SOCIAL ANXIETY DISORDER

Social Anxiety Disorder (SAD) is type of anxiety disorder that is characterized by an extreme fear of social situations due to possibility of embarrassment or scrutiny. The fear of social situations manifests as symptoms of anxiety (link to anxiety page), and can make it difficult to interact with others. SAD is sometimes referred to as Social Phobia. In order to be diagnosed with SAD, a doctor must determine that you meet the following criteria:[1]

  • A persistent fear of social or performance situations in which you will be exposed to strangers or the possibility of scrutiny. The fear is that you will act in an anxious way that will be embarrassing and humiliating.
  • Exposure to feared situations provokes anxiety or possibly a panic attack
  • You recognize that your fear is unreasonable or excessive
  • You avoid feared situations or endure them with anxiety
  • The avoidance, anxious anticipation, or distress in the feared situation significantly interferes with your normal routine, occupational/academic functioning, social activities, and relationships

According to the criteria for diagnosing SAD, the fear, anxiety, or avoidance must last for 6 months or more.

Canadian Statistics

  • The lifetime occurrance rate of SAD ranges from 8-13%.[2]
  • Women are more likely to experience SAD, when compared to men.2
  • People are more likely to experience SAD if their relatives have had SAD.2
  • Rates of SAD are higher among people who abuse alcohol.2
  • People with SAD are more likely to experience MDD, Panic Disorder, and Drug/Alcohol dependency.[3]
  • As women get older, their rates of SAD are more proportionate to those of men.[4]
  • Fifty-percent of SAD cases have the “speaking fear” subtype, and 50% have the “complex fears” subtype.2
  • In 2004, People with SAD were twice as likely to report missing at least one work day in a two-week period.[5]
  • In 2013, 93% of people with a Mood/Anxiety Disorder were taking prescription medications. Of these people, only 20% had received psychological counselling.[6]

Behaviours associated with Social Anxiety Disorder:

  • Deciding not to act in the play you have been rehearsing for at the last minute.
  • Failing a class because you called out sick the day of a presentation
  • Skipping a date last minute that you were previously excited about
  • Leaving a party immediately after arriving because you were too anxious
  • Leaving the house when your roommate has friends over
  • Avoiding big purchases because you might have to talk to a salesperson

Feelings associated with Social Anxiety Disorder:

  • Worried
  • Embarrassed
  • Anxious
  • Lonely
  • Depressed
  • Disappointed

Thoughts associated with Social Anxiety Disorder:

  • “I can’t be a bridesmaid at my sister’s wedding. I’ll have to stand on stage and I am going to look so silly.”
  • “It sucks that I can’t go to the company Christmas party, but I know I would not be able to handle talking to people all night.”
  • “I totally messed up that interaction with her! She knew I was anxious and now I look like an idiot.”
  • “I was enjoying my salsa classes until the instructor asked me to dance in front of the class. Now I can never go back.”

Social Anxiety Disorder and the Body:

The symptoms of SAD mimic the symptoms of other anxiety disorders. The physical symptoms include:

  • Sweaty or cold hands
  • Nausea
  • Trembling muscles
  • Rapid heart rate
  • Sleeplessness
  • Dizziness

Social Anxiety Disorder and the Brain:

One area of the brain that has been studied in relation to SAD is the amygdala. According to research, the amygdala is involved in a network of brain activity that creates the fear response. In further detail, the amygdala appears to be responsible for learning fear and storing memories of fear.[7] Studies of the brain and SAD consistently reveal that amygdala hyperactivity is one feature of SAD. Furthermore, the connection between the amygdala and other pathways in the brain appears to be dysfunctional in people who experience SAD.[8]

Does Psychology Work?

There are several well-researched and effective psychological treatments for Social Anxiety Disorder.

  • Cognitive Behavioural Therapy (CBT): CBT is a type of psychological therapy that is commonly used in the treatment of anxiety disorders. The goal of CBT is to change the way you feel by changing the way you think and act. CBT works to help you change your thoughts, beliefs and assumptions; it also teaches you how to take actions that are likely to produce good results. Studies of CBT have shown that is an effective treatment for reducing the symptoms of SAD.[9] Exposure therapy appears to be one of the most effective types of CBT interventions, and involves a systematic and repeated approach to feared stimuli as well as internal responses.[10] According to other research studies, CBT has been shown to be more effective at treating SAD in the long term than pharmacological treatments.[11]
  • Mindfulness-Based Therapy (MBT): MBT is a psychological treatment derived from ancient Buddhist and yoga practices. The goal of mindfulness is to bring you to a non- judgemental state of mind that is present and accepting. Furthermore, the practice of staying aware in the present moment can help combat the avoidant tendencies of people with anxiety.[12]Multiple studies have shown that MBT is an effective treatment for SAD, even when it is not combined with CBT.[13] In one study, mindful breathing practices were more effective at treating the symptoms of SAD than using distractions. The clients in this study showed a reduction in emotional reactivity while improving their emotional regulation skills.[14]

Tips for Managing SAD!

