Do You Or Someone You Know Suffer From Social Anxiety Disorder?

According to the Australian Bureau of Statistics’ (ABS) National Health Survey: First Results, 2017-18, rates of mental illness are increasing. In our clinics, we have seen a similar trend.

Figure 1. One in seven people experience anxiety disorders with social anxiety and posttraumatic stress disorder being the most common types of anxiety disorders. Source: The Department of Health.

Social Anxiety Disorder, also known as Social Anxiety or Social Phobia, is one of the most common mental health conditions with over 13% of our population developing this illness over their lifetime.

What Is Social Anxiety Disorder (SAD)? 

Social Anxiety Disorder is more than feeling shy or nervous with strangers. It is an experience of fear, and sometimes intense anxiety when in a social situation. People with social anxiety tend to avoid unfamiliar social situations, and this limits their ability to live active and fulfilling lives.

Social Anxiety Disorder can significantly impair a person’s social life and may sometimes have a devastating impact on other areas of their life too.

Figure 2. Anxiety disorders have the greatest disturbance in social life. Source: The Department of Health.

Everyday interactions such as giving a presentation at work, attending a party, eating in public or asking a stranger for directions can be extremely stressful and distressing for someone suffering from this disorder.

People with social anxiety may feel severe anxiety and worry excessively as a result of being fixated on how others perceive them.

As a result, they may have an overwhelming fear of embarrassing and humiliating themselves in front of others. This excessive worry and fear may cause them to actively avoid social situations or suffer through them with great distress. 

Why Is Social Anxiety Disorder Also Known As ‘Social Phobia’? 

A phobia is an irrational fear of certain situations and objects. Common phobias include a fear of spiders (arachnophobia) and fear of heights (acrophobia). While it is normal to have some fear of spiders or heights, it becomes a phobia when it is an irrational fear, such as feeling fear when you see a picture of a spider, in the case of arachnophobia. 

It follows that a Social Phobia is an irrational fear of social situations. It is normal to have some anxiety when interacting with people socially, however, it becomes irrational when the anxiety becomes extreme and causes unnecessary avoidance of certain situations.

Social Anxiety Disorder Symptoms 

Social Anxiety Disorder can manifest in a range of physical, behavioural and emotional symptoms: 

  • Physical symptoms are triggered by a “flight or fight” response in the body and these physiological responses include shortness of breath, increased heart rate, blushing, stomach irritation, trembling, sweating and difficulty with concentration.
  • Long-term experience of social phobia can lead to physical symptoms such as a constant feeling of fatigue and headaches.
  • Typical behavioural symptoms include actively avoiding social situations or leaving early, keeping quiet at an event and not looking at others but focusing on yourself.
  • Emotional symptoms include feelings of embarrassment, shame, loneliness and feeling like you have not reached your potential due to social phobia.

Treatment For People With Social Anxiety

Most people with social anxiety seek a general practitioner (see below).

Figure 3. Health services used by people with social anxiety. Source: ANZJP.

1. Cognitive Behavioural Therapy (CBT)

CBT is a very effective treatment for Social Anxiety Disorder with some studies showing that 80% of sufferers have benefited from receiving CBT. This treatment involves working with a mental health professional to recognise and challenge unhelpful thoughts and behaviour patterns, as well as to form positive and helpful coping strategies to improve a person’s wellbeing and quality of life. 

Some unhelpful thoughts patterns that lead to social phobia might include: 

  • “I am boring.”
  • “I am not smart enough.”
  • “They are laughing at me.”
  • “I look awkward.”
  • “People can tell that I am uncomfortable.”

Treatment will assist with identifying these thoughts, and develop strategies to manage them, such as building self-esteem and confidence.

2. Mindfulness-Based Therapy

Mindfulness-based therapies assist with managing the symptoms of social anxiety, when they arise during social situations. Mindfulness helps teach you how to deal with the fear associated with social phobia, and to be more comfortable in social situations, without having to avoid them.

3. Self-Help Strategies

Relaxation strategies can be useful to calm yourself from those distressing physical symptoms of social anxiety. Engaging in meditation and breathing exercises can decrease the intensity of the fear response and help you calm down quickly.

4. Graded Exposure Therapy

Graded Exposure Therapy in the treatment of social phobia is the process of slowly and deliberately increasing a person’s exposure to social situations that would normally cause them an anxiety response. The process is ‘graded’, beginning with situations that are relatively easy (such as asking a stranger for directions) to more difficult situations (such as speaking about yourself in front of a group).

Graded Exposure Therapy assists a person with social phobia to slowly build their confidence in social situations, eventually overcoming their fears. 

Social Anxiety In Children 

Children can also present with social anxiety, and this commonly looks like extreme shyness. Children will avoid speaking to unfamiliar people, will become quiet (refuse to talk), will not make eye contact, will sit away from a group and exclude themselves from games or activities with their peers.

Figure 4. Females experience a much higher rate of anxiety disorders compared to males. Source: The Department of Health.

Social Anxiety treatment for children can be different from treatment in adults, and tend to focus on behavioural interventions, social skills training and increasing ’emotional literacy’ (teaching children to identify and name their emotions). 

Sometimes, social anxiety symptoms in children can be a sign of another developmental condition. Please see your health professional to establish the correct diagnosis and treatment plan. 

Can Social Anxiety Be Cured? 

Social phobia can prevent people from performing their normal activities (health professionals refer to this as days out of role and this is based on the previous 30 days). Social anxiety disorder is attributed to 4.7 days out of role.

The great news is that Social Anxiety Disorder can be managed, and in many cases cured.

Figure 5. The average number of days out of role for people with anxiety disorders was 4.4 days. Source: The Department of Health.

The process of learning to manage your anxiety is extremely rewarding and fulfilling, and provides you with significant benefits and skills including personal insight, self-awareness, and the increased ability to self-reflect. These are useful in all areas of life, and will always remain with you long after you have accomplished your goals in treating social anxiety. 

Social Anxiety Disorder Case Study 

Lisa* (not her real name) is 19 years old and is beginning her life as a university student. She is close to her family and also has a group of close friends who she spends most of her time with. 

Lisa has never been in a relationship, but her friends are all starting to date and have boyfriends and girlfriends. 

Lisa has always felt anxiety in social situations. She has found it difficult to give speeches and presentations in class, and struggles to talk to new people who are outside of her immediate friendship group. In high school, she often felt uncomfortable, but was generally able to manage this. 

However, since going to university, her level of anxiety has increased. This is likely because her environment is now very different. She is in many classes by herself (without her friends), and is now required to speak more frequently to new people. In addition to this, her friends are all ‘branching out’ and making new friends and romantic relationships, leaving less time to spend with her. 

Lisa now feels that she is ‘being left behind’ by her friends, and not coping in her classes with new people. She feels distress almost everyday, and does not know what to do. She knows about social anxiety and social phobia, and feels that she might have this health condition. However, does not know what to do about it herself, and is scared that she will always feel this way. 

After a few months of feeling like this, Lisa eventually spoke to her parents about her situation and they encouraged her to meet with her doctor, who then referred her to see a psychologist. 

The psychologist confirmed that Lisa was experiencing social anxiety disorder. In the first session, the psychologist was very reassuring to Lisa, because they understood exactly how she was feeling, and identified a range of other situations which she felt anxious about, which she hadn’t even recognised herself until then. 

The psychologist was also quickly able to establish a ‘treatment plan’ outlining what treatment entails, and how this would help Lisa with her anxiety. After a few sessions with the psychologist, Lisa had the confidence that her condition could be managed and even cured, and that she wouldn’t have to accept anxiety as her norm.