social settings). The panic occurs due to fear that others will notice that they are nervous and judge them negatively because of it. Symptoms can include blushing or fear of blushing (also known as erythrophobia), heart racing, shakiness, feeling sick on the stomach, lightheadedness and sweaty palms. Often excessive sweating can become the principal concern of those experiencing social anxiety perhaps leading to a diagnosis of hyperhydriosis. The DSM-IV (which is the manual used by psychologists to diagnose psychological problems) lists the following symptoms as occurring when you have SAD.
Avoidance of social situations (e.g. work meetings, social gatherings).
- Worry about embarrassing yourself .
Fear that others will judge you negatively (e.g. as weak, crazy, stupid etc).
Fear that they you appear inarticulate when conversing with others.
May avoid eating, drinking or writing in public for fear that others will see their hands shaking.
What Causes Social Anxiety Disorder? Research has shown that SAD is a very common problem. For example a recent U.S. survey indicated that in any given twelve month period 7.9% of the American population meet the DSM-IV criteria for its diagnosis (1). What's more, some studies have indicated that as many as 60% of people rate themselves as shy, which can be seen as an indicator of mild social anxiety.
Several theories exist to explain the development of SAD including genetic causes, the evolutionary hypothesis, environmental learning and the existence of a chemical inbalance in the brain. There is evidence to indicate that chemical changes do occur within the brain when an individual is feeling anxious however the consensus is that these changes occur as a response to anxiety producing thoughts and exposure to anxiety producing situations. As such the chemical changes which are experienced are in fact symptoms of SAD rather than a cause (see more below under 'what about medication?').
Evolutionary psychologists see the existence of social anxiety as having been very important for the survival of our ancestors. The theory states that in ancient times it was very important to be liked by others in your tribe because if you weren't you may have been socially shunned and have missed out on gaining access to limited food supplies and also not had as many opportunities to mate with the opposite sex and have children. Even more importantly, if you were really disliked you may have been cast out of the tribe and one person in a world full of tigers and other predators would be unlikely to live long. As a result we now all have an inbuilt genetic desire to be approved of by others even though these days we can get food and live safely without maintaining strong social bonds to others. This desire exists in most of us and if it becomes attached to the you can feel social anxiety strongly enough to become panicky in situations where you may be judged by others. You typically then respond by avoiding those situations and the anxiety grows.
Moreover, most theorists believe that the reasons some people develop SAD in the modern world are multifactorial, likely including some genetic factors but primarily resultant of environmental learning (particularly during childhood), For example, if at some stage you felt embarrassed enough to become panicky in a social situation the uncomfortable feelings produced may then lead to avoidance of anxiety producing social situations and the social anxiety grows. Subsequently, we all have the potential to develop SAD if environmental conditions are just right. The good news about this is that if social anxiety can be learned it can also be unlearned. All that is needed is the right knowledge and a strong desire to feel comfortable in social situations.
What Can be Done to Help me with Social Anxiety Disorder ?
Cognitive behaviour therapy (CBT) is the best evidenced treatment for SAD (click here for more about CBT). A standard CBT program for SAD usually requires about 10 visits to a psychologist. The treatment is skills and knowledge focused and involves developing new understanding and techniques which you then apply over time to eliminate the unwanted symptoms. Groupwork for SAD has also been shown to produce excellent lasting results. The best thing about using these approaches is that the changes you experience are long lasting and typically lead to full recovery over a relatively short period of time. As most SAD sufferers realise, techniques such as avoiding anxiety producing social situations, or thoughts, and keeping busy or distracted (even distraction through attempting relaxation techniques) only provide temporary relief at best and you are usually left with a sense of the anxiety always looming in the background waiting to pounce the next time you have to enter a social situation. At NSWADTC we are currently enrolling people into group SAD classes (typically after completion of an individual program). You can receive either individual or group CBT (or a combination of both) at the centre depending on your preference although some groupwork is recommended for optimum results.
What about Medication? It has been widely acknowledged that medication does not provide a cure for anxiety disorders or depression and SAD is no exception to this rule.
People are often prescribed some form of medication for SAD by their doctor prior to seeking help from a psychologist and at times medication use may be indicated, particularly if your level of anxiety is so high that you are unable to successfully engage in appropriate therapy with your psychologist. At these times medication can help in reducing the physical symptoms associated with strong anxiety so that you can attend well to learning the skills involved in creating permanent change. Typically, elimination of the need for medication is an achievable part of completing a CBT program for anxiety. It is important to remember however, that any changes to your medication must first be discussed with your doctor.
Remember: Most people feel uncomfortable to some degree in social settings (particularly at first). If however the discomfort is strong and leads to significant social avoidance you may have developed SAD. If this is the case it doesn't mean that you have to learn to live with the symptoms. SAD is a problem which can occur for almost anybody under the right circumstances and experiencing social anxiety doesn't mean that there is something wrong with your brain, or that you are doomed to be uncomfortable around people forever. Excellent treatment is now available for SAD and full recovery is usually achievable in the short term, typically without the need for medication. If you would like to know more about how our confidential individual or group treatment programs may be able to help you, click on contact us to arrange to talk with one of our psychologists.
(1) reference: Kessler et al (1994) in Crozier and Alden (2005) The Essential Handbook of Social Anxiety for Clinicians, John Wiley & Sons LTD.
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