Social Anxiety Disorder

Social Anxiety Disorder is  more than shyness or uncomfortableness in social situations​. Social anxiety disorder exists when normal everyday interactions cause significant anxiety, triggering abnormal self-consciousness and embarrassment because of fears of being judged negatively by others.

Typically, extreme emotions invite unhealthy psychological adaptations to disperse the weighty emotions. With social anxiety disorder, a common maladaptation is social avoidance. These unhealthy reactions further disrupt the sufferers life. The severe stress caused by this disorder impacts relationships, daily routines, work, school, and other activities.

Symptoms

• Fear of situations that may lead to negative judgements about you.
• Excessive worry about embarrassing or humiliating yourself
• Intense fear of interacting or talking with strangers or unfamiliar acquittances 
• Fear that others will notice your anxiety
• Fear of the physical symptoms of anxiety and shame such as blushing, sweating, trembling or having a shaky voice
• Intense fear or anxiety during social situations
• Excessive fear of offending someone
• Blushing
• Fast heartbeat
• Trembling
• Sweating
• Upset stomach or nausea
• Trouble catching your breath
• Dizziness or lightheadedness
• Feeling that your mind has gone blank
• Muscle tension rigidity
• “Out-of-body” sensation
• Constant ruminations analyzing a performance or interaction, identifying flaws
• Fearing the worst possible consequences from every negative experience during a social situation
• Avoiding doing things or speaking to people to protect against experiencing embarrassment
• Avoiding of situations (birthday parties) where you would be the center of attention
• Avoiding interactions with unfamiliar people
• Skipping parties or social gatherings
• Missing work or school to avoid embarrassment
• Not starting conversations
• Not making eye contact
• Avoiding dates
• Never entering a room in which people are already seated
• Never returning items to a store
• Afraid to eat in front of others
• Refusing to use a public restroom

Causes of Social Anxiety Disorder

Social anxiety disorder is, like most psychological disorders, both a product of nature and nurture. The disorder most likely has traces in both, beginning with biological susceptibilities and forming through environmental triggering events and exposures.

Social anxiety disorder usually begins to exhibit symptoms on or around thirteen years of age. The anxiety can often be linked to a triggering event or string of events such as abuse, bullying, or teasing. Naturally shy kids (introverts) are more likely to become socially anxious adults. Children with overbearing or controlling parents are also more susceptible to later life social anxieties. Health conditions that draw attention to your appearance or voice also can trigger social anxiety.

Developmental Theory of Cause

A 2021 paper investigating the connection between structural differences in the hippocampus and amygdala in macaque monkeys with behavioral inhibition discovered that monkeys had several genetic structural brain differences that correlated with behavioral inhibition differences (Villard et al. 2021). Children exhibiting behavioral inhibition are at greater risk of developing social anxieties later in life.

Genetics

The research is conclusive: genetics strongly influences behaviors, and behaviors influences environments, and environments impacts psychological and physical development. A child’s sensitivity can alter felt experiences creating trauma for one and joyous excitement for another. Novelty is good, of course, until it traumatizes.

Recent studies have discovered altered serotonin function in certain brain regions of patients diagnosed with social anxiety disorder. As journalist Scott Stossel warns “the association of dopamine and serotonin with social phobia doesn’t prove that neurotransmitter deficits cause social anxiety—those irregularities could be the effects of social anxiety, the neurochemical ‘scars’ that develop when a brain becomes overstressed from having to be so vigilant all the time, constantly scanning the environment for social threats” (2015).

Yet, as we look at the growing body of research, such as the earlier cited study on the macaque monkeys, it supports theories that genetics (brain structures) impact function (altered serotonin and dopamine presence) in key brain areas associated with social anxiety.

Treatment for Social Anxiety Disorder

Therapy

Cognitive behavioral therapy (CBT) has proven helpful for treating social anxiety disorder. CBT teaches different ways of thinking, behaving, and reacting to situations that may help relieve some anxiousness over social situations. Cognitive behavior individual and group therapy has shown to be effective treatments for social anxiety disorder (Goldin et al. 2021;​ Leichsenring & Leweke, 2017).

