Social Anxiety Disorder in Adults
It's the adult who has never dated because he's too shy to talk to members of the opposite sex. It's the quiet employee who is under-appreciated by his co-workers and underpaid by his company. It's that great, funny person that you know, but who suffers from loneliness because s/he is too shy unless around close friends and relatives...
Do you have any of the following?
- Significant and persistent fears of social or performance situations in which embarrassment, rejection, or scrutiny are possible.
- You either avoid such situations, or endure them with distress (e.g. having symptoms of anxiety)
- The fear is unreasonable and/or causes problems in your life
If you answer positive to any of these screening questions, then read on to learn more...
It is normal for everyone to be shy at certain times. For example, many people would have some nervousness about doing a big presentation, or about meeting a new boss for the first time. Having "just enough" shyness is good because it helps prevent people from doing things that might get them embarrassed or into trouble. But if you are feeling so shy that it causes you problems at school, work or relationships, then it may be social anxiety disorder...
Social anxiety (aka social phobia, or social anxiety disorder) is a condition where people get extremely anxious in social situations (especially around new people or situations) and tend to worry about what other people think about them, e.g. worrying they will do something and be humiliated or embarrassed. The anxiety is so severe that it paralyzes people, leading them to avoid and withdraw from social situations. Deep down, they would like to be able to be with and easily talk with other people, if only the anxiety didn't get in the way.
Human beings have an alarm system hard-wired into us. This alarm system helped us survive as hunter-gatherers. For example, when faced with a danger, such as being attacked by a sabre tooth tiger, our alarm system would activate (via a rush of adrenaline), which would then allow us to either "fight" the danger, or take "flight" (and run away).
We no longer live as hunter-gatherers, but rather in modern society. Fortunately, most of us no longer face the same physical dangers that we used to face, we continue to have various stresses and "dangers" in modern society. Our stresses and "dangers" include social expectations, fitting in with others, getting along with other people, as well people that may range from being not so nice, to outright mean and bullying.
In social anxiety, the person's alarm system is overly sensitive, and becomes triggered by social situations. Why is that person's alarm system overly sensitive? A combination of different factors that can contribute to one's social anxiety such as:
- Genetics: Some people are simply wired to be more sensitive, and this "hard wiring" can be passed through the genes from parents to their children. It is actually good to be sensitive, especially in a world of insensitivity, however the key is balance. With social anxiety, the sensitivity is excessive.
- Life experiences: In the ideal world, we would all have experiences where you have experienced other people as being nice and accepting. In people with social anxiety, they may have had stressful social situations, such as teasing, bullying or other stressful social interactions, with teacher(s), family member(s) or others.
People with social phobia have usually been shy all their life, but it becomes more noticeable around the teenage years, as social stresses increase.
It affects people of all ages, and it is believed that 8% of Canadians have had symptoms of it at some point in their lives (Stats Can, 2002).
People with social anxiety may notice the following before and/or during social situations:
- Blushing, sweating, feeling hot
- Trembling, shaking
- Difficulty talking or making eye contact
According to the DSM (a manual of mental health conditions used by professionals), there are two main types of social anxiety disorder:
|1. Generalized||Tend to avoid (or endure with distress) a wide variety of social situations: starting up conversation with others (who aren't close friends); talking to strangers; talking on the phone; expressing personal opinions; talking to those in authority (e.g., teacher, employer).|
|2. Non-generalized (aka "Performance Anxiety")||Difficulties mainly in performance situations, such as public speaking, talking in classes or meetings; performing music or acting on stage; eating or drinking in front of others.|
Are you worried that you may have problems with social anxiety? If so, then speak with a health professional. Your health professional can help make sure that there are no medical conditions contributing to the anxiety, such as hormone problems. Your doctor can then help with any referrals to more specialized mental health services or professionals in the community, such as a psychologist.
When left untreated or ignored, people with untreated social anxiety report a lower quality of life, including a higher risk of being either unemployed, or being paid less if they are employed. In the long run, untreated social anxiety may contribute to other problems such as depression and substance abuse.
The good news is that there are many effective treatments for social anxiety.
Professionals such as occupational therapists (OT), social workers, psychologists, psychiatrists can help people overcome social anxiety through a variety of techniques.
|Self-regulation||One starts with identifying when one is calm ("in the green zone"), versus getting stressed ("in the yellow"), and getting overwhelmed in fight/flight ("in the red zone"). |
One can then learn different strategies to use in order to feel calmer, which can differ depending on the zone.
When in the green zone, we can talk about our problems to problem-solve them.
When in the yellow zone, we may be getting stressed out and don't want to problem-solve; we may need people to just listen to us and empathize with how we are feeling. We may not want people to tell us to do deep breathing, or tell us to relax.
