Shyness and Social Anxiety

By John Montopoli, LMFT,

For some people, extreme fear or worry interferes with having satisfying social experiences. Social anxiety disorder (SAD) or social phobia is the third most common mental health issue after depression and alcoholism. About 13% of all people will experience social anxiety at some point in their lives. Typical symptoms include:

  • anxiety and self-consciousness in everyday social situations
  • fear of being watched and judged negatively by others
  • being embarrassed or humiliated by one’s own actions
  • physical symptoms like blushing, profuse sweating, trembling, nausea, and difficulty talking
  • avoiding situations that have previously caused extreme discomfort.

Social anxiety can be viewed on a continuum. On the mild end, you may have a lifelong pattern of shyness.

In the middle of the spectrum, your anxiety might be limited to one specific social situation such as public speaking or attending office parties.

In the most severe cases, you may experience intense fear and avoidance of almost all social interactions. Anxiety often goes hand in hand with other mental health problems such as depression or drug use.

“Cognitive-Behavioral Therapy is highly effective in helping to reduce the symptoms”

A form of psychotherapy called Cognitive-Behavioral Therapy is highly effective in helping to reduce the symptoms of SAD. In therapy, you are first taught to identify the thoughts that contribute to the social anxiety that you experience. You also learn to objectively evaluate your beliefs about the feared situations. Next, techniques such as gradual, planned exposure to the feared situation are used to help you have positive experiences to strengthen the changes in your beliefs.

How do I know if I should seek out treatment for social anxiety?

Although people often seek help when their fear or worry becomes so overwhelming that it affects their ability to function in school or work situations, you don’t have to wait this long. Effective help is available for even low to moderate levels of social anxiety.

What can I expect if I decide to seek out psychotherapy for social anxiety?

Cognitive behavioral therapy for the treatment of social anxiety is geared towards reducing anxiety in social situations. As a problem-focused treatment, it tends to be short-term ranging from just a few sessions for the mild cases to upwards of a year for the more severe cases. In most cases, you will meet with a therapist weekly to engage in structured talk therapy that focuses on improving your thoughts, fears, and pattern of behavior. Group therapy and social skills training classes can also be helpful components to your treatment plan.

Can medications help in the treatment of social anxiety?

Some anti-depression and anti-anxiety medications such as the SSRI’s can be effective treatment for social anxiety.

Research shows that a combination of psychiatric medication and cognitive behavioral therapy can have the most beneficial effect in decreasing social anxiety symptoms. Consult with your psychotherapist and health care provider or psychiatrist to discuss if the combination treatment is appropriate for you.

Questions to consider:

  • “Do you become anxious in anticipation of or while involved in a social or performance situation?”
  • “Do you avoid or are highly anxious in social or performance situations, being the center of attention, or talking with people?”
  • “Are you overly concerned about doing or saying something embarrassing or humiliating in front of others?”
  • “Do you think others might think badly of you for what you do or say?”
  • “Does your anxiety about social or performance situations interfere with your ability to participate in work or social activities or decrease you level of enjoyment in life?”

If you answer “yes” to one or more of these questions, consider being evaluated for SAD by a licensed mental health professional experienced in treating this disorder.

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