Maybe there is something big coming up — a speech, a big decision, a sensitive conversation with a loved one or a co-worker — that dominates your thoughts.
This is anxiety. Worrying on occasion is a very human response to challenging circumstances.
When this sensation often or constantly gets in the way of enjoying everyday events involving other people, it can become a barrier to work, family life and friendships.
Social anxiety disorder affects an estimated 12.1% of people aged 18 or older in the United States in their lifetimes. More than 7% have dealt with it in the last year.
What is it, exactly? How do you know when you or a loved one is struggling? What can you do to help yourself or the person with the disorder?
We talked with Michelle Hinseth, a mental health counselor at Sanford Vermillion Clinic, about social anxiety disorder and how to effectively manage it.
What is social anxiety disorder?
Social anxiety disorder most often begins with a fear of social settings. It causes people to want to avoid large crowds, busy stores, parties — essentially any setting that involves other people and makes them feel uncomfortable.
“It can be a panic that even includes interaction with friends or co-workers seen regularly,” Hinseth said. “It usually comes down to a fear of feeling rejected or judged or that they’re going to embarrass or humiliate themselves. It can have a huge impact on daily life. For those struggling with it, any exchange can create an intense amount of anxiety.”
Being bombarded with what Hinseth calls “perfectly curated people” on television and via the internet can play a role in setting unrealistic expectations for interaction with others.
“When you’re watching someone deal with a situation smoothly, sometimes you neglect to remember you’re watching a video that might have taken 10 takes to get right,” she said. “People expect they’re going to be able to walk into a situation and not have any awkwardness — that there will be no strange parts of the conversation. That’s unrealistic. We’re human. We’re going to have those funny moments where we’re at a loss for words, or we put our foot in our mouth.”
Signs and symptoms of social anxiety
High anxiety levels in anticipation of a social situation are an indication an individual is experiencing social anxiety disorder.
Most often it manifests itself in avoidance. People will not attend an event because of the social anxiety they’re feeling or will tolerate an event as best they can but with great discomfort.
“People will also worry that their anxiety is going to cause others to look at them and form negative evaluations,” Hinseth said. “The anxiety itself begets further worry. It is, ‘Well, what if they notice how nervous I am and I start to stumble over my words?’ It can have a snowball effect.”
According to the National Institute of Mental Health, people with social anxiety disorder may:
- Blush, sweat, or tremble.
- Have a rapid heart rate.
- Feel their “mind going blank” or feel sick to their stomach.
- Have a rigid body posture or speak with an overly soft voice.
- Find it difficult to make eye contact, be around people they don’t know, or talk to people in social situations, even when they want to.
- Feel self-consciousness or fear that people will judge them negatively.
- Avoid places where there are other people.
Avoidance of uncomfortable situations is one solution for eliminating anxiety but not the only one, nor is it always the best one.
“I always try to tell people that they should try to gauge it so that they don’t bail out of a situation too quickly,” Hinseth said. “Avoidance can create a negative cycle of its own.”
“Toughing it out” in some instances can have long-term quality-of-life benefits.
“There can be an element of exposure therapy,” Hinseth said. “We can learn how to handle some situations even when we’re scared. With practice, or with having a safe person with you to be your buffer or anchor point, it can be an effective strategy.”
How can you tell if a child has social anxiety?
It is normal for a child to feel anxious about interacting with adults. The stress of talking to a teacher or a coach is not the same as stressing out about going to a birthday party with peers.
“A lot of times you may not see any signs of social anxiety until a child is in middle school,” Hinseth said. “Before then most kids can stay within their comfortable social circles. When you start getting older, however, you get exposed to more situations and more people. That’s when you may notice if it’s going to be a problem.”
The signs are often the same as they are for adults. Kids will want to avoid situations that make them feel self-conscious. This can include a reluctance to contribute to class discussions, or acting withdrawn. Physical symptoms can include sweating, shaking, nausea and a racing heartbeat.
What are people with social anxiety feeling?
Mentally, the battles within can feel overwhelming.
“There is usually a lot of over-analysis or over-thinking,” Hinseth said. “People will try to prepare for every possible scenario they might encounter. It’s done as a way of trying to overcome anxiety, but trying to come up with all those scenarios can create its own complications.”
It can be brought on by something as routine as a visit to the grocery store. The individual dealing with social anxiety may have experienced panic at the store the last time and is now avoiding the store because of what happened before.
“It’s a belief that people are going to have a negative impression of you in some way,” Hinseth said. “As with anxiety in most regards, most often you’re overestimating how likely this situation will be a negative experience vs. a neutral or positive experience.”
How can people reduce the effects of social anxiety?
Education and communication are great places to start. Learning more about social anxiety disorder via reputable medical organizations can provide a better handle on what is going on. Hinseth encourages individuals to be open to talking about how they’re feeling with someone they trust.
“A lot of times a loved one will be able to help you,” Hinseth said. “They might be able to talk you through it or help you come up with some ideas that will help you come up with a plan.”
The plan could include having an understanding or arrangement with a loved one where, when things start getting difficult, the person dealing with anxiety can talk to someone on short notice.
“It can be great to have someone who provides you with a ‘we’ll get through this together’ kind of a conversation,” Hinseth said. “Sometimes just saying your thoughts out loud or talking about the things you’re afraid of can make them less scary. Once they’re outside your head and not just bouncing around in there, sometimes they don’t seem quite as bad.”
Access to care — while also maintaining anonymity — is often available from reputable mental health organizations via their websites. Users can often seek online platforms where they can share experiences or seek advice.
“We have more opportunities than ever to seek help anonymously,” Hinseth said. “You can text helplines and gain access to online counseling without face-to-face conversations or even phone calls in many cases.”
How is social anxiety treated?
The first step can be getting a diagnosis from a mental health professional.
Social anxiety disorder is generally treated with psychotherapy, commonly referred to as talk therapy, as well as medication prescribed by providers.
Help can start with a conversation with a primary care provider or a behavioral health professional. Sometimes patients will not want to involve friends or family members because that is one of the sources of anxiety.
“If you can’t quite get a handle on it, or need some support while you try to work on building up your skills and your comfort, medication is certainly an option,” Hinseth said. “You might have other health conditions so you should never rule out having a conversation with your doctor. Doctors can refer people on for additional support. The important thing is to reach out in some form.”
What can people expect in a conversation with a counselor?
Conversations with a counselor can be very specific to social anxiety or can cover a broader range. Hinseth will often begin with a conversation about a patient’s history with other mental health challenges and also explore any family history involving mental health or trauma.
“We try to cover all the bases in our initial appointment,” she said. “That can be challenging because many times you’re meeting that person for the first time. Overall, the conversations can be as broad or narrow as you want them to be.”
Patients always have the option to decline to share anything they’re not ready to talk about.
“Primarily our conversations are about their history, their symptoms and what they’ve been experiencing recently,” Hinseth said. “We want to know what led them to finally make that phone call to set up an appointment.”
Individuals who want to know more about care options can visit Sanford Health behavioral health services.
Learn more
- Childhood anxiety: Tips for parents on signs & coping skills
- Warning signs and ways to manage stress
- NFL prospect overcomes mental health issues on path to pros
…
Posted In Behavioral Health, Family Medicine, Healthy Living, Internal Medicine, Vermillion
