Those who struggle with social anxiety experience anxiety in various social situations, especially where they feel they may be negatively judged by others. Often, there is a vicious cycle that unfolds roughly like this: Something triggers an anxiety response in the social setting, such as the fear of saying something foolish, underperforming, facing rejection, etc. Most of the time, it's not easy to pinpoint exactly what one is afraid of; one just become anxious. When we become anxious, the body exhibits various reactions, such as feeling unwell, trembling, stiffening, blushing, sweating, etc. It is easy to become afraid that others will notice these reactions, that they will perceive our fear. This becomes another thing to be afraid of, adding to our anxiety and triggering more anxiety responses. When we are scared, we automatically enter a kind of defense mode, turning on the "radar" to scan for threats. The problem with this is that we become hyper-aware of both our own anxiety reactions and signals from the surroundings. This way, anxiety can unfold as a self-reinforcing cycle. For some, anxiety can escalate into a panic attack where they feel they are about to faint and must get away, especially in situations where they feel trapped with no escape route. Panic attacks are so frightening in themselves that they can lead to another fear, namely the fear of experiencing new panic attacks. This is how what is initially meant to protect us from dangers becomes a self-sustaining anxiety machine.
When social anxiety is strong, it can paralyze us. We become so afraid of experiencing anxiety that we hesitate to be social or to interact with other people at all. Some experience anxiety in small daily events, such as meetings at work or going to the store, etc. However, the most typical situations are those where we are particularly visible, and we feel the likelihood of criticism is greater, for example, when we have to perform activities in the presence of others, like giving presentations, speaking in a gathering, etc. A central characteristic of social anxiety is that the person actively tries to avoid situations that may lead to anxiety. A negative side effect of this avoidance is that we don't have the opportunity to practice overcoming anxiety. Instead, avoidance has the opposite effect, confirming to the nervous system that these situations are dangerous, further lowering the threshold for experiencing anxiety in such situations.
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Why do some people experience social anxiety?
Some individuals have a long-standing relationship with social anxiety, perhaps starting as a strong shyness as children. For others, it may emerge more suddenly in adulthood. The reasons why each person develops social anxiety are highly diverse, involving a complex interplay of genetic, biological, psychological, and social factors. Anxious parents serving as role models can contribute, and experiences of loneliness and bullying in school seem to be big predisposing factors. Social anxiety often coexists with other types of anxiety and depression, making it challenging to determine what came first. Sometimes, a person is simply anxious, and being in a social situation intensifies the anxiety because they feel it is visible to others. In other cases, individuals have low self-esteem, and because they harbor negative thoughts about themselves, they unconsciously assume that others will think the same. As I have discussed in this post, all anxieties originate from evolutionarily advantageous mechanisms. Being alert to social rejection has had a crucial function for humans in our evolution, helping to explain why we can experience strong bodily symptoms in seemingly harmless situations. Many of those I meet with social anxiety cannot easily point to specific causes from their upbringing or other life circumstances that explain why they have anxiety. Fortunately, this doesn't matter much because the treatment principles remain the same.
Treatment of social anxiety
I tailor the treatment to each individual, but some principles are common. It is crucial to build strong motivation for change so that we can confront anxiety effectively. I use psychoeducation, similar to what you've read in the paragraphs above, to help the anxious person understand and explain the symptoms they are struggling with. When one can see oneself from an external perspective, label their symptoms, and explain why they occur, they have already made significant progress in regulating their own anxiety. I sometimes provide patients with techniques to better endure difficult situations and encourage them to confront challenging situations rather than avoid them. For those with strong social anxiety, the act of entering therapy itself can be very anxiety-inducing. Not only does it involve partially exposing themselves and their anxiety to a stranger, but to a psychologist, a kind of authority on what is "normal," making this fertile ground for social anxiety. Therefore, I often begin by examining the automatic assumptions that arise in our interactions, exploring what these tell us about the psyche of the person dealing with social anxiety. This, too, is a form of exposure therapy. I will also try to collaborate on planing how you can do your own step-by-step exposure therapy by yourself in-between sessions.