Most people have experienced some
apprehension when faced with a social situation. Giving a speech may not come
as naturally to some as to others, or some might feel butterflies in their stomach
during a job interview. Sometimes, people may even feel a little nervous while
speaking to a stranger or stumble over a few words while asking someone out on
a date. Social anxiety, however, is more than just the shyness or discomfort
someone would experience in those awkward situations. Social anxiety is such an
intense fear of being embarrassed that people reluctantly endure those situations
or they tend to avoid them all together.
To people who suffer from social anxiety, staying away from social
interaction is often the path of least resistance. But, no matter how intense
the feelings of anxiety are, there is still hope. By understanding the causes
including culture, society, neurological, or contextual conditioning, and by using
one of the following treatments: social imagination, skills training, cognitive
behavioral therapy, group therapy, or medication; people absolutely can
overcome social anxiety.
The first step in treating social anxiety
is to understand what causes it. Stefan G. Hofmann, PhD, and other contributors
point out that the defining feature of social anxiety is the fear of negative
evaluation of others (1117). Because of
this, it is directly linked to social standards and role expectations, which
are culturally dependent (Hoffmann et al. 1117). Social organizations that
emphasize the interdependence of its members are referred to as collectivistic.
Those that reward individual achievement and success over those of the group are
individualistic. It should be apparent that collectivistic societies tend to
have a lower occurrence of social anxiety because there is normally not as much
evaluation of individuals. People living in Asia will be less likely to
experience social anxiety, while people living in Russia and the United States will
be more likely to experience social anxiety (Hoffman et al. 1124).
But what, specifically, causes the fear? Heidemarie
Blumenthal and her colleagues at the University of Arkansas show us that as
with most other psychological diagnoses, adolescence is a key period in the
development of social anxiety (1134). During puberty, there is profound
psychosocial development as youths experience extensive physical growth and
developing of primary and secondary sexual characteristics (Blumenthal et al. 1134).
Also, during this time, youths will reach skeletal maturity and attain
reproductive capability (Blumenthal et al. 1134). These intense changes set the
stage for the future vulnerability of social anxiety symptom manifestation
(Blumenthal et al. 1134). As adolescents become more unfamiliar and more
conscientious about their changing body and moods, a greater potential exists that
their social interactions will be negative.
From this early negative social
interaction, an exaggerated fear response will develop. Sabin G. Shah, a
graduate student at Tufts University, and others illustrate how the brain
structures of the amygdala and insula react to negative stimulus in patients
suffering from a generalized social anxiety (296). From their experiment, it
was found that the generalized social anxiety is normally associated with a
negative affectivity in that negative facial expressions and negative images
yielded more of a reaction to the brain structures than positive ones (Shah et
al. 301). In other words, people
suffering from social anxiety are much more aware and much more sensitive of
the negative social interactions than the positive social interactions. This
negative affectivity continuously feeds the social fear as they imagine the worst
and try to avoid social interactions entirely.
Contextual conditioning is also at work. Joannie
M. Schrof, an author for U.S. News &
World Report, observes that a fear “marker” is attached to the details of a
situation in which the trauma was experienced (e.g. place, time of day,
background music) (50). If, for example, children get tongue-lashings from a
teacher, they will feel nervous the next few times they step into the classroom
(Schrof et al. 50). Unfortunately, the brain is sometimes too good at making
associations and the anxiety “grows like a cancer”, attaching itself to the act
of entering any classroom or talking
to any teacher and thus
generalizations are made (Schrof et al. 50). While this “weariness of other
creatures” has contributed to the overall survival of the human race, it also
plays a large role in the generalized social anxiety that people so often
experience even though there is often no threat at all (Schrof et al. 50).
So, what can be done to reduce social
anxiety to a manageable level or to eliminate it all together? First of all,
the patient needs to be retrained or rewired. If they are expecting the worst
when interacting with others, they have to, instead, be trained to expect something
other than the worst. Remember, the goal is to fight the belief that others
will pass negative judgment and unbearable humiliation will result (Schrof et
al. 50). We can accomplish that through many different methods.
