Treatment for Social Anxiety
Social anxiety disorder affects up to seven percent of the adult population in the United States each year. People with severe social anxiety are significantly restricted in their personal and professional lives, and without treatment they may never learn to feel comfortable around other people. But treatment for social anxiety, which includes individual and group psychotherapy, medication, and various complementary treatment methods, has helped untold numbers of social anxiety sufferers find lasting and sustainable relief from their most disabling symptoms.
What is Social Anxiety?
Social anxiety is a pervasive and often intense fear of social interaction and of the judgments of other people in general.
If the symptoms of social anxiety are severe and manifest in a variety of circumstances, an individual may be diagnosed with social anxiety disorder, a debilitating mental health condition that affects up to 15 million American adults (and several million more adolescents and children) each year.
People suffering from social anxiety disorder, which is also known as social phobia, come to dread most encounters with other people. They worry they’ll be judged or rejected for their performance—or simply rejected out of hand—and left feeling embarrassed or humiliated as a result.
The fears of social anxiety disorder sufferers are not realistic and show an excessive concern with the opinions of others. Self-esteem issues are at the root of social anxiety, along with a chronic lack of social skills based on limited exposure to conversations and other social interactions.
What Causes Social Anxiety Disorder?
- Genetic predisposition. Having a parent or sibling with social anxiety disorder increases the odds of diagnosis by a factor of 10.
- Exposure to trauma in childhood. Physical, sexual, and emotional abuse of all types can play a role in social anxiety, as can ongoing family conflict, the loss of a parent, or being repeatedly victimized by bullying.
- Shy in temperament. Children who are naturally shy or quiet are more likely to be diagnosed with social anxiety disorder as they mature.
- Medical or appearance-related conditions. People insecure over their disabilities or physical features may develop social anxiety as a side effect of their self-consciousness.
Diagnosing Social Anxiety Disorder
Mental health professionals will diagnose social anxiety disorder based on the presence of its distinctive symptoms, which are both physical and emotional.
The physical symptoms of social anxiety include:
- Rapid heartbeat
- Shaking, trembling
- Dry mouth
- Breathing problems
- Muscle tension
- Stumbling, inarticulate speech
- Slowed thinking
Most if not all of these symptoms will manifest in those with significant social anxiety problems. But the psychological and emotional symptoms of social anxiety must also be present for a diagnosis to be made. These include:
- Fear of being judged or scorned in a broad range of social situations
- Constant second-guessing and harsh self-judgments over social performance
- Strong anticipatory anxiety before a social event
- Feelings of shame, guilt, embarrassment, and inferiority following routine social encounters
- Overwhelming feelings of inferiority and inadequacy during meetings with authority figures
- Overreacting to actual feedback from other people (being devastated by rejection or criticism, or feeling overly ecstatic when praised or congratulated)
- Strong and persistent patterns of social avoidance
If such symptoms have been experienced for several months or years, and are interfering with daily living in a multitude of ways, a diagnosis of social anxiety disorder may be in order.
Treatment Regimens for Social Anxiety Disorder
A comprehensive treatment regimen for social anxiety disorder should include individual and group psychotherapy, along with medication. Family therapy sessions may also be provided if social anxiety has caused tension or misunderstandings between family members.
Holistic healing practices are frequently prescribed or recommended for social anxiety sufferers, since these mind-body techniques can help reduce the physical symptoms of stress and anxiety.
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Multiple studies have confirmed the effectiveness of cognitive behavioral therapy (CBT) against the symptoms of social anxiety, which explains why CBT is considered the gold standard of therapies among mental health professionals who work with social anxiety sufferers.
During individual counseling sessions, social anxiety patients and therapists will work together to identify the negative, anxiety-induced (and inducing) thoughts that reinforce the hold of social anxiety over the patient’s life. Through the application of cognitive restructuring techniques, more rational and constructive ways of thinking will then be developed to replace old thinking patterns that obstruct the path to recovery.
In addition to CBT, psychodynamic therapy and eye movement desensitization and reprocessing (EMDR) are two other forms of therapy that have produced good results when used to treat social anxiety patients.
In psychodynamic therapy, mental health specialists help social anxiety sufferers dig below the surface of their thoughts and behavior, to trace the roots of their social anxiety problems back to traumatic or stressful experiences in childhood (or afterward). The goal of psychodynamic therapy is to help patients resolve past conflicts and find self-forgiveness, so they can transcend the hidden barriers that have held them back for so long.
With EMDR, the patient is taught how to use directed eye movements to defuse distressing emotions that arise when mentally visualizing anxiety-producing situations. As an action-oriented form of therapy, EMDR introduces practical techniques that can help social anxiety sufferers reprogram their brains to replace negative obsessions with positive thoughts and emotions.
