Social Anxiety Disorder

Dealing with Social Anxiety Disorder 

By The Fix staff 01/21/15

Social Anxiety: What It Is and What To Do About It

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Social Anxiety Disorder

How many times have you heard, or said, "I'll [put socially challenging activity here, like dance, speak in public, ask someone for a date] after I've had a few [drinks, hits, tokes – whatever] to loosen me up and make me do it better." But it doesn't. It just makes you think you're doing it better, but you're really not. People who have phobias – and Social Anxiety Disorder is one -- are up to twice as likely to be alcoholics compared to those who do not have phobias.

You know what the real irony is? According to the National Institute of Mental Health, only 7.9% of adult Americans deal with Social Anxiety, while 74% of adult Americans fear speaking in public. Neither will kill you, but anxiety or a phobia does not respond to logic.

Signs and Symptoms of Social Anxiety Disorder

Social Anxiety is more than being shy. Social Anxiety (or phobia) is an extreme fear of social situations and can be so extreme it can affect relationships with friends, family, and colleagues. People with social phobia are terrified of being embarrassed in social situations. The most telling sign is fearful behavior in a variety of social situations that seems out of proportion to what is occurring. Examples of these situations are conversations with strangers, eating dinner out (it doesn't even have to be at a restaurant), or going to a party or concert. This intense fearful behavior has to last more than six months, to ensure the fear isn't transient or temporary.

Tests for Social Anxiety

There are no physical medical tests to diagnose Social Anxiety Disorder. Other conditions can be ruled out, though. Tests for Social Anxiety Disorder are psychological. They can start with a self-screening tool. The individual who wants to know about their condition takes a quiz to see if any social anxiety indicators arise. If the answer is yes, it becomes time for a psychiatrist or psychologist to conduct a diagnostic interview.

Once a person is diagnosed with Social Anxiety Disorder, a number of treatment options are available.

Social Anxiety Treatment Options

Psychotherapy and medication together have been found to be the most effective treatment combination.

Non-Medication Options

A healthy eating and exercise program has beneficial, if sparsely-documented, effects on any anxiety, including social anxiety symptoms. Also, the placebo effect, i.e., a perceived improvement in a medical condition, can positively affect a person's condition.

Each of the therapies listed (presented in alphabetical order) are effective in treating anxiety disorders and each is a form of behavior-modification therapy. The decision the prospective client/patient needs to make is which therapy to try first. Every person is different and the treatment protocol that works for one person may not work for another.

  1. Acceptance and Commitment Therapy (ACT) – uses strategies of acceptance and mindfulness (living in the moment and experiencing things without judgment) and behavior change to cope with unwanted thoughts, feelings, and sensations. ACT teaches skills to accept these experiences and place them in a different context. This helps a person develop greater clarity about personal values and commit to needed behavior change.
  2. Cognitive-Behavioral Therapy (CBT) – the over-arching name for all behavior-modification therapies. This form of therapy includes reading, practicing new skills, and completing homework assignments. CBT engages a person's emotions through their intellect and emphasizes changing behaviors. Often, the thinking is that if the person can change their behavior, changes in thoughts and feelings will follow.
  3. Exposure Therapy –This therapy involves the therapist gradually exposing the person to the feared object or anxiety-producing situation in order to make the person less sensitive to the thing's/situation's effects. This could involve starting with going to small get-togethers with familiar people, then small events with strangers, and so on, giving the social anxiety client/patient a chance to function successfully in each environment.
  4. Eye Movement Desensitization and Reprocessing (EMDR) – has been found to be especially successful in treating any anxiety based in trauma, such as PTSD. When it comes to Social Anxiety Disorder, if there was a specific event associated with its onset, EMDR might help a person get relief.
  5. Interpersonal Therapy (IPT) – a short-term therapy of 12-16 one-hour sessions that addresses the depression believed to underlie the anxiety condition.

Complementary and Alternative Treatment for Social Anxiety

There is a growing body of scientific evidence to show that complementary and alternative treatment can be effective in treating mental health challenges. These approaches don't necessarily have much support in the United States mainstream medicine community, but in the final analysis, a treatment's success or failure must be measured by the client/patient.

  1. Acupuncture - the Chinese practice of putting very fine needles into the body at specific points to manipulate the body's flow of energy.
  2. Meditation – According to the National Center for Complementary and Alternative Medicine, a 2014 systematic review and meta-analysis of 47 trials in 3,515 participants found that mindfulness meditation programs had moderate evidence of improved anxiety. For some, moderate improvement is enough.
  3. Stress and Relaxation Techniques – can be used as part of a treatment program for phobias or panic disorder. People dealing with Social Anxiety Disorder also benefit. Relaxation techniques are used to relieve anxiety for people in stressful situations, such as certain medical procedures or social situations.
  4. Tai Chi - combines breathing, balancing, and meditation by moving slowly through a specific sequence of postures. The practice of this oldest martial art benefits an individual by strengthening both mind and body when practiced consistently.
  5. Yoga – involves breathing techniques, stretching, physical postures, and meditation. When done on a regular basis, it has many of the same benefits as tai chi. Yoga is one of the ten most used complementary medicinal practices.

Medication for Social Anxiety Disorder

All medications have side effects, no matter how innocuous they may seem. The trick is to be able to balance the benefits the medication provides with the side effects it can cause. Very few medications exist that specifically address social anxiety issues. Most of these medications are geared toward depression, but four main classes have shown some success when used with anxiety disorders:

  1. Benzodiazepines - Because these drugs are addictive, they are used only as short-term solutions for quick relief at the start of a course of anxiety treatment. Benzos, as they are called, include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). Their use follows the classic addiction progression in that after a relatively short time, more of the drug is needed to attain the same effect as a lower dose did previously. For this reason, caution must be used when prescribing or taking these drugs.
  2. Beta Blockers - work by obstructing the effect of adrenaline. They are designed to lessen heart rate, blood pressure, pounding of the heart, and shaking voice and quaking limbs. These meds are good for calming a person down in specific situations, like when giving a speech. They are not recommended for ongoing use.
  3. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) - work in almost the same way as SSRIs and so are also considered when prescribing for anxiety issues. Venlafaxine (Effexor) and duloxetine (Cymbalta) help to elevate sad moods, smooth out highs and lows on moods, and help relieve actual physical pain.
  4. Selective Serotonin-Reuptake Inhibitors (SSRIs) - work by preventing the body from re-absorbing the available serotonin in the brain. They are considered an effective treatment for all anxiety disorders, if the side effects can be tolerated. Paroxetine (Paxil), and sertraline (Zoloft) are considered to be especially effective for Social Anxiety Disorder. Some side effects include causing problems with sleep, problems with sexual performance, and gaining unwanted weight.

No matter which anxiety treatment a person chooses to begin with, they can always make changes and adjustments until they reach the right treatment combination that works for them. Because the treatment for any mental illness, especially something like social anxiety, is so individual, only the person suffering from the disorder can really tell what is successful and what isn't.

This may be particularly upsetting for close family and friends. They may observe improvement one day, only to see what they perceive as backsliding the next. Patience and unconditional positive support are the best ways to help the anxiety sufferer. Family and close friends who are brave enough to confront their own issues that might be unknowingly adding to the anxiety burden provide an exceptionally high-quality level of support.

All anti-anxiety programs need to be done continuously on an ongoing basis in order to be successful. As mentioned before, there is no real cure for anxiety, but its impact can be minimized by learning and sticking to what works.

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