Social Anxiety Disorder: How to Manage and How to Thrive

Imagine being caught in a riptide. Your breath hitches and heart starts beating so loudly that you can’t hear the crashing waves. You are paralyzed and don’t know whether you will sink or swim. Suddenly, you feel energy flood your body and every hair on your back and arms stand up with anticipation.

You begin to swim, focused on nothing else except the beach. All of this takes less than 15 seconds, but when you get out of the current, you feel like you’ve been swimming for 15 hours.

This example of a flight-or-fight response is similar to the ones people experience in most dangerous, life-threatening situations. Our brain assesses the risk and tells our body how to respond

It is called an automatic stress response to danger, and under it, the body moves faster, bleeds less, and floods muscles with energy hormones while the brain disengages from all other input other than the main threat. This response is instinctual and meant to aid in survival.

But what if this happened every time you had to talk with someone new? Or every time you went to class, or church, or a party? What if this automatic stress response kicked in at coffee shops and shopping malls and yoga studios, and it always seemed like you were being swept out to sea, even when you were on a business call? This kind of survival response can be exhausting when triggered all the time, and can seriously affect a person’s quality of life.

Social anxiety disorder is like this. People with social anxiety fear embarrassment, being judged and evaluated negatively by others, and finding themselves in situations where they could be scrutinized. This fear leads to the avoidance of social situations altogether.

Sometimes this anxiety can be overwhelming. Social anxiety disorders correlate with a low quality of life. There is a greater risk of dropping out of school, experiencing lower work productivity, and receiving a lower income (Edmund Bourne, Ph.D. 2015). For this to be a clinical diagnosis, however, this fear or anxiety must stick around for six months or longer.

Humans crave connection and we are created for community and positive interaction. Social interaction is necessary for people to thrive. Just as food helps fuel the body, social interaction helps fuel the brain. When a social anxiety disorder is ignored, it puts a person at risk for unhealthy thoughts and behaviors.

While anxiety in itself can be helpful (it typically serves as a prompt to grow or change), paralyzing anxiety can be dangerous. The key is to learn how to manage the anxiety so that it is not so overwhelming that the person is unable to function.

Planning Recovery

Several interventions exist for addressing and treating social anxiety, but the most important thing to know is: ask for help. Help can look different for each person but exists in many forms. Read a book on different treatment approaches, enlist the support of family and/or friends, or meet with a therapist. Just take the first step!

We hope this post will provide you with an overview of successful interventions and give you examples of common treatment plans for this disorder. The four following approaches can help people cope with their social anxiety:

1. Relaxation Training
2. Core Belief Transformation
3. Exposure Tasking
4. Personal Assertiveness Practice

While these four things aren’t the totality of intervention for a social anxiety disorder, they give a good overview of what a therapist might do to help someone manage their diagnosis.

Relaxation Training

We tend to perform best when we feel relaxed. We are more alert and energized, and willing to approach uncomfortable situations. With an anxiety disorder, however, relaxation seems out of reach. This is partly because the fight-or-flight response is antithetical to the relaxation response.

It takes practice. Relaxation training decreases an overactive heart rate, respiration, high blood pressure, muscle tension, and oxygen consumption. It calms the overly analytical brain and increases skin resistance and alpha wave activity in the brain. (Edmund Bourne, Anxiety and Phobia Workbook, 2015).

Since people with social anxiety disorders often have past negative social experiences, they avoid future experiences in an attempt to mitigate any humiliation or degradation they might perceive. This avoidance ultimately strengthens the anxiety response to social situations. With mastery of relaxation techniques, the same person can gain confidence in social situations (even if they had past negative experiences).

Relaxation training can take the form of guided imagery, yoga, progressive muscle relaxation, and abdominal breathing. The method one chooses isn’t as important as the frequency with which they practice their chosen method. Twenty to thirty minutes a day can produce positive, life-changing results.

This is typically the first step to overcoming social anxiety. If you can relax, you can better assess risks. Relaxation helps free a person to face the situation they have previously learned to avoid.

Core Belief Transformation

Our thoughts are powerful, and when they are unhelpful, they can be powerful barriers to overcoming social anxiety. Our willingness to participate in social activities is directly related to how we think about ourselves, about others, about the situation, etc. Negative thoughts lead to increased anxiety.

