Feeling nervous in social situations is part of being human. But when fear of judgment, embarrassment, or rejection begins to interfere with daily life, it may be more than shyness.
At Midpoint Counseling, we understand how overwhelming social anxiety can become, and how it can quietly shape your life over time. Here’s how to recognize the signs, understand the root causes, and find effective strategies for change.
QUICK FACTS
- Social anxiety disorder usually develops gradually over the course of several years.
- Avoidance is often used ineffectively as a strategy to reduce uncomfortable feelings.
- Building tolerance for discomfort and uncertainty are essential for recovery.
- Social anxiety disorder is highly treatable with the right approach.
CORE CONCEPTS
What is Social Anxiety Disorder?
Social Anxiety Disorder (SAD) involves a persistent fear of being negatively evaluated or rejected by others. It can affect just about any activity that involves contact with other people.
Essential Features of SAD:
Experiencing little control over your emotional reactions around others
Preoccupation with social failures and judgements
Rumination about these situations after they’ve happened
Symptoms lasting 6 months or more despite efforts to manage them
By the time this anxiety starts interfering with things you need to do at work, at school, with peers, or in your leisure time, it’s considered to be “disordered.”
About 12.1% of adults in the U.S. experience social anxiety disorder at some point in their lives.1
SAD appears to come on gradually over the course of several years rather than suddenly, so it can be difficult to detect when it first starts becoming a problem.
Most of the time it’s apparent by adolescence, but there are also childhood factors associated with its later development.2 Shyness, which is an aversion to novel situations, is an example of one such factor.
SAD tends to last for many years if it’s not treated. Although the severity of it may decrease as one gets older, the longer it goes untreated the greater the risk of developing other issues like depression.
Midpoint Counseling provides anxiety treatment for adults across Washington. Reach out today for more info.
THE SCIENCE BEHIND SOCIAL ANXIETY
Biological Factors that Contribute to SAD
No brain or body scan can diagnose an anxiety disorder, but they've given us a good look into underlying factors that affect mood and behavior.
Variations in the body’s serotonin transporter gene. This is linked to hyperactivity of the brain’s “fear network,” which contributes to anxious thinking and hypervigilance.3, 4
Variations in the medial prefrontal cortex, which leads to excessive self-focused attention and preoccupation with negative evaluations.5
Altered activity in the insula, which leads to increased preoccupation with what your body is feeling and a greater risk of panic.
Brain chemistry and genetics influence anxiety, but they aren't its only causes.
CONTEXTUAL INFLUENCES ON SAD
Environmental Factors in Social Anxiety
Environmental factors include everything that happens around the body that influence anxiety. The following are common experiences associated with the development of social anxiety disorder:
Experiences in utero before you were born
Over-control from parents, which restricts opportunities to explore and learn new skills independently6
Lack of warmth and affection from caregivers, which fosters insecure attachments
Chaotic home environment
Underdeveloped social skills
Trauma history
Bullying, teasing, or embarrassment from others
Personality development
The brain develops into your 20s, making it vulnerable to the effects of stress for a long time.7
But recurring stressors at any point in your life can put your brain in a state of vigilance to help mobilize your body to deal with it. This ongoing stress takes a heavy toll on the body, which can lead to changes in how your nervous system responds to new uncertain or ambiguous situations.
THE TRAP OF SHORT-TERM RELIEF
Avoidance as an Ineffective Solution
The most effective way to reduce discomfort in a social situation is to avoid it. It’s easy to do and requires no skill, which is why it’s the most common response to feeling anxious.
Social anxiety disorder involves the over-use of avoidance when it’s not necessary.
This ends up maintaining problems with anxiety rather than resolving them because you never learn how to better handle the situation. See if you can identify yourself in any of these four types of avoidance:
Situational Avoidance
- Avoiding people, places, or situations so that you don’t have to face something that needs your attention. This can be complete avoidance, like not going to a social event, or partial avoidance, like going but not talking to anyone.
- Overcommitting to others to avoid the anxiety of upsetting someone or feeling left out during an event.
- Anxiously pursuing others by pushing for conversations or spending time together to avoid situations that are ambiguous or uncertain.
Cognitive Avoidance
- Interpreting social issues as unimportant so that you let yourself off the hook for needing to think about it anymore.
- Suppressing thoughts by refusing to think about a social issue at all, even if you know it’s important.
- Conveniently forgetting about plans or commitments. It may seem to be accidental until a pattern appears and you develop a reputation for being unreliable or uncaring.
Protective Avoidance
- Reassurance-seeking to make sure others aren’t upset with you, still like you, or approve of you in some way.
- Over-analyzing situations when there’s ambiguity that can’t be easily figured out. Rather than avoiding thoughts, this is using them to convince yourself that nothing bad happened.
- Worrying about “what ifs” to protect against all the potential risks that lie in an uncertain future.
Emotional Avoidance
- Blunting uncomfortable feelings in social situations with drugs, alcohol, or food.
- Relaxation exercises that are misused with the goal of eliminating unwanted feelings. To be used healthily, relaxation skills help you feel through sensations, not as a tool to get them to go away.
- Dissociating as an automatic nervous system reaction to protect against unwanted experiences. It feels like you’re spacing out, mind going blank, and other senses feeling fuzzy.
