How To Live Well With Social Anxiety

Many of us experience social situations that cause us anxiety. For some, meeting new people is a challenge. For others, just walking into a room full of strangers is uncomfortable. Because we like to avoid discomfort, most of us try to develop workarounds that allow us to be out in the world and forming new relationships.

When the anxiety begins to keep us from activities, interfere with work, or prevent us from participating in social gatherings, it may be time to look more closely at our social phobia, understand it and get help.

Social Anxiety Disorder

For the purposes of this discussion, it is good to have a sense for what an actual diagnosis of social anxiety disorder looks like, so we can better assess our own symptoms and determine whether or not we should seek the assistance of a mental health counselor. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), describes Social Anxiety Disorder as follows:

1. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g. – having a conversation, meeting unfamiliar people), being observed (e.g. – eating or drinking), and performing in front of other (e.g. – giving a speech).

Note: in children, the anxiety must occur in pure settings and not just during interactions with adults.

2. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e.- will be humiliating or embarrassing; will lead to rejection or offend others).
3. The social situations almost always provoked fear or anxiety.

Note: in children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

4. The social situations are avoided or endured with intense fear or anxiety.
5. The fear or anxiety is out of proportion to the actual threat posed by the social situation, and to the socio-cultural context.
6. The fear, anxiety, or avoidance is persistent, typically lasting for six months or more.
7. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
8. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medication.
9. The fear, anxiety or importance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
10. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

It is important not to self-diagnose when wondering about mental disorders, for the same reason you shouldn’t self-diagnose with medical problems. You want to be sure you receive the right treatment. If you find your symptoms on this list, or they are particularly distressing or disruptive, your best course is to find a therapist and get a proper diagnosis.
 
 

First Steps: Reconnecting to Our Bodies

Because anxiety can be so uncomfortable, our natural reaction is going to be to distance ourselves from it, try to stuff it somewhere and not feel it. This is counterproductive both to diagnosis and successful treatment. The next time you feel anxiety, try turning toward it within you. Acknowledge you’re feeling it, “I’m feeling anxious right now.”

Be curious about it, “Where am I feeling it?” It may be in your stomach, or your neck, or your chest. Sometimes anxiety comes with tingling in the hands or fingers. See if you can get it under control with deep breathing, in through the nose and out through the mouth, on a slow three count. After a minute of deep breathing, see if you can identify the trigger.

Sometimes it will be obvious. For example, you just remembered you’re going to a party with a bunch of strangers and your anxiety spiked. Other times it may seem to come from nowhere. Then it’s good to ask the question, “I wonder what that’s about?” This is always a good question when anger or anxiety increase suddenly. Even if the answer is, “I have no idea” the fact you are asking the question sets you on a course toward recovery.

The Complexity of Triggers

Because of the interconnectedness of our bodies, minds, and emotions, there are many possible causes for our various anxieties, including social ones. In response to our early traumatic experiences, we develop emotional defenses that protect us both from further injury and from experiencing the pain of the trauma.

You can think of it like having furniture in your emotional room covered in sheets. Since you can’t see it, you keep bumping into it. Working with a therapist to understand your triggers is like taking the sheets off the furniture one by one.

If you can see it, you’re less likely to bump into it as often, and when you do, to know what it is. In time you may even find another place for it so it’s not out in the middle of the room anymore.

Understanding Our Social Anxiety

When trying to get a read on our social anxieties, it is helpful to have a range in mind. When you notice your anxiety is up, give it a number, “My anxiety is a 6 on a scale of 10.” If you start self-checking this way, and your anxiety is consistently in the 7 to 10 range over the space of a week or two, set up an appointment with a therapist.

Left unchecked, high levels of anxiety actually condition our body to be anxious, which is one of the reasons some anxiety disorders only respond to medication.

Once you’ve identified the severity of your anxiety, the next step is to try to reduce it using whatever tools you have available. We cannot think clearly if our anxiety is up. As mentioned above, deep breathing in through the nose and out through the mouth can be an effective method of telling your sympathetic nervous system (fight/flight) it’s okay to calm down.

As you’re breathing, you might try to focus on a single thing, like a word or a smooth stone. Our minds can only think about one thing at a time. It is impossible to dwell on a fear if we are dwelling on a stone or a calming word. It may be very hard to focus at first and seem like we are actually thinking of 9 things at a time, but in actuality, we are racing through them one at a time.

