Social Anxiety: Symptoms, Treatments and Alternative Approaches

You are not alone.

Social anxiety is more than just being shy. It is similar to a "phobia" because a person views social interactions and social situations with apprehension and avoidance. It differs from other specific phobias because it is a lot broader and extends across situations: It is not focused on just one object or specific situation.

Social anxiety entails intense mental and, often, physical responses to various aspects of a social setting. These people are often "embarrassed", and concerned that they are being scrutinized, ostracized, and negatively judged. They have a fear of rejection; a fear of being perceived as awkward or anxious. The feelings occur in social situations or in anticipation of attendance at social affairs. Frequently, after the event, there is a negative self-evaluation; a feeling of social failure and unease.

Discomfort of Social Anxiety

Why Do People Develop Social Anxiety?

Social anxiety is a misperception. The neurologic underpinnings of this particular anxiety disorder are discussed above. Past negative events often set the stage for the development of this problem: Negative interactions with others in the past (especially family), abuse, neglect, trauma, as well as consistent bullying. Continual neural bombardment of these stressful or traumatic events can cause a change in the path and chemistry of neurons, leading to a misperception of others' actions, causing inordinate fear and anxiety.

While it can occur later in life, social anxiety often begins in childhood, resulting from inadequate, intimidating, and/or sometimes abusive relationships within the family, peer group (i.e., bullying), or in schools. All of those relationships can create a "do or die" foundation for future feelings of confidence and future relationships. That is, family, friends, teachers, and counselors often play an integral role in the development of a child’s self-esteem and self-confidence: They can help erode it or they can help build it in ways that you cannot imagine. I have seen both. I am not sure that teachers realize this, or perhaps they forget: They are in a position to identify a child at risk; they can explore those children’s strengths and can help a child build skills to accomplish things that they and others recognize as a gift. This builds a child's world and helps build self-esteem, which often contributes to the foundation of functional adulthood. I was that lucky, shy kid who had a teacher in my life who believed in me when I felt no one else did. I have never forgotten that.

Symptoms of Social Anxiety

 Physical symptoms are not unusual when a socially anxious person is being confronted with interactions they might perceive as uncomfortable, sweating, blushing, tremors, and avoiding eye contact. A person faced with this might avoid speaking, speak softly (others even over-talk). Awareness of these behaviors can make a person even more socially anxious. It can be a vicious cycle.

Social anxiety can be mild, focused on one particular type of social situation or so extreme and pervasive that it interferes with normal functioning at work, in relationships, during a public speaking event, attendance at important events, eating in public, using public restrooms, interacting with the public in general; even going out shopping.

Sometimes social anxiety involves different "rituals". For example, over preparation before an event, cancellation of attendance to a social event; a person may over-prepare, get lost when driving to an event or arrive late (a cancellation of participation at social events), tardiness to an event (a trait which is certainly not exclusive to social anxiety) or a person might drive around the block a few times before arriving.

Approaches and Treatments for Social Anxiety: Symptoms, Treatments, and Alternative Approaches

Whether social phobia is mild or severe—if it’s interfering with daily life—it’s time to take a closer look at social anxiety: symptoms, treatments, and alternative approaches that can help. Talking to a counselor is often a helpful first step in understanding your own experience and exploring support options tailored to your needs.

Whether social phobia is mild or severe—if it’s interfering with daily life—you need to hit it head-on. It’s important to understand the symptoms. Talking to a counselor can be a helpful first step in understanding social anxiety symptoms and in guiding you to treatments and alternative approaches tailored to your needs.

Of course, practice a lot of the self-support measures: Eat nutritionally, get enough sleep (lack of sleep can be a detriment to moods), exercise, and take care of your body in general.

While some of the treatments (below) for general anxiety can be used here, there are also some very specific, often successful treatments available for social phobia (and phobias in general) which are quite different from those used in the treatment of general anxiety. Many of these involve exposure therapy: This type of therapy is done with the support of a counselor who assists a person as they personally confront their feared situations. This systematic desensitization helps make people less sensitive to a situation so they feel more at ease. The exposure sessions can be done several times in one-hour sessions or through one long session. And, they are often done in conjunction with SSRIs and SNRIs and beta-blockers (sometimes used to help symptoms-like a rapid heart rate while public speaking). Although it can be done with no medications at all. There are several exposure therapies.

Toastmasters is a highly esteemed international organization that, among other things, helps individuals with social anxiety engage in their own systematic desensitization. Many members have the same kinds of socialization issues, from public speaking to personal interaction. It is a training ground for speaking with and to others. It is a great self-help approach. You just have to take the first step to go to the first meeting - give them a call.

For social anxiety, the MAYO Clinic also has a great page with various small steps you can take to help yourself.   