The relief that comes from any of these strategies only lasts until the next situation forces us to start over again. We never feel more confident in our abilities or better equipped to freely participate in the wide variety of social situations that life requires of all of us.
Midpoint Counseling provides in-person and virtual therapy for social anxiety. Contact us to learn how we can help.
EVIDENCE-BASED APPROACHES TO SAD
3 Targets for Treating Social Anxiety Disorder
There are three core targets for treating social anxiety disorder. Those who work to let go of avoidance as a strategy and aim for these targets instead are much more likely to experience relief.
1. Build your tolerance for uncertainty.
The goal here is flexibility that allows you to continue doing meaningful things without needing to have all the answers. When you don’t have this, life becomes about eliminating ambiguity, rigidly controlling situations, fixating on negative possibilities, and over-preparing to prevent their occurrence. Intolerance of uncertainty and overestimations of risk are at the heart of most issues with anxiety and why they’re so important to bring within healthy limits.
2. Increase your tolerance for discomfort.
This is the most researched factor underlying all problems managing anxiety. It refers to your personal threshold for being with uncomfortable physical and emotional sensations before interpreting them as bad or in need of attention. The lower your threshold, the more fixated you’ll be on signals from your body rather than building mastery over the situation that caused the trouble.
3. Strengthen your confidence in your abilities.
Difficulties navigating feelings of uncertainty and discomfort can naturally bring doubt to your abilities to cope. If you don’t trust that you can handle certain challenges, it becomes harder to risk new healthy behavior. This target involves cultivating your power and influence over problematic anxiety so that you no longer have to resort to worry, avoidance, or other unhelpful strategies.
RELIEF STARTS WITH THE RIGHT SUPPORT
How Therapy Helps with Social Anxiety Disorder
Social anxiety can be tough to manage on your own! That’s where the help of a trained therapist comes in. While there are many approaches to these problems, some have more evidence supporting their efficacy than others.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is currently considered one of the most effective treatments for adult anxiety disorders.8
CBT consists of scientifically informed interventions that help by:
Supporting greater understanding and empathy for current challenges
Addressing thoughts that have been distorted by SAD
Providing strategies to manage discomfort and uncertainty
Promoting behavior changes that support long-term recovery
In 2020, the American Medical Association published an analysis of 69 trials on the long-term outcomes of CBT on anxiety-related disorders. These were then compared to the outcomes from supportive therapy, relaxation training, psychoeducation, and placebo medication. This was over 4,000 people who were observed over time, and after 12 months post-treatment, anxiety symptoms were still lower in those who received CBT compared to the other treatments.9
While there may be returns to old and unhelpful habits due to the complexities of life, therapy and new skills learned can help to reduce the duration and severity of these lapses.
FINDING SUPPORT
Break Free from Social Anxiety
Breaking free from social concerns and unhelpful coping strategies means aiming for new targets. New skills and behaviors for responding to such situations can help bring anxiety that’s gotten out of hand back under healthy control. If you’ve been struggling with worry and having difficulty doing things that you want to be doing, consider reaching out to us at Midpoint Counseling. We’re here to help you find greater balance and freedom from the overwhelming experiences of social anxiety.
References:
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Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593
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Lijster, J. M., Dierckx, B., Utens, E. M., Verhulst, F. C., Zieldorff, C., Dieleman, G. C., & Legerstee, J. S. (2017). The Age of Onset of Anxiety Disorders. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 62(4), 237–246. https://doi.org/10.1177/0706743716640757
-
Lonsdorf, T. B., & Kalisch, R. (2011). A review on experimental and clinical genetic associations studies on fear conditioning, extinction and cognitive-behavioral treatment. Translational psychiatry, 1(9), e41. https://doi.org/10.1038/tp.2011.36
-
Klucken, T., Alexander, N., Schweckendiek, J., Merz, C. J., Kagerer, S., Osinsky, R., Walter, B., Vaitl, D., Hennig, J., & Stark, R. (2013). Individual differences in neural correlates of fear conditioning as a function of 5-HTTLPR and stressful life events. Social cognitive and affective neuroscience, 8(3), 318–325. https://doi.org/10.1093/scan/nss005
-
Stein D. J. (2015). Social anxiety disorder and the psychobiology of self-consciousness. Frontiers in human neuroscience, 9, 489. https://doi.org/10.3389/fnhum.2015.00489
-
Brook, C. A., & Schmidt, L. A. (2008). Social anxiety disorder: a review of environmental risk factors. Neuropsychiatric disease and treatment, 4(1), 123–143. https://doi.org/10.2147/ndt.s1799
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Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric disease and treatment, 9, 449–461. https://doi.org/10.2147/NDT.S39776
-
Otte C. (2011). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues in clinical neuroscience, 13(4), 413–421. https://doi.org/10.31887/DCNS.2011.13.4/cotte
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van Dis, E. A. M., van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C. L. H., van den Heuvel, R. M., Cuijpers, P., & Engelhard, I. M. (2020). Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis. JAMA psychiatry, 77(3), 265–273. https://doi.org/10.1001/jamapsychiatry.2019.3986
Jason Peruchini, LMFT
Jason Peruchini is a licensed psychotherapist and anxiety treatment professional who helps people address issues in mental health to live better lives.