We can stop the circus if we can control our focus. It will likely take practice. Positive affirmations can also help reduce our anxious feelings. Much of what we worry about is based on a lie (e.g. – “God is doing this to punish me”) or an unreal event (e.g. – “I’m going to get cancer”). If it hasn’t happened, we can rightly recognize that it is not happening now.

There are thousands of things that can kill me. It is an utter waste of time to try to guess what it’s going to be. Living in the moment means not dwelling on the future or the past. All we have is now and now is enough.

Once your anxiety is under control enough to think more clearly, think about what is causing your social anxiety. Nervousness about running into somebody you’re out of sorts with is not really social anxiety. Nervousness about running into anyone you don’t know is probably social anxiety.

Ask yourself what it is that frightens you about the situation. Not knowing what to say (looking like a fool)? Accidentally saying the wrong thing (looking like a fool or a jerk)? Breaking something by accident (looking clumsy and hence like a fool)?

Notice, in each of these cases, the underlying fear. If we look like a fool or a jerk, people will reject us, and we will be despised and alone. Forever. That is the underlying fear. It isn’t true, but it is what the young parts of our psyche fears, almost more than death. Abandonment.

This is why the stakes may seem so high around your social anxieties. Once you begin to understand the breadth and depth of your feelings around your social anxiety, you can begin to develop a plan and techniques to manage the situation and combat the lies you have allowed yourself to believe about it.

Learning to Manage Social Anxiety

Because everyone’s experience is different, there is not enough space here to try to address everyone’s situation. I will, therefore, use a couple of vignettes with some examples of possible approaches, in the hopes that a more generalized and helpful picture may emerge for you around your own situation.

Vignette 1 – A man in his late 20s has a job at a large business where there are no interior walls and the desks are arranged in groups. Everyone sees and contributes to everyone else’s work. One morning he walks into the office and suddenly his heart is pounding, he feels dizzy and must steady himself on the wall. He flees the building and is unable to consider going back without paralyzing anxiety gripping him.

Possible Approaches – First, anytime you have symptoms like dizziness or chest pains, it is strongly recommended that you have yourself checked by a physician to rule out medical causes. Having ruled out medical causes, we can begin to look at possible environmental causes.

Has anyone he is uncomfortable with moved closer to him? Has his work been called into question, and he’s been shrugging it off to the point it is a huge anxiety? Has the constant pressure of the scrutiny of his coworkers finally gotten to him? Has something else changed about the workspace or his work relationships that is causing increased anxiety?

Having ruled out environmental factors, it’s time to look at possible psychodynamic contributors, such as a critical mother or father who always made him feel one down. This, however, can take much longer to resolve, so something must be done to shore up his confidence so that he can continue to function in the workplace.

Here, tools like those mentioned above would be recommended, to calm anxiety in the moment, find a single focus, and locate himself in the present. If the anxiety has persisted for more than six months, it may not respond to these kinds of somatic techniques, and an appointment with a psychiatrist to discuss anti-anxiety medication might be indicated. Patience and persistence in pursuit of a diagnosis will offer him the best chance of getting the proper care that will help him.

Vignette 2 – A woman in her mid-30s has always felt some anxiety being in public places, but one evening at a party where she knows almost no one, her anxiety ramps up so badly she has to flee the building.

Possible Approaches – Similarly to the man in the previous vignette, if the anxiety is manifesting as chest pains or dizziness, a visit to the doctor would be a good place to start.

If the anxious feelings calm with her departure from the party, then the next step might be ruling out environmental factors. Was there anything about the room that was threatening in a familiar way? Were there any smells that might have triggered an emotional response to an old trauma?

Did someone say something that was a trigger? Was there anyone who seemed familiar, but she couldn’t place and so mentally dismissed them (but might be similar to someone threatening from her past)?

As before, once ruling out environmental factors, psychodynamic causes are worth a look, but again, she doesn’t want to have to avoid parties for the months or years that process might take. Here a desensitization process might be helpful.

First, she should try attending another party to verify that this is a recurring problem. Next, she should try meeting a friend and stranger together, then a friend and four or five strangers, and so on, each time monitoring her anxiety and watching for triggers. This way she can begin to get a sense of the depth and breadth of her anxiety and develop workarounds to address her specific issues.

Despite similarities in experience, everyone’s anxiety is unique to them. We need courage and determination to face our fears and be curious about them, so we can develop techniques to reduce our anxiety. If the disruption to our lives is significant, it is better to get help sooner rather than later and learn to be curious and kind to yourself as you move gradually toward growth and health.