In group therapy lessons, social anxiety patients will put what they’ve studied into actual practice, in a safe, non-judgmental environment alongside peers who share their perspectives, health issues, and life histories. Role playing exercises and honest discussions will help social anxiety sufferers gradually reinvent their approach to social interactions, in a context where performance isn’t being judged and where exposure to imagined dangers is gradual and controlled.
The longer this type of practice continues the more comfortable patients will become in their social interactions, and eventually they can take what they’ve learned and apply it to their real-world encounters.
Exposing social anxiety sufferers to the situations they fear only works if they aren’t overwhelmed and can build up their new social skills gradually and progressively. Applied CBT therapy in group settings is perfect for establishing a moderate but sustainable pace of recovery.
The preferred medications for social anxiety disorder include:
- Antidepressants. There are three types of antidepressants frequently prescribed for social anxiety disorder: SSRIs (Prozac, Zoloft, Paxil, Luvox), SNRIs (Effexor, Effexor XR, Cymbalta), and MAOIs (Nardil). Antidepressants from the SSRI class are usually the first choice for social anxiety treatment, because their side effects are more manageable and because so many social anxiety sufferers also have issues with depression.
- Benzodiazepines. This class of anti-anxiety medication is commonly used against social anxiety symptoms, although benzodiazepine use must be carefully monitored since these drugs are highly addictive. The benzodiazepines most often prescribed for social anxiety are Xanax and Klonopin.
- Beta blockers. These drugs are a popular and effective choice for stopping the physical symptoms of severe anxiety. The beta blockers most often used to combat social anxiety include Inderal and Tenormin.
Mind-body healing methods that promote conscious reflection, stress relief, and emotional management are highly effective against the symptoms of many mental health disorders, including social anxiety. Social anxiety sufferers in recovery must strive to build new and better habits of thinking, acting, and responding, and that makes activities like yoga, meditation, massage therapy, equine therapy, Tai Chi, biofeedback, and art and music therapy a perfect complement to the practices of CBT and other forms of psychotherapy.
Other possible additions to a social anxiety recovery regimen include social skills training and symptom management training, which are frequently introduced in psychotherapy but can be taught in separate courses as well.
Social Anxiety and Co-Occurring Disorders
People with severe social anxiety are at significant risk for other emotional and behavioral health issues, and rates of major depression and substance abuse are especially high among those diagnosed with social anxiety disorder.
One study found that 53 percent of people seeking treatment for social anxiety reported at least one previous incidence of depression. Meanwhile, up to one-in-five social anxiety disorder sufferers will develop an alcohol abuse problem, and rates of illicit drug use and abuse are also higher among this group.
Other conditions common to social anxiety sufferers include panic disorder, PTSD, bipolar disorder, dysthymia, and avoidant personality disorder.
Outpatient vs. Inpatient Treatment
Overcoming social anxiety and shyness requires a long-term commitment, and that will include active participation in outpatient treatment programs under the care of mental health professionals. These programs will likely include individual psychotherapy plus regular attendance at social anxiety support group meetings, where peer feedback and reinforcement will be freely available.
But outpatient treatment will usually be more effective if it is supplemented by initial enrollment in an inpatient treatment program for social anxiety at a residential mental health facility.
Inpatient programs are designed to maximize the effects of evidence-based therapies that have helped significant numbers of social anxiety sufferers make transformative shifts in their thinking and behavior.
People with a diagnosis for social anxiety disorder shouldn’t underestimate how much work it will take to gain the advantage over their condition, and starting recovery with an extended stay in a residential treatment clinic is the best way to put a true commitment to change into action.
When co-occurring mental or behavioral health problems are present, inpatient treatment is by far the most promising option. In these cases, integrated, intensive treatment services that address all symptoms from all disorders simultaneously are necessary for sustained healing to occur.
Social Anxiety Under Control
Social anxiety can be mentally, physically, and emotionally exhausting. Too often those who develop its most severe type of symptoms are left to suffer in silence, since most people have no idea how common social anxiety disorder is or how disabling its symptoms can be.
But social anxiety sufferers who find the strength and courage to ask for help have excellent prospects for recovery.
Reprogramming their thinking, behavior, and the neural pathways that support their anxiety will take time and dedicated effort, plus the assistance of mental health professionals trained and experienced in the treatment of social anxiety disorder. Fortunately, superior inpatient and outpatient treatment programs for social anxiety are now widely available, and the number of people who’ve found qualified assistance in their struggle to overcome social anxiety has expanded dramatically in recent years.
Social anxiety disorder cannot be completely cured. But with targeted, continuous treatment its most extreme symptoms can be gradually reduced in intensity, until they no longer prevent social anxiety sufferers from building satisfying relationships or pursuing their visions of a good and enjoyable life.