Five Ways To Manage Social Anxiety Disorder

Social anxiety disorder, also called social phobia, is a condition that affects millions of people worldwide and can have unique effects on their everyday life and mental health. Problems related to an individual’s professional, social, and personal life can arise due to the symptoms of social anxiety disorder. If you or someone you know is living with social anxiety, it's essential to recognize its impact and take the necessary steps to manage it.

Fortunately, several scientifically supported methods are available for managing social anxiety disorder to help improve the quality of life around family, friends, work performance, and more. In this post, we explore five such approaches that could be beneficial as part of a comprehensive plan for managing social anxiety disorder.

What is social anxiety disorder?

Social anxiety disorder (SAD) is an anxiety disorder that affects how a person feels and behaves around others. It’s important to note that this acronym is also used for seasonal affective disorder, which is a distinct and different condition. In this article, we use SAD exclusively to reference social anxiety disorder.

People with SAD usually feel anxious or uncomfortable in social situations, such as meeting new people, giving a speech, or talking to someone they don’t know. They may also struggle with low self-esteem as a result of their other symptoms. 

The primary characteristic of SAD, as listed in the Diagnostic and Statistical Manual of Mental Disorders, is an intense fear of being judged by others. Because of this, individuals with the disorder may feel self-conscious in public. They may avoid being social or endure those situations with significant discomfort. When they must attend an event, they may feel anticipatory anxiety or imagine the worst outcome possible occurring during their interactions. According to the Anxiety and Depression Association of America, the physical and psychological symptoms of the disorder can lead to an anxiety attack in some social situations.  

There is a big difference between SAD and the concept of “shyness” or simply feeling nervous. Shyness is a normal part of life that usually goes away over time. Social anxiety disorder isn’t just shyness. It is an intense, persistent fear that can significantly impact an individual’s life, as explained by the Substance Abuse and Mental Health Services Administration: “Depending on the severity, some people may find it difficult to go through common, everyday experiences, such as making eye contact, attending gatherings, dating, using public restrooms, starting conversations, or going to work and school.”

Causes 

The cause of SAD is not fully known. However, certain risk factors are thought to contribute to its development, including having a family member with the disorder, altered brain chemistry, and challenging life experiences.  

People with SAD may have specific genes that make them more prone to anxiety disorders. They may also have an imbalance of certain chemicals in the brain, such as serotonin. Serotonin is a neurotransmitter that helps control mood. Low levels of serotonin are linked to anxiety and depression. Abnormalities in the structure and function of certain brain regions—caused by biological and genetic factors—have been connected to social anxiety disorder specifically.

Life experiences and environmental factors also play a role in the development of SAD. For example, people who have experienced trauma or been ridiculed or bullied are more likely to develop SAD. Having parents or other close family members with anxiety disorders may also increase the risk. 

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Symptoms of social anxiety disorder 

The behavioral signs and symptoms of SAD can vary from person to person. However, they usually start during the teenage years or early adulthood. According to the Diagnostic and Statistical Manual of Mental Disorders, to have social anxiety disorder diagnosed, an individual usually must have experienced symptoms for at least six months. 

The most common symptoms include: 

• Intense fear of social situations, such as meeting new people, public speaking, or going on dates 
• Avoidance of social situations out of fear of embarrassment 
• Intense anxiety in anticipation of a social situation
• Physical symptoms such as trembling, shallow breathing, rapid heart rate, sweating, blushing, and stomach upset 
• Fear that others will notice the physical symptoms (particularly what the individual believes are the more noticeable or negative ones)

These symptoms can interfere with school, work, and personal relationships. They can also lead to alcohol or substance use as people try to self-medicate their anxiety. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Treatments

It can be hard to manage anxiety that arises out of the fear of being judged, leaving those with the condition feeling isolated and uncomfortable in social situations. Because they may be averse to everyday interactions, people with social anxiety might have a harder time than others seeking care. Even if they know how to treat social anxiety disorder, the fear of judgment may prevent them from reaching out for help. 

According to the Anxiety and Depression Association of America, “fewer than 5% of people with social anxiety disorder seek treatment in the year following initial onset and more than a third of people report symptoms for 10 or more years before seeking help”. If you believe you’re living with social anxiety, a healthcare professional can provide you with screenings and determine whether further testing (e.g., a physical exam, social anxiety inventory), a diagnosis, and psychological treatment are necessary. 

So, how is social anxiety disorder treated? Experts have identified several research-backed psychological treatments that can help individuals reduce symptoms of—and even overcome—social anxiety. While you may have identified your own techniques for relieving anxiety (for example, physical exercise, support groups, or social skills training), the methods below may be able to work in conjunction with your current routine. 

Medication

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medication for social anxiety disorder.

SSRIs increase serotonin levels, a neurotransmitter that helps control mood, appetite, and sleep, in the brain. They effectively reduce symptoms such as fear, avoidance behavior, physical sensations of fear, and difficulty speaking in social settings. Commonly prescribed SSRIs include fluoxetine, sertraline, and paroxetine. Serotonin and norepinephrine reuptake inhibitors (SNRIs) have also been proven effective in treating social anxiety disorder. 

Benzodiazepines are another type of medication used to treat social anxiety disorder. These anti-anxiety medications work by increasing levels of gamma-aminobutyric acid (GABA) in the brain, reducing overactivity in nerve cells associated with fear and panic. 

Benzodiazepines can be effective for managing severe symptoms but may also cause side effects such as drowsiness or confusion. Benzodiazepines that may be prescribed by a medical or mental health specialist include alprazolam, lorazepam, and diazepam. 