We find that the more intense the thoughts are, the more intense the feelings are. The goal of managing any anxiety disorder is to reduce anxiety levels so that one is free to engage their social world. For example, someone with a social anxiety disorder might think and believe that they will look foolish if they speak in a meeting.

The more they think this, the higher their anxiety climbs, making it almost impossible for them to speak up. If they can change their belief that they are “foolish” and switch it to something less intense, like “I’m concerned others won’t like my ideas,” they are freer to explore ways to challenge that thought and speak up.

Edmund Bourne, Ph.D., recommends five questions for lowering the intensity of negative thoughts and challenging mistaken beliefs:

1. What objective evidence do you have for this belief?
2. Does this belief ALWAYS hold true for you?
3. Does this belief take into account the negative and positive outcomes? (Does it look at the whole picture?)
4. Does this belief give you peace of mind or promote your well-being?
5. Did you choose this belief on your own, or did it come from your experience growing up in your family?

Asking these questions will better help a person develop new thoughts that are less anxiety-provoking. While difficult to do at first, a supportive therapist can help those with social anxiety challenge their core beliefs so they can engage their social world without fear.

Exposure Tasking

Social anxiety disorder acts like a phobia. When you are afraid of something, you tend to avoid it. People with social anxiety disorder avoid social situations. They experience anxiety when confronted with particular stimuli (speaking in public, taking public transportation, attending parties, etc.), and when they avoid that stimulus, their anxiety is reduced.

The avoidance is like a reward-system and the more it happens, the more it creates a pathway in the brain to allow it to happen. The brain starts making the connection automatically, and the avoidance becomes second-nature. When anxiety reactions get hardwired into a person’s brain, it can be difficult to re-route.

However, our brains are built to adapt, change, and form new connections. This is called neuroplasticity. This rewiring process is also called exposure and exposure helps people unlearn “the connection between anxiety and a particular situation.” (Bourne, 2015).

Exposure tasking allows a person to enter a scary situation, feel their anxiety rise, endure the anxiety, and realize they can survive it. This ultimately allows that person to unlearn their anxiety response and gain confidence in their ability to handle it.

The key to doing this is to break down the exposure tasks into manageable chunks. The anxiety can be mastered in successive stages instead of all at once.

For example:

Fred is afraid of public speaking. He chooses exposure tasking to help him conquer his fear. He first imagines himself on stage speaking in front of a crowd. While doing this, he acknowledges all his thoughts and feelings.

If they are negative, he replaces them with positive. Next, he practices in front of a mirror. After he feels comfortable, he gathers a group of friends. On this goes until he is able to face the anxiety-provoking situation, literally rewiring his brain.

Personal Assertiveness Practice

The final approach that can help someone cope with social anxiety is assertive communication. This is a direct, non-reactive, clear, and honest form of self-expression that allows a person to interact with others in a non-anxious way.

The key elements of assertive communication include the following:

• Identifying personal needs;
• Describing facts;
• Sharing personal feelings;
• Making personal requests;
• Providing positive reasons for need.

For example, if Fred was angry at a friend who always canceled plans, his first step would be to figure out his need. His need would be reliability. After identifying this need, he would sit down with his friend to discuss the facts in a non-emotional way. “You have canceled plans the past 5 times we’ve made them.”

Then he’d share his feelings. “This makes me feel unsure and confused.” Finally, he’d make his request by providing positive reasons for it. “I need you to keep plans when we make them or not make plans until you know for sure that you can go. It will help me feel confident in our relationship and give me assurance that we are in a good place.”

Even if Fred’s friend did not respond well, Fred has demonstrated that he can stand up for himself and not let his anxiety rule his friendships or create unhealthy relationships. Practicing this is key to being able to do this in everyday situations.

Conclusion

These four areas of intervention are just a small overview of what treatment looks like for social anxiety disorder. This is not a substantial how-to, as much as it is an informative look at what needs to happen when approaching this diagnosis.

There is help, intervention, and healing for social anxiety. Recovery is achievable and with the right supports in place, it is a journey worth taking.