One method is called sociological
imagination. This encourages patients to seek understanding as it relates to
the larger historical picture. In “It’s Not My Fault: Overcoming Social Anxiety
through Social Imagination”, the author takes us through a tour of his life and
the things that may have contributed to the anxiety he struggles with (42). In
understanding how society has contributed to his social anxiety, he can better
cope with it. He walks us through his military life as a child and explains how
being sent to many different military bases hurt him instead of helping with socialization
skills (“Fault” 42). He took on
different roles as a child and treated the world as a theatre, shying away from
who he really was to avoid embarrassment (“Fault” 43). Eventually, not confronting his fears caused
him to avoid all types of social contact (“Fault” 47). Later on in life,
however, he became very capable of dealing with social anxiety (“Fault” 47). Looking
inside one’s own thoughts and seeking understanding for the external forces
that affect us can be a very important first step in conquering social anxiety.
Another method to treat social anxiety is
to develop certain skills. Robin F. Cappe and Lynn E. Alden, PhD, explain how
important it is for patients to not have their attention focused on themselves
(796). They believe that the majority of the anxiety comes from not being able
to effectively interact with other people and emphasize four very important
skills to help: active listening, empathetic responding, communicating respect,
and self-disclosure (Cappe and Alden 796). These same skills are commonly
taught in human relations training, but modified to apply to social
interactions with friends.
One such skill is active listening. Lucetta
B. Comer and Tanya Drollinger, with the Department of Consumer Sciences and Retailing
at Purdue University, define active listening as a process in which the
listener receives messages, processes them, and responds so as to encourage
further communication (15). In active listening, we must include both verbal
and non-verbal messages including body positioning, eye contact, facial
expressions, and emotion (Comer and Drollinger 15). Being an active listener
means that you provide verbal and nonverbal feedback to the speaker such as
acknowledgements that you understand what is being said (Comer and Drollinger
15).
Empathetic responding, an advance method
of acknowledgement, is another useful social skill. Empathy is defined as
understanding another person’s thoughts and feelings with some degree of
accuracy (Comer and Drollinger 15). It
involves listening on an intuitive as well as literal level (Comer and
Drollinger 15). To respond with empathy gives speakers a sense that you
understand what they are saying. Once they feel that you “get them”, they are
more encouraged to open up. Being able to empathize with someone takes the
attention away from you and helps to relieve social anxiety.
A skill commonly overlooked would be communicating
respect to someone in a social interaction. Kyu-Taik Sung, president of
Elder-Respect, Inc., and Ruth E. Dunkle, Professor of Social Work at the
University of Michigan, describe respect as a benevolent, altruistic, or
sympathetic expression of regard for other persons (251). Respect calls for
more than one’s attention (Sung and Dunkle 251). Communicating respect means
using courteous manners, using respectful language, and treating others as you
would want to be treated (Sung and Dunkle 253).
The last skill of self-disclosure is
revealing more about oneself to others. Rimantas Koclunas, a Professor of
Clinical Psychology at the University of Vilnius and Tatjan Dragan, a
psychologist from the Psychology Section of the Lithuanian Police Department
Personnel Board, describe self-disclosure using two aspects: the “here-and-now”
and historical “there-and-then” (346). There are also two types of disclosure: disclosing personal information such as
personal difficulties, unresolved problems, aims and wishes, strong and weak
points of your personality, positive and negative experiences; and the ability
to share reactions to the events occurring immediately in the conversation
(Koclunas and Dragan 346). When you practice self-disclosure, you develop
established conditions of trust, interpersonal warmth and support in your
social interactions (Koclunas and Dragan 349).
Cognitive Behavioral Therapy is another
method for controlling social anxiety. One psychologist will take patients to
an elevator where she asks them to ride up and down and make small talk with
fellow passengers (Schrof et al. 50). Sometimes it takes 10 or 15 rides, and
sometimes it takes all day, but eventually, the patients’ hearts stop racing
for fear of what the people in the elevator think of them (Schrof et al. 50).
