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Social Anxiety

Social Anxiety • Shyness • Social Awkwardness • Social Phobia

For some people, extreme fear or worry interferes with having satisfying social experiences.  Social anxiety disorder (SAD) or social phobia is the fourth most common mental health issue after depression, alcoholism, and specific phobias.  About 13% of all people will experience social anxiety at some point in their lives.  Typical symptoms include:

  • anxiety and self-consciousness in everyday social situations
  • fear of being watched and judged negatively by others
  • being embarrassed or humiliated by one’s own actions
  • physical symptoms like blushing, profuse sweating, trembling,  nausea, and difficulty talking
  • avoiding situations that have previously caused extreme discomfort.

Social anxiety is viewed on a continuum. On the mild end, people may have a lifelong pattern of shyness with associated mild anxiety.  In the middle of the spectrum, people’s anxiety might be limited to one specific social situation such as public speaking or attending office parties.  In the most severe cases, people may experience intense fear and avoidance of almost all social interactions.  SAD often co-exists with other mental health issues such as depression or drug use.

A form of psychotherapy called Cognitive-Behavioral Therapy is highly effective in helping to reduce the symptoms of SAD.  In therapy, people are taught to identify the thoughts that contribute to the feared social situations.  They also learn to objectively evaluate distorted beliefs about the feared stimulus.  Behavioral techniques such as gradual, planned exposure to the feared situation help individuals experience positive reinforcement to coincide with the changes in their beliefs.

How do I know if I should seek out treatment for social anxiety?

People often seek help when their fear or worry becomes so overwhelming that it affects their ability to function in school or work situations at a satisfactory level.

What could I expect if I decide to seek out psychotherapy for social anxiety?

Cognitive behavioral therapy for the treatment of social anxiety is focused on alleviating the symptoms of anxiety in social situations.  As a problem-focused treatment, it tends to be short-term ranging from just a few sessions for the mild cases to upwards of a year for the more severe cases.  Your therapist will assess whether one-on-one therapy is most appropriate for you.  Group therapy and social skills training classes can also be additional components to your treatment plan.

Can medications help in the treatment of social anxiety?

Some anti-depression and anti-anxiety medications such as the SSRI’s can be effective treatment for social anxiety. Research shows that a combination of psychiatric medication and cognitive behavioral therapy can have the most beneficial effect in decreasing social anxiety symptoms.  Consult with your psychotherapist and healthcare provider or psychiatrist to discuss if the combination treatment is appropriate for you.

Questions to ask yourself about your social anxiety:

“Do I become anxious in anticipation of or while involved  in a social or performance situation?”

“Do I avoid social or performance situations , being the center of attention, or talking with people?”

“Am I overly concerned about doing or saying something embarrassing or humiliating in front of others?”

“Do I think other’s might think badly of me for what I do or say?”

“Does my anxiety about social or performance situations interfere with my ability to participate in work  or social activities?”

If you answer “yes” to one or more of these questions, consider being evaluated for SAD by a licensed mental health professional experienced in treating this disorder.

This article is written by John R. Montopoli, LMFT, LPCC

John R. Montopoli is a Licensed Marriage and Family Therapist (CA License MFC # 39800 & LPC # 317) in private practice.  He has helped clients recover from anxiety disorders for over 14 years.  John has completed an intensive training program at the Beck Institute for Cognitive Therapy and Research in Philadelphia, PA, under the direction of Aaron Beck, MD, one of the pioneers in the field of Cognitive therapy. He has also received training from the San Francisco Bay Area Center for Cognitive Therapy.  His practice is located in the Pacific Heights area of San Francisco.