Approaches and Treatments for Generalized Anxiety

There are a lot of different approaches to improve general anxiety, which is good because not everyone will respond to one approach, and not everyone will like the same approach. In serious cases, medication along with therapy is the best way to go, but again, not all people care for one or the other.

General Approaches to Anxiety

• First of all, you want to try to attack this early, especially if it is increasing

• Acknowledging your feelings

• Staying present in the moment

• Relaxation exercises, mentioned many times in the above discussion, play a big role in reducing feelings of stress and anxiety:  

           -Deep breathing exercises

           -Progressive muscle relaxation techniques

           -Mindfulness (reportedly helps with your emotional processing and with cognitive flexibility/reaction formation via the brain's prefrontal cortex and limbic areas (especially the amygdala) as evidenced by MRIs),

• Meditation

• Yoga

• Read self-help books

• Social support - Engage with Family, friends, or groups

      (even online)

• A healthy diet and exercise may be involved in

       developing greater neuroplastic patterns so that you can "re-form" your anxious thoughts

• Journaling

• Do things you enjoy

• Avoid alcohol and drugs (these are often a means of self-medication that are used by those who do not want to deal with therapy or other medications for mental health, but they eventually have harmful physical and neurological effects)

• Get enough sleep

• Get Counseling. Sometimes we get into a rut, and our brain keeps circulating the same anxious messages. Counseling helps you "retrain" your brain to learn other patterns and to see things from a different perspective. Some of these approaches include

            CBT  - Cognitive behavioral therapy                                                                                  DBT - Dialectical Behavioral Therapy

            ERT - Emotion Regulatory Therapy

• EMDR (this is an unconventional treatment that often helps. It reportedly helps by decreasing activity in the brain's fear center, the amygdala (especially for trauma).

Over-the-Counter Medicines Which May Help Anxiety

There are no over-the-counter commercial treatments for anxiety except possibly an antihistamine, which will help make a person possibly more relaxed and tired.

• Benadryl/diphenhydramine as directed over the counter

Considered Alternative and Herbal Approaches to Anxiety

• L-Theanine

• ​Lemon balm

• ​Valerian

• Magnesium

• Kava kava

• CBD or medical marijuana

• Vitamins -  Band D and Omega 3s

• Aromatherapy (especially lavender, chamomile, and others)

Prescriptive Treatments for Anxiety

• SSRIs - Selective serotonin reuptake inhibitors.  (common: Celexa/citalopram, Lexapro/escitalopram, Prozac/fluoxetine, Luvox/fluvoxamine, Paxil/paroxetine, Zoloft/sertraline, Trintellix/vortioxetine)These increase the availability of serotonin neurotransmitters for use in the brain. These work by enhancing cortical (thinking) processes (assists well with therapies) and possibly by decreasing excitation in the amygdala (emotion center).

• SNRIs - Serotonin-norepinephrine reuptake inhibitors - (common: Effexor /venlafaxine, Cymbalta/duloxetine, and Pristiq/desvenlafaxine. These medications help decrease activity in the amygdala.

• Other Antianxiety Medications- Remeron/mirtazapine is used off-label for anxiety (not FDA approved for this problem). This medication actually causes greater production of serotonin in the brain. Buspar/buspirone increases serotonin and decreases dopamine (an excitatory neurotransmitter in the amygdala).

• Barbiturates and benzodiazepines increase GABA (these work very well for episodic moments of great anxiety, but both are potentially very addictive and should not be used on an ongoing basis)

There are many medications and many approaches that can help with anxiety. If your anxiety is making your life uncomfortable, if it is causing unhappiness or making it hard to function, talk to someone to see if there might be something you can do to help yourself out of that rut.

Problem with Medications?

• Are you having side effects? Many can cause side effects, especially stomach symptoms in the beginning. Typically, these settle down. However, if your side effects are too bad, especially if you start feeling more anxiety or depression, talk to the person who prescribed them (ideally) or another healthcare provider.

• The medications don't seem to be helping? It typically takes these medications about two to three weeks to start working well. Don't give up and be sure not to skip any doses (you might end up on an emotional roller coaster ride!). If it continues to be ineffective, you may need an increased dose, an add-on medication, or a switch.

• Do you feel blunted? "I don't want to take these medicines. I don't don't seem to feel any emotion". This is a fairly common complaint about antianxiety (and antidepressant) medications. If this is occurring, and you think the loss of feelings is worse than your anxiety, you can have your prescriber change your medication to one that works differently, or you can try some therapy instead.

• I feel great, I think I will come off my medications. Not a good idea. Don't just drop off your medication - it's probably helping. Speak to your prescriber about decreasing it slowly so you don't end up in "shock" (too much of an anxiety rebound). I have met a lot of people who just drop off their medications, and they realize how bad they feel without them.