Putting patients in embarrassing situations or situations that would normally
elicit social anxiety helps them confront their biggest fears and eventually
deal with them. If they have enough experiences that are positive, they will
eventually extinguish their fears of social anxiety. This social exercise of
engaging others until it is second nature is much like our gym workouts to stay
physically healthy (Schrof et al. 50).
This particular behavioral therapy
is a form of in vivo exposure. Ronald M. Rapee, a professor in the Macquarie
University Department of Psychology, describes in vivo exposure as a cognitive
restructuring individually tailored to target the specific social fears of the
patient. Patients start with tasks that cause little or no discomfort and
eventually work up to more strenuous activities. Eventually, they are able to
conquer their biggest social phobias (Rapee et al. 320).
Over the years, group therapy has been found
to be a good treatment for a variety of disorders. It can, however, be
especially helpful in treating social anxiety. The group setting itself
encourages social interaction. Since others in the group share your anxiety, you
are likely to receive less negative evaluations. In group settings, you are
able to easily practice the skills that will make you more comfortable with
social interaction. Diane Damer, a psychologist from the University of Texas at
Austin, and colleagues explain that the cost benefits of group therapy are far
greater than those of individual therapy. There also is mounting evidence in
studies that group therapy can prove to be more effect (Damer et al. 10).
In some cases of social anxiety, one
might also turn to medication. As
outlined in the article “Treating social anxiety disorder” from Harvard Mental Health Letter, selective
serotonin reuptake inhibitors (SSRIs) and one serotonin and norepinephrine
reuptake inhibitor (SNRI) are considered the best medical options for the
generalized form of social anxiety disorder (1). However, if there is a
specific social phobia, beta-blockers or benzodiazepines should first be
considered (“Treating” 1).
Serotonin is a neurotransmitter used by
your body to regulate mood, sleep, appetite, and pain sensation. Reduced
serotonin transmission contributes to anxiety. SSRIs such as citalopram
(Celexa), paroxetine (Paxil), and sertraline (Zoloft) increase the availability
of serotonin thereby decreasing social anxiety (“Treating” 2). Venlafaxine
(Effexor) is an SNRI that targets not only serotonin, but also norepinephrine.
Norepinephrine is also known as adrenaline (“Treating” 2). Coincidentally, SSRIs are also used to treat
depression. In comparison, only half the dosage used to treat depression is
used in treating social anxiety (“Treating” 3).
To medically treat the specific phobia of
public speaking, doctors will sometimes prescribe beta-blockers. Although,
these are typically prescribed patients with heart disease, beta-blockers like
propranolol (Inderal) can help to counter symptoms of social anxiety, such as
sweating, rapid heartbeat, or shortness of breath (“Treating” 3). Several
studies suggest that taking this type of drug about an hour before speaking,
this can greatly reduce the effects of social anxiety (“Treating” 3).
Benzodiazepines are another medication used
to treat specific social anxiety disorders. They work by boosting the activity
of gamma-aminobutyric acid, which is an “inhibitory” neurotransmitter (“Treating”
3). In other words, it suppresses signals that are traveling down a neural
pathway (“Treating” 3). This will have a calming effect on anxiety symptoms.
Unfortunately, people taking benzodiazepines can become physically dependent
upon them and there is some potential for abuse.
When it comes to social anxiety, there
are many treatment options available. In a world of computers and smart phones,
social interactions are not as common as they once were. Where there used to be
a natural “overcoming of shyness”, people are more inclined to take the easier
path and avoid these situations. That’s why it’s so important to recognize the
causes of social anxiety as well as the treatments available. Whether someone
uses social imagination, skills training, cognitive behavioral therapy, group
therapy, or medication, there should be no reason for anybody to suffer;
overcoming social anxiety is absolutely possible.
Works
Cited
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Comer, Lucetta B., and Drollinger, Tanya
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