Stossel wrote, “many studies are now finding that cognitive-behavioral therapy, or CBT, is the safest and most effective treatment for many forms of depression and anxiety disorders” (2015). 

CBT attempts to retrain thought processes. In social anxiety disorders, the reframing of fears of disapproval in the focus. For many this doesn’t make the anxiety disappear, but provides an avenue for regulating and minimizing the impact.

Exposure therapy treats social anxiety disorder through gradually increasing exposure to social environments. the theory theorizes that by gradually stepping into the fear within a safe environment, rather than avoiding it, social situations become less frightening. The exposures theoretically weaken conditioned responses to unpleasant stimuli.

By experiencing a feared situation, discovering tools to manage the anxiety, and then surviving the encounter, we have successful experience to draw upon in future encounters, building confidence in our ability to manage rascal emotions. However, when exposure therapy fails, igniting anxiety beyond our capability to process, the exposure strengthens fear responses rather than cure them.

Mindfulness

Mindfulness trains individuals to increase present moment awareness and curiosity, fostering approach rather than avoidance techniques. Acceptance of feelings through attention to the feeling without judgement or running narratives is a key component of mindfulness.

Mindfulness techniques theorize that the our running narratives amp up the feelings, creating harsh environments. Skills of meditation, mindful breathing, and non-judgmental present moment awareness help people soothe emotions and calm anxieties.​Support groups provide a safe environment to learn social skills and techniques in safe social settings. Participating in support groups with others experiencing similar fears may decrease feelings of inadequacy while learning from their experiences of success and failure. Groups also provide opportunities to practice new skills through role-playing.

Medication

Three types of medication are commonly prescribed to treat social anxiety disorder:

• Anti-anxiety medications
• Antidepressants
• Beta-blockers

Anti-anxiety medications begin working right away, reducing anxious feelings. Anti-anxiety medications are usually not taken over long periods of time. Taking anti-anxiety medication over longer spans often leads to increased tolerance, requiring higher and higher doses to provide relief. Because of increased tolerance to the medication, patients may become dependent on them. Doctors usually prescribe anti-anxiety medications for short periods to regain balance while starting other longer term treatments.​

Antidepressants relieve many symptoms of social anxiety disorder. Antidepressant medications may take several weeks before working. Antidepressants also have several side effects, such as headaches, nausea, or difficulty sleeping. The side effects are usually not severe, especially when the antidepressant doses start off low and are slowly increased over time.​Beta-blockers manage the physical symptoms of anxiety, such as an increased heart rate, sweating, or tremors. By alleviating the physical symptoms, many people are able to manage social situations, gaining confidence as they successfully navigate social interactions without a downward spiral into uncontrollable emotions.

A Few Closing Words from Flourishing Life Society

Social anxiety disorder can be debilitating. Those that never experienced the anxiety often misunderstand and gladfully and confidently provide superficial remedies. Working through the fear is an individual process, often requiring professional assistance. No therapy, prescription or lifestyle change will completely make the reactive anxieties go extinct, however, many can help you manage, moving the experience from destructive and isolated to uncomfortably workable. 

Last Update: March 22, 2024

References:

Goldin, P., Thurston, M., Allende, S., Moodie, C., Dixon, M., Heimberg, R., & Gross, J. (2021). Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder. JAMA Psychiatry, 78(10).

​Leichsenring, F., & Leweke, F. (2017). Social Anxiety Disorder. The New England Journal of Medicine, 376(23), 2255-2264.

Stossel, S. (2015). My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind. Vintage; Reprint edition.

​Villard, J., Bennett, J., Bliss‐Moreau, E., Capitanio, J., Fox, N., Amaral, D., & Lavenex, P. (2021). Structural differences in the hippocampus and amygdala of behaviorally inhibited macaque monkeys. Hippocampus, 31(8), 858-868.

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