Thought to be particularly effective for the performance anxiety type of social anxiety disorder, beta-blockers are used to treat physical symptoms, such as trembling hands or racing heart rate. Beta-blockers block adrenaline receptors in the body, which helps reduce these physical symptoms without affecting mental processes or emotions.

Examples of commonly prescribed beta blockers include propranolol and atenolol. 

Psychotherapy for social anxiety disorder

Through psychotherapy, people with SAD can gain relief and improved emotional stability. Therapy provides participants with an opportunity to develop their social skills, identify the sources of their feelings, and address symptoms of potential comorbid mental health conditions. 

Cognitive behavioral therapy (CBT) is the most frequently prescribed treatment for SAD and involves practicing techniques to challenge negative thoughts and replace them with more helpful beliefs. By reframing the thought patterns that are underlying negative feelings and behaviors, participants can alleviate and even overcome social phobia. 

This form of talk therapy also works on developing alternative coping strategies for high-anxiety situations such as public speaking or a crowded social gathering.

Other treatments include:

• Dialectical behavior therapy (DBT)

• Eye movement desensitization reprocessing (EMDR), acceptance and commitment therapy (ACT)

• Interpersonal psychotherapy (IPT).

These forms of behavioral therapy provide different but equally effective approaches to managing SAD symptoms while helping the person develop positive relationships with others.

Acceptance and commitment therapy (ACT) 

Acceptance and commitment therapy (ACT) is a form of cognitive behavioral therapy focusing on acceptance and mindfulness. Mindfulness is the ability to feel connected to the present moment without judgment. Acceptance means recognizing and accepting our thoughts and feelings without trying to change them. ACT aims to help people live in the present moment and make value-based choices, even in the face of complex thoughts and feelings. 

Acceptance and commitment therapy can be used alongside other techniques, like progressive muscle relaxation (PMR). In addition to challenges related to mental health, issues connected to physical health can occur in individuals with social anxiety disorder. Because muscle tension can be one of the physical symptoms of the condition, intentionally tensing various muscle groups and relieving that tension can be beneficial. It’s recommended these routines be done for at least 20 minutes, with studies showing this amount of time is effective against the types of stress that techniques like progressive muscle relaxation reduce.  

Another effective companion to ACT is breathing exercises. Because social anxiety can lead to hyperventilation, deep breathing can be beneficial in reducing anxious feelings and returning a person’s breathing to a normal pattern. While there are a number of ways to complete these exercises, the majority focus on slow deep breaths and sustained, even exhales. 

ACT works by potentially helping people change the way they relate to their thoughts and feelings. For example, people with SAD often try to avoid or control their anxiety-related thoughts and feelings. This avoidance can lead to more anxiety and distress over time. A mental health professional practicing ACT can help an individual become more aware of their thoughts and feelings without trying to control or change them.

There is a great deal of research showing that ACT is an effective treatment for SAD. For example, in one study, people who received ACT reported less social anxiety and better quality of life after treatment than those who received no treatment.

Psychodynamic treatments

Psychodynamic treatments are a promising alternative to managing social anxiety disorder. They focus on uncovering unconscious thoughts, feelings, and behaviors that underlie the anxious experiences associated with social interactions.

This form of treatment examines how a person's unique history contributes to their current behavior and looks for new ways to manage emotional conflicts. During psychodynamic sessions, it is crucial for individuals to talk openly and honestly about their thoughts, feelings, and relationships, as this will create an atmosphere of trust between patient and clinician.

Those with social anxiety tend to use psychodynamic treatments as a way to focus on cognitive restructuring; in the process they learn skills through techniques like assertiveness training, which can explicitly target anxiety-related experiences associated with daily living.

It may be an excellent choice for those who have experienced unresolved conflicts in relation to interpersonal interactions, as it centers on understanding underlying processes to recognize issues that may be causing distress.

Exposure therapy 

Exposure therapy is an effective treatment for social anxiety disorder (SAD) which helps individuals to confront their fear of specific situations or objects. This type of therapy aims to get someone out of their “comfort zone” by slowly exposing them to the situation or object they are avoiding. This may allow them to gain mastery over a fear they previously felt anxious about. This can also help them to change anxious thoughts and beliefs toward those things, allowing them to manage their social anxiety disorder more effectively.

Following exposure treatments, people can gain increased self-confidence, improved skills in managing distress, and better-coping strategies that help reduce extreme avoidance behaviors. Additionally, research has found that when combined with cognitive restructuring techniques such as Cognitive Behavioral Therapy (CBT), exposure therapy can be particularly powerful in helping individuals overcome their fears and stressful situations.

How online therapy can help you treat social anxiety disorder

Through online cognitive-behavioral and interpersonal treatments, clients can learn coping skills that can greatly reduce their symptoms and improve health. Some advantages of online social anxiety therapy include improved life quality and relationships, healthier ways to address stress, increased self-awareness and confidence in social situations, and an enhanced ability to cope with upsetting emotions.

Addressing anxiety disorders with online therapy

In addition to these benefits, research has also shown that online therapy is a lasting solution for SAD compared to other interventions. With appropriate treatment from a qualified professional, clients can achieve life-long improvements from their time spent in therapy.

This research suggests that regularly engaging in online therapy helps SAD sufferers respond differently when faced with certain social situations, significantly reducing anxiety levels.

Furthermore, they become better able to isolate and identify problem areas so that every step can be taken toward finding an appropriate solution. Finally, with each session, clients are sent home feeling more prepared to engage selectively and adroitly with others.