Understanding the depth of social anxiety: Can therapy help?

"I remember a time when I was feeling anxious to talk on office calls due to the fear of being watched, heard by others, and criticized negatively. I hated the open office culture. I would become self-conscious with tons of questions clouding my mind. Am I speaking too loudly? Did I make any mistakes? Is everyone watching me? "

I believe many of you have been in my shoes. Although social anxiety disorder (SAD) affects many Indians, it is still an alien term with low awareness in India. It is also often misunderstood as shyness, rudeness, or introversion.

It’s important to understand that shyness and introversion are traits; however, SAD is a mental disorder. It is more than shyness, and not all introverts are socially anxious.

While mental illnesses such as anxiety and depression are gaining public attention and understanding, SAD is often unknown and unrecognised by many people as a "mental illness that needs support."

It is hardly spoken of in the context of mental illness in India.

What is Social Anxiety Disorder?

It is the anxiety caused due to the extreme fear of being judged negatively by others. It stems from the fear of being ridiculed or publicly embarrassed in the event of any mistakes made by the individual.

Here are the behavioural symptoms of social anxiety:

• While for some, it may occur during the giving of a public speech, for others, it could be while talking to strangers or in dating scenarios.

• Some may avoid all social events such as parties, group conversations, etc.

• Some may feel anxious about going to school or work.

• Taking the limelight or centre stage or making an entry into rooms could create panic for some.

• Avoiding known faces in the public to skip saying a "Hello"

• Avoiding normal phone calls

• Being too careful not to offend someone.

• Similarly, in the workplace, talking to superiors, giving a presentation, taking a phone call, eating with others in the cafeteria, etc. could cause extreme social anxiety.

• Over-analysis of a social situation and identifying one's flaws

• I was expecting the worst thing to happen during social interactions.

However, everyone does not experience social anxiety symptoms.

Physical symptoms:

Social anxiety can be observed through physical effects on the body, such as:

• Difficulty maintaining eye contact

• Racing heartbeat

• Speech stutter

• Going blank briefly

• Not getting the right words

• Talking too much

• Oversharing

• Laughing or blushing too much

• Sweaty palms

• Shaking

• Speaking too softly,

• Breathing difficulties

• Muscle tension

• Dizziness

• Rigid body posture

Lack of understanding exacerbates the problem.

For example, with back-to-back Indian festivals blocking the calendar, those with extreme SAD may find it difficult to come out of their rooms to meet the cohort of guests. Culturally, we are expected to be warm and exchange casual conversations with guests, which can create panic among individuals with SAD. They are buried in their thoughts: What do they say now? Am I talking too much? Am I making sense?

However, when the individual withdraws from participating in the conversation, it is viewed as rude behaviour by family members.

With such labelling and a lack of understanding from others, people with SAD might feel reluctant to talk about how they feel and further retreat into their shells, which could lower their self-esteem, leading to depressive disorders.

The Causes of Social Anxiety Disorder (SAD):

It typically starts around the teen years, and there is no single cause for it. SAD is a combination of genetic, upbringing, and environmental factors.

• A child is more likely to develop SAD if either parent has one.

• People with an overactive amygdala constantly stay in fear mode and may display higher anxiety levels in social settings.

• Also, medical conditions that draw attention can increase self-consciousness and can cause SAD in individuals.

• SAD could also be learned if the caregivers were overprotective, controlled their children or modelled anxious behaviours in a public setting.

• It may also occur due to early negative experiences such as bullying, teasing, rejection, ridicule, or humiliation.

• Learned behaviours such as taking life seriously and being a perfectionist could lower the tolerance to failure and induce anxiety.

Mental health impacts of Social Anxiety Disorder (SAD)

Low awareness, lack of support, and a safe space to talk about it can adversely impact the mental health of individuals, leading to:

• Low self-esteem

• Depression

• It is difficult to be an assertive communicator.

• Self-criticism

• Heightened sensitivity to criticism

• Isolation

• Weak social skills

• Substance abuse: increased alcohol and drug consumption

• Suicide

When to seek help?

Living with extreme social anxiety can impact work-life and relationships and rob you of the joy of life. If you notice your loved one avoiding work or skipping school or avoiding social situations with family, friends, or co-workers and displaying these social anxiety symptoms, it is important to seek professional support.

Displaying avoidant behaviour can offer temporary comfort, but it also reinforces to the individual their inability to handle triggers healthily.

How to overcome social anxiety? Treatments for SAD

Cognitive-behavioural Therapy (CBT)

CBT is a highly effective form of treatment for social anxiety disorders. By working with a trained psychotherapist, individuals can identify and eliminate negative thoughts and behaviours that cause severe social anxiety and replace negative internal dialogues with positive ones. As therapists understand social anxiety, they can support individuals to manage their fears more constructively. CBT helps individuals self-soothe and imparts coping skills to handle social situations confidently.

Exposure Therapy, a form of CBT, can be used to remove the fear of particular situations. By systematically exposing the individual to situations that they find threatening, the individual learns to overcome social anxiety completely. It provides a long-term solution for treating social anxiety disorder.

For example, if someone fears a conflict and avoids it, exposure therapy will gradually help them to face conflicts and look at disagreements in a more positive light.

At Manoshala, our CBT therapists undertake a multidisciplinary approach based on each client's requirements.

Group Therapy

As we live in a world where sociability through talking is an acceptable form of expression, people with SAD often beat themselves up for not measuring up to the standard. The good news is that painting or learning music can be therapeutic and act as a medium to unleash one's true self. Individuals can express themselves through art, music, and body movement.

At Manoshala, we work with 98 experts from institutions such as Harvard, NYU, and Berkeley. Our experts will take you through various creative interventions to better manage your anxiety.

Book a pre-screening session with us to understand the art therapy that is best for your social anxiety disorder treatment.

Final Thoughts

Living with social anxiety is difficult. It magnifies our fears out of proportion and prevents us from seeing things for what they are. If we don’t learn to question our irrational fears in healthy ways, we run the risk of making bad decisions that can negatively impact our personal and work lives. Hence, it is important to seek help if you or your loved ones display symptoms.

Social anxiety disorder treatments can lower fears and enable people to lead calmer lives. At the same time, it’s also crucial to break the stigma, educate society about social anxiety, and foster conversations around it.

References:

1. Social Anxiety: More than just shyness from National Institute of Mental Health, Link

2. Social Anxiety from NHS, UK, Link

3. Social Anxiety Disorder from Healthline, Link

4. What Is Social Anxiety Disorder or Social Phobia? from WebMD, Link

Written by Padmapriyadarshini