  • Realistic Thinking:[15] A large part of SAD is assuming that negative things are going to happen in social situations. If you have SAD, you might fear that nobody will like you, that you will say something “stupid,” or that you will make a mistake. Thinking negatively about social situations is likely to worsen your anxiety, and it can help to remember that thoughts are not facts. In order to think more realistically, it is important to first identify your negative thoughts. Once you have done this, you can ask yourself questions such as:
  • Am I completely positive that this will happen?
  • What could I do to cope if the worst did happen?
  • What would I say to a friend who was thinking the way that I am?

Answering these questions can help reduce anxiety by balancing out your negative thinking with more realistic thoughts.

  • Breathe Deeply:[16] One of the most common symptoms of anxiety is difficulty breathing. When this symptom arises, it can worsen anxiety and create more panic. You can combat this feeling by learning how breathe deeply through your abdomen. In order for this technique to be effective during an episode of anxiety, you must practice it when you are not anxious. Try lying down and resting your hand on your stomach. Breathe deeply and slowly, feeling your abdomen rise as you inhale, and sink as you exhale. Practice this skill during your daily routines in order to make it more familiar and comfortable. Being aware of your breath and skilled at controlling it can help the next time anxiety arises.
  • Accept Uncertainty: Studies have found that poor tolerance of uncertainty is linked to SAD.[17] People with a low uncertainty tolerance view negative events as unacceptable, and may have anxiety at even the thought of an event turning out negatively. In order to improve your tolerance of uncertainty, you can do the following:[18]
  • Notice negative thoughts without reacting. Instead of judging or clinging to your thoughts, practice observing your thoughts and feelings.
  • Accept that uncertainty is part of life. Remember that everyone faces uncertainty and that it is unavoidable. Once you have done this, it may be easier to come up with strategies for tolerating uncertainty.
  • Focus on the present moment. Usually, the intolerable situation is somewhere in the future. In order to ease fears of uncertainty, pay attention to what is happening in the here-and-now. You can do this by listening to sounds, observing your surroundings, or focusing on your breathing.

People’s experience of SAD may be diverse, meaning that you can meet the criteria for SAD with different variations of SAD symptoms. It is not uncommon to experience two or more mental health conditions at the same time, and we at Hopewell Psychological are prepared to counsel people faced with this challenge. Hopewell Psychological understands that no two people are alike, and offers a variety of treatment options to meet your unique needs. We use current and evidence-based treatments to ensure that you are receiving the best care possible. We offer individual therapy as well as for couples, families, and groups looking to improve their interpersonal relationships.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] “DSM-5 Definition of Social Anxiety.” Social Anxiety Institute. Social Anxiety Institute, 2017. Web. 22 Apr. 2017.

[2] “Section B-Anxiety Disorders.” Statistics Canada. Statistics Canada, 27 Nov. 2015. Web. 22 Apr. 2017.

[3] “Social Anxiety Disorder-Beyond Shyness.” The Daily. Statistics Canada, 26 Oct. 2004. Web. 22 Apr. 2017.

[4] “Chapter 5: Anxiety Disorders.” The Human Face of Mental Health and Mental Illness in Canada. Mood Disorders Society of Canada, 2016. Web. 22 Apr. 2017.

[5] Shields, Margot. “Social Anxiety Disorder-beyond shyness.” Health Reports. Statistics Canada, 15 (2004): 45.

[6] “Mood and Anxiety Disorders in Canada.” Government of Canada. Government of Canada, 3 June 2015. Web. 22 Apr. 2017.

[7] Li, Haohong, et al. “Experience-dependent modification of the central amygdala fear circuit.” Nature Neuroscience 16.3 (2013): 332-339.

[8] Phan, K. Luan, et al. “Association between amygdala hyperactivity to harsh faces and severity of social anxiety in generalized social phobia.” Biological psychiatry 59.5 (2006): 424-429.

[9] Olatunji, Bunmi O., et al. “Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings.” Psychiatric Clinics of North America 33.3 (2010): 557-577.

[10] See 4

[11] Hofmann, Stefan G., et al. “The efficacy of cognitive behavioral therapy: a review of meta-analyses.” Cognitive Therapy and Research 36.5 (2012): 427-440.

[12] Hofmann, Stefan G., et al. “The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review.” Journal of Consulting and Clinical Psychology 78.2 (2010): 169-183.

[13] See 6

[14] Goldin, Philipe R., and Gross, James J. “Effects of Mindfulness-based stress reduction on emotion regulation in social anxiety disorder.” Emotion 10.1 (2010): 83-91.

[15] “Self-Help Strategies for Social Anxiety.” AnxietyBC. AnxietyBC, 2007-2016. Web. 22 Apr. 2017.

[16] Markway, Barbara. “Must-have coping strategies for social anxiety.” Psychology Today. Psychology Today, 14 May 2013. Web. 22 Apr. 2017.

[17] Carleton, R. Nicholas, et al. “‘It’s not just the judgements–It’s that I don’t know’”: Intolerance of uncertainty as a predictor of social anxiety.” Journal of Anxiety Disorders 24.2 (2010): 189-195.

[18] Saulsman, L., et al. “What? Me Worry!?” Centre for Clinical Interventions. 2015. http://www.cci.health.wa.gov.au/docs/GAD_9_2015_Uncertainty.pdf. Web. Apr. 2017.

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