Social Anxiety – Symptoms, Causes And Treatment

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What is social anxiety? 

Social anxiety, also known as social phobia, refers to the intense fear or discomfort a person experiences in social situations, when interacting with another person or with a group, or when having to do an activity in front of others. The person feels fear and discomfort because they believe that they will behave inappropriately, that they will humiliate or offend others, or that they will show symptoms of anxiety that will cause negative evaluation and rejection.

There are times when we all feel anxious when we anticipate, think about, or find ourselves in new or demanding social situations, but anxiety is temporary and does not interfere with our lives. However, if a person experiences intense anxiety frequently and in many social situations, then negative effects are created as their daily life is disrupted, their functioning is reduced and their social activities are limited.

In this case, the anxiety can develop into social anxiety disorder, which is defined as “An overt fear or anxiety about one or more social situations in which the individual may be exposed to scrutiny by others”. Examples of such situations include social interactions (e.g., talking to strangers), when others may be observing the person (e.g., when eating or drinking), and when having to perform an action in front of others (e.g., make a speech).

Other social situations that cause anxiety include a date, a job interview, a phone call, or situations where the person has to express their opinion or assert a right.

To be diagnosed with social anxiety disorder, anxiety must be persistent and typically last for 6 months or more, cause clinically significant distress or impairment in the person’s social, work, or other important areas of functioning, and not be due to substances, another mental disorder, or illness.

Social anxiety can be expressed in specific situations, in relation to the performance of the individual, and concern only the fear experienced in the face of a public speech. On the other hand, it can be generalized, leading to fear and pressure in various social situations and causing worry, indecision, bad mood, feeling of inferiority, or negative self-criticism.

To manage it, the individual may eventually avoid social situations or endure them with intense discomfort.

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Symptoms of social anxiety

Social anxiety manifests itself through physical, emotional or cognitive symptoms.

Physical symptoms usually include shaking, flushing, racing heart, dizziness, nausea, tendency to faint, difficulty breathing, sweating, difficulty concentrating, speaking or communicating with others, strong urge to run away, panic attacks, minimal eye contact, or excessively low voice.

Emotional symptoms, which may not be apparent to others, however the person strongly experiences, include a great fear of criticism or rejection, a sense of danger or threat, weakness or anxiety, persistent self-consciousness or self-awareness, or low self-esteem.

On a cognitive level, the symptoms concern the negative thoughts and assumptions that the person makes about himself and the social environment where he is. These include overly high standards of social performance (e.g., “I must always find something interesting to say”), incorrect and conditional beliefs about the consequences of one’s behavior (e.g., “If I show that I am anxious, others will think I’m incompetent”) or overwhelming negative self-beliefs (e.g., “I’m boring”, “No one likes me”, “I’m inadequate”).

These kinds of thoughts and beliefs trigger anxiety, because they lead the person to believe that they will behave in an inadequate way (e.g., “I won’t have anything to say”, “I’ll shake”, “I’ll blush” etc.) or to evaluate his performance negatively (“I’m incompetent”, “I’m not doing anything right”).

These thoughts are often accompanied and reinforced by a negative and distorted self-image, such as when the person thinks they look “like a beetroot” when they’re a little red, or when they think others can sense their anxiety (“I feel like I’m shaking, so everyone notices my trembling”).

Also, they may come from earlier social traumas such as rejection by parents or bullying by peers.

Factors that cause or contribute to social anxiety

Social anxiety is a result of the combination and influence of different factors. In relation to biological factors, studies focus on the amygdala, which is the center of emotion management, the prefrontal cortex which contributes to risk assessment, and the motor cortex which controls muscles. As the analysis of these factors is beyond the aims of this article, we will focus on the role of the amygdala.

The amygdala, part of the limbic system of the brain, which is also connected to other parts, is a system of neurons in which sensory stimuli are concentrated for the purpose of the person’s quick reaction. It is the main core of processing, controlling and expressing positive or negative emotions as well as the association of memories with them, and it affects the control of aggression, the regulation of sexual behavior, the management of fear and even more primitive survival reactions.

The amygdala contributes to how a person perceives the information they receive from the external environment resulting in, if judged as a threat, fear or anxiety. The “Fight-Flight-Freeze” stress response is then activated, which indicates the connection of the amygdala with the sympathetic nervous system.

Also, amygdala function is associated with the memory of past events with negative emotional charge. According to neuroimaging studies, individuals experiencing social anxiety show increased bilateral amygdala activation, an indication of heightened vigilance and fear in response to social stimuli.

Hereditary factors contribute up to about 30% and increase the chances that a person will experience social anxiety if they have first-degree relatives who meet criteria for social anxiety disorder.

The individual’s temperament can cause excessive inhibitions when it comes to engaging in new activities or meeting other people. It is often an early sign of social anxiety that appears at an early age, and is expressed as great shyness in front of strangers. The family environment affects the person as, through the observation of his relatives, he adopts dysfunctional reaction mechanisms, such as avoiding social interactions or passive behavior.

Also, the parenting style plays a role, especially if the parents, due to the stress they themselves experience, exercise excessive control over their child, reject them, are overprotective or critical. Negative experiences, usually at an early age, such as separation from parents, family violence or bullying by peers, are factors that trigger anxiety.

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Factors that perpetuate social anxiety

Social anxiety is perpetuated through three basic processes that prevent the individual from discovering that his negative thoughts and predictions are unrealistic, that his fears are exaggerated, or that other people are not hostile:

1. He focuses too much on himself rather than on the social situation he is involved in, turning his attention inwards to observe and control how he feels and how he thinks he appears to others. Thus, he becomes even more aware of the stress he is experiencing, which reinforces his negative thoughts so that he does not communicate with others or notice their positive response.

2. Uses safety behaviors in an attempt to prevent feared outcomes. For example, he prepares topics for discussion, hides his face with his hair or heavy make-up if he is afraid of blushing, holds the coffee cup tightly so that his hands are not shaking, etc. These safety behaviors also negatively affect the people around him, as if he is afraid that he will be boring, he constantly controls and censors what he says and then others think that he is not interested in talking with them and are wary, which reinforces the fear and anxiety he experiences.

3. Avoids participating in social situations. This reaction may reduce anxiety, but the relief is temporary as the discomfort returns in the face of a new social situation, creating a vicious cycle that prevents the person from facing their fears, managing their discomfort, and being functional in his life.

Complications and negative effects of social anxiety

Without treatment, the symptoms of social anxiety can intensify and cause serious problems as the person’s difficulty communicating or interacting with others – family, colleagues, friends – negatively affects their daily life. Also, avoiding social situations prevents opportunities on a personal, professional, social or academic level.

For example, the fear of the interview can deprive you of prospects for professional advancement, the avoidance of meeting new people leads to loneliness, or the frequent avoidance of social situations results in isolation.

Also, using alcohol or other substances as a means of dealing with stress leads to more problems in physical or mental health or in interpersonal relationships. In some cases, anxiety can even lead to depression, self-harm, or suicidal tendencies.

How to deal with social anxiety

Social anxiety can be treated with therapy based on a specific and widely tested protocol.

Through treatment for social anxiety, the individual acquires knowledge and skills that help them to:

  • understand his stress and the effects it has on his life
  • focus his attention on the external environment and not on himself
  • manage worries about the future and challenge negative thoughts by replacing them with more realistic ones
  • reduce self-criticism
  • avoid safety behaviors to establish that his fears are unfounded, that other people are not hostile, or that he has the skills to cope in a social situation
  • deal with traumatic memories
  • use relaxation techniques
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