The Least Understood Anxiety Disorder

Social anxiety is the fear of social situations and the interaction with other people that can automatically bring on feelings of self-consciousness, judgment, evaluation, and scrutiny. Put another way, social anxiety is the fear and anxiety of being judged and evaluated negatively by other people, leading to feelings of inadequacy, embarrassment, humiliation, and depression. If a person usually becomes anxious in social situations, but seems fine when they are alone, then "social phobia" may be the problem.

Social anxiety disorder (social phobia) is a much more common problem than past estimates have led us to think. Millions of people all over the world suffer from this devastating and traumatic problem every day, either from a specific social phobia or from a more generalized social phobia

In the United States, epidemiological studies have recently pegged social anxiety disorder as the third largest psychological disorder in the country.

A specific social phobia would be the fear of speaking in front of groups, whereas generalized social phobia indicates that the person is anxious, nervous, and uncomfortable in almost all social situations.

People with social anxiety disorder usually experience significant emotional distress in the following situations:

Being introduced to other people

Being teased or criticized

Being the center of attention

Being watched while doing something

Meeting people in authority ("important people")

Most social encounters, especially with strangers

Going around the room (or table) in a circle and having to say something

This list is certainly not a complete list of symptoms -- other feelings may be associated with social anxiety as well.

The physiological manifestations that accompany social anxiety may include intense fear, racing heart, turning red or blushing, excessive sweating, dry throat and mouth, trembling, swallowing with difficulty, and muscle twitches. Constant, intense anxiety that does not go away is the most common feature.

People with social anxiety disorder know that their anxiety is irrational and does not make "head" sense. Nevertheless, "knowing" something is never the same thing as "believing" and "feeling" something. Thus, in people with social anxiety, thoughts and feelings of anxiety persist and show no signs of going away despite the fact that socially-anxious people "face their fears" every day of their lives. Only the appropriate therapy works on this, the largest anxiety disorder, the one that no one knows anything about.

The good news is that cognitive-behavioral therapy for social phobia has been markedly successful. People who have had this anxiety problem for long periods of time have blossomed while in therapy. After cognitive-behavioral therapy, people with this problem report a changed life -- one that is no longer controlled by fear and anxiety.

Social anxiety, as well as the other anxiety problems, can be successfully treated. In seeking help for this problem, search for a specialist -- someone who understands this problem well and knows how to treat it. Become an informed client and ask questions. Do they understand that you feel very self-conscious, that others are watching and forming a negative evaluation about you – or do they minimize what you’re saying and just say, "No, No, No, you’re exaggerating...."

Now it is true that we who have gone through social phobia do realize our mind is overexaggerating, but it still feels like others are watching and judging us. Our self-consciousness is very real. If your psychologist/mental health care worker does not understand this, YOU KNOW MORE THAN THEY DO about social anxiety. It is very doubtful they will be able to help you.

Also, remember that the true professional will always welcome your questions. If they seem stand-offish and unfriendly, they should not be your choice of a therapist. Those of us who have or have had social anxiety need support, encouragement, and a relatively stress-free environment while we are in therapy.

Does your therapist say, "Face your fears and they’ll go away?" Sorry, but this therapist does not understand the dynamics of social anxiety. We have constantly faced our fears ever since birth – we’ve HAD TO – and we feel more fearful now than we did in the past. Seek another therapist. It is imperative you find a psychologist who understands social anxiety completely – because if they don’t even know what it is – how will they know what to do to help you overcome it?

Getting over social anxiety disorder is not an easy task; yet many thousands have already done it. While you’re in the middle of the problem, it feels hopeless – it feels that you’ll never ever get better. Life is just one gut-wrenching anxiety problem after another. But this can be stopped, quenched, and killed in a relatively short period of time – but you must find a cognitive-behavioral therapist who understands and specializes in the treatment of social anxiety.

The most important elements in conquering social anxiety are:

1. An understanding and awareness of the problem,

2. A commitment to carry through with cognitive-behavioral therapy even when it seems difficult,

3. Practice, practice, practice to get that information deep down into your brain so that it becomes habitual and automatic.

4. Participation in a social anxiety therapy group in which you can slowly and gradually work on problems that cause you anxiety in the real world. That is, the person who feels anxious while reading in public uses specific strategies to meet his goal, whereas the person who wants to learn how to make introductions and engage in small talk during social activities slowly works toward her goals. We use role-plays, acting, the tape recorder and video camera, question and answer periods, mock job interviews, and doing foolish things deliberately as part of our behavioral therapy group for people with social anxiety.  Real-life "experiments" are also conducted with other group members and mentors.

Note: We use a ladder or "hierarchy" as a flexible guide in our planning. We want to practice, meet our goals, move up our expectations, meet our goals, move up our expectations until our goal is finally met. WE DO NOT PRESSURE, PUSH, or CAJOLE. NO NEGATIVE tactic is employed because I strongly feel that the individual must choose to participate at her own pace. If she wants to sit there in group and not say a word, that’s O.K. I’ll never force her to do a thing. But here’s the secret: This has never happened! Everyone in the group understands why they are there and, despite an amount of anxiety that is naturally present, they voluntarily choose to work on their specific anxieties. This is much more practical and real-life than being forced to do something.

Our therapy groups are always encouraging, positive, and supportive. Social anxiety people are among the nicest people in the world. Get involved in getting better, go to a meeting and find out......

It is impossible to stop a motivated person who refuses to give up practicing. The role of the therapist is to know specifically what to do and how quickly to do it. This sounds easy, but it is not. You must be practicing the right material and you must proceed at the correct pace for your own anxieties. You are more in control of this than you think.

Today, cognitive-behavioral therapy is used to treat both forms of social phobia. With cognitive-behavioral therapy, we do not wallow in the past and continually bring it up --- because it doesn’t do us any good. Instead, we focus on present-day problems and symptoms and use many small techniques and methods to eradicate anxiety thinking and negative expectations. Here’s where motivation and practice come in. The more you can practice these small techniques at home, the quicker anxiety can be reduced and social phobia can be conquered.

-- Thomas A. Richards, Ph.D.,
Psychologist,
The Social Anxiety Institute, Inc.

Social Anxiety: James - Part 1

James discusses his view of social anxiety.

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