When in the red zone, we may be so stressed out, that we might just want someone to sit with us and not say anything; or give us space (and check in with us a few minutes later); and we usually want things to be quieter, with less sensory stimulation (such as less people around, less sound).
|Changing worry thoughts into more helping thoughts||Common fears in social anxiety include:|
Replace those thoughts with more helpful thoughts such as:
|Exposure||Exposure is gradually and repeatedly exposing the person to the feared situation, until the person is no longer afraid of the situation. When faced with a challenging situation, exposure is about breaking the challenging situation into smaller less challenging situations, and doing it step-by-step, and fighting the natural impulse to completely avoid.|
For example, someone who is afraid to talk to teachers might do it step-by-step such as:
|Role plays||Role plays are where one practices new ways of responding to situations that are scary. For example, imagine an adult who is anxious about what to say when meeting new people. One might practice that situation with a therapist (or a friend or family member), or even just talking in front of a mirror.|
|Social skills training||This is here a person is explicitly taught the steps and rules of effective social interaction. Learning about social skills is something that we expect most people to simply learn, or pick up on their own. At school, most people don't get any "course" on how to talk to others, how to make friends, or other key life skills. But because people with social anxiety tend to avoid social situations, they end up having fewer chances to learn social skills. Thus, it can be helpful to provide direct teaching about social and interpersonal skills.|
|Problem-solving:||Working together with the person to figure out what problems are causing stress and then deal with them. The person is taught how to solve problems systematically by brainstorming, estimating the advantages and disadvantages of various possible solutions to a problem, and planning the steps involved in implementing the best solution. It is important for the person to learn how to go through this process whenever he or she faces a problem, not simply to learn how to solve one immediate problem.|
Social anxiety tends to trick people into avoiding problems (and situations), and so one of the key strategies in cognitive behaviour therapy (or any therapy, for that matter) is to simply help people to gradually face their problems (and situations) gradually more and more.
Has the person tried counseling/therapy and other strategies without success? Or is the anxiety so severe the talking to a professional has not been possible? If so, then medications may be helpful to dampen and turn down the body's alarm system, thereby reducing anxiety. This then allows the person to benefit from other strategies such as counseling/therapy. Evidence shows that when appropriately used, medication is safe and effective (Bridge, JAMA, Apr 18, 2007). There is also evidence that suggests medications in combination with psychotherapy may be more effective than using medications alone, or psychotherapy alone (Walkup et al., 2008).
Although treatments such as CBT are classically given by mental health professionals (such as psychologists), many of these techniques can be easily learned by people with social anxiety themselves.
Help the person get help.
- Offer to accompany drive your friend or relative to the appointment
Support the person with any treatments recommended, whether it be talking therapy or medications or other treatments.
Acknowledge your friend or relative's distress in having social anxiety.
- Don't tell them to just snap out of it
- Don't intentionally put them on the spot, or make them the focus of attention, unless you have their permission... E.g. don't plan big surprise parties without asking them ahead of time in general how they'd feel about a big surprise party...
Specific Things to Help with Social Anxiety
Help your friend come up with positive coping thoughts to fight the worry thoughts of social anxiety
- In order to fight the social anxiety thoughts such as "You'll make a fool of yourself", gently state that there are other possibilities, "You'll do fine", "Its going to be fun", etc..
- Be flexible and help your friend/relative build an ‘exposure hierarchy'.
Statistics Canada. (2002). 2002 Canadian Community Health Survey (CCHS): Mental Health and Well-being.
Canadian Psychiatric Association. (2006). Clinical Practice Guidelines on the Management of Social Anxiety Disorder, retrieved Nov 6, 2008 from http://publications.cpa-apc.org/media.php?mid=448&xwm=true.
Websites and Organizations
Information from the Anxiety Treatment and Research Centre. http://www.anxietytreatment.ca/socialphobia.htm
Information from the National Institutes of Mental Health
Anxiety Disorders Association of Canada
Painfully Shy: How to Overcome Social Anxiety & Reclaim Your Life (2003), by
Barbara Markway and Gregory Markway.
The Shyness and Social Anxiety Workbook (2000) by Martin Anthony and Richard P. Swinson.
Overcoming Shyness & Social Phobia: A Step-by-Step Guide (1998) by Ronald M. Rapee.
Beyond Shyness: How to Conquer Social Anxieties (1994) by Jonathon Berent.
Written by the eMentalHealth Team, with help from psychologist Dr. Barry Schneider and colleagues at the Department of Psychology at the University of Ottawa.
Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.
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Date of Last Revision: May 30, 2020