How do you feel when talking to authority figures? Calling someone you don’t know well? Giving a speech or presentation? Speaking up at a meeting?
For many people, these situations occasion strong feelings of anxiety, and thus are avoided at all costs. As many as one out of 8 people silently suffer from social anxiety disorder (also known as social phobia). After major depression, alcohol dependence, and specific phobia, social anxiety disorder is the most common disorder in the United States - affecting approximately 15 million Americans.
Until 1980, social anxiety disorder (SAD) was unknown to the public and professionals alike - often misconstrued as shyness or introversion. This pervasive disorder is characterized by heightened levels of anxiety that significantly interfere with nearly all aspects of one’s life, including work, school, and personal relationships. This interference is paired feelings of significant distress due to social anxiety.
SAD is primarily a self-focused disorder in which individuals have a significant fear of being embarrassed or looking stupid. This fear causes the person to avoid doing things in front of others or speaking to others. This avoidance often results in crafting a life in which seemingly threatening situations can be avoided. This avoidance inevitably leads to missing out on life - including job opportunities, relationships, hobbies, and furthering one’s education. This avoidance also contributes to secondary problems such as depression, loneliness, social isolation, and substance abuse.
With an early onset (most people with SAD experience symptoms before the age of 18), unless people with SAD receive help, the vicious cycle of fear and avoidance continues throughout a person’s life and creates significant impairments. The costs are clear. SAD has been associated with increased school dropout, poor social integration, lower rates of marriage, increased divorce, and increased suicidal ideation.
Although most people feel some sort of anxiety when going on a first date, interviewing for an important job, or giving a toast at their best friend’s wedding, this anxiety is typically temporary and context specific. For those with SAD, however, this anxiety may occur before, during, and well after the event is over.
Commonly, individuals with SAD ruminate on fears of being evaluated negatively by others, saying the wrong thing, or that their physical symptoms of SAD, for example, sweating, shaky voice, face turning red, will be noticed and evaluated by others. These fears create an enormous amount of suffering and often lead to other problems in the person’s life.
At Stanford University, several randomized controlled trials of psychosocial interventions for SAD are currently under way. These studies provide free, non-pharmacological treatment to adults with SAD. Participants take part in either Cognitive Behavioral Therapy (CBT) or Mindfulness-Based Stress Reduction (MBSR) and have the opportunity to contribute to meaningful research on SAD.
CBT helps in understanding the nature of SAD, noticing one’s thoughts and challenging some of distorted thoughts that generate negative views of oneself. Further, through gradual exposure to anxiety provoking situations that are typically avoided, it becomes possible to develop more accurate and adaptive ways of thinking and behaving.
MBSR helps to train the ability to direct attention from moment to moment without any critical judgment. Through enhancing awareness and acceptance of what is actually happening in the moment, negative self-judgment and rumination is lessened, making it possible to develop more adaptive ways of thinking and behaving. In MBSR, these attentional skills are cultivated by using meditation as a tool.
Though fast acting medication for SAD can provide momentary relief for the physical and emotional discomfort of anxiety, non-pharmacological interventions teach individuals practical skills and tools that may be used in a variety of contexts, including those that create social anxiety.
Empirical results from studies of CBT and MBSR for SAD have shown reductions in negative symptoms such as anxiety, depression, stress, loneliness, emotional reactivity, and increases in positive symptoms including emotion regulation, satisfaction with life, self-esteem, and self-compassion. Additionally, follow-up data suggest that these benefits are sustained one year following treatment.
Stanford University is currently offering free treatment in the form of 12 weeks of group Cognitive Behavioral Therapy (CBT) or 12 weeks of group Mindfulness Based Stress Reduction (MBSR) to adults between the ages of 21 to 55. If you or someone you know has social anxiety disorder, please know that short-term, effective, non-pharmacological treatments exist and can help you or your friend overcome this disorder.