What is Social Anxiety?
Social anxiety is a type of anxiety disorder that is typically characterised by a fear of negative scrutiny by other people (Hedman, Strom, Stunkel & Mortberg, 2013). Most people have some level of anxiety when entering new and unfamiliar social situations. To some extent, most people fear negative judgement by others. Social anxiety disorder is when this anxiety becomes debilitating and results in impairment in social and occupational functioning.
Those struggling with social anxiety disorder experience an exaggerated and inappropriate fear of being negatively evaluated by those around them in both social and performance situations (Seedat, 2013) to the point at which their performance and functioning in social situations is impaired or they avoid them altogether by withdrawing completely from social situations. In these situations people may experience the usual symptoms of anxiety; namely racing heart or heart palpitations, sweating, trembling, stuttering, and feeling dizzy, nervous butterflies in the stomach, upset stomach such as diarrhoea, dry mouth and shortness of breath.
This intense anxiety is situation specific, unlike generalised anxiety disorder, and the person tends to experience anxiety only when in social or performance situations, or when anticipating such events. Due to the fact that a primary characteristic of social anxiety is a heightened sensitivity to a perceived threat of negative evaluation, it has further been suggested that people struggling with social anxiety also tend to have a general hypersensitivity to threats in their environment (Kimbrel, 2008).
As such, people with social anxiety disorder tend to be hypersensitive to any evaluation from those in their social and occupational situations. Perceiving risk of negative evaluation and a fear of being excluded is a common anxiety to most people. Social anxiety, however, is more debilitating and those struggling with it find it very difficult to cope in those situations. Due to the fact that this form of anxiety is so common, some have even theorised that social anxiety is an evolutionary way of preventing an individual from behaving in ways which may exclude them from the general community or society (Hedman et al., 2013).
Social anxiety disorder, along with specific phobias, have an earlier onset than other anxiety disorder and typically start at around 13 years of age with an onset age of 25 or later being rare (Seedat, 2013). It is typically an adult disorder and there are more females that struggle with social anxiety disorder than males (Seedat, 2013).
The most studied and effective treatment for social anxiety disorder is cognitive behaviour and behaviour therapy where important factors for success include the individual’s motivation and commitment to treatment and having available alternate coping strategies and support structures (Sadock & Sadock, 2003).
The cognitive behaviour therapy techniques involve psycho-education around the disorder – the symptoms and presentation as well as education around the factors that maintain it. In this sense, the individual is shown how his anxiety behaviours (such as withdrawing from conversation) actually exacerbate and feed into the social anxiety.
People struggling with social anxiety tend to have a heightened awareness of self and often negatively evaluate their own behaviours in social situations, leading to anxiety attacks and anxiety behaviours, which then feed back into negative self-perceptions and fuel the belief that others are also evaluating them negatively. Cognitive behaviour therapy looks at these irrational beliefs and self-perceptions and attempts to challenge the negative thought patterns that result in anxious behaviours.
Relaxation training and other coping skills are also taught alongside the therapy (Seedat, 2013). Hypnotherapy can be a very useful tool in therapy to reinforce relaxation and coping skills and to adjust self-perceptions in social situations.
Overcoming social anxiety disorder is no easy task, but is certainly achievable through committed treatment with a psychiatrist or psychologist and the use of cognitive behaviour techniques.
Hedman, E., Ström, P., Stünkel, A., & Mörtberg, E. (2013). Shame and Guilt in Social Anxiety Disorder: Effects of Cognitive Behavior Therapy and Association with Social Anxiety and Depressive Symptoms. Plos ONE, 8(4), 1-8.
Kimbrel, N. A. (2008). A model of the development and maintenance of generalised social phobia. Clinical Psychology Review. 28, 592-612
Sadock, B. J. & Sadock, V. A. (2003): Synopsis of Psychiatry: Behavioral Sciences / Clinical Psychiatry. Philedelphia Lippincott Williams & Wilkins
Seedat, S. S. (2013). Social anxiety disorder (social phobia). South African Journal Of Psychiatry, 192-196