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October 2011: Wellness Section

How to deal with and treat social anxiety disorder.

Social Anxiety Disorder
Many people get nervous or self-conscious on occasion. Public speaking or interviewing for a new job can cause even the most relaxed person to feel some anxiety. But Social Anxiety Disorder (SAD) is more than just shyness or occasional nerves. It’s an intense fear of embarrassing yourself – intense enough to avoid any situation that might trigger these feelings.

Jillian, for example, won’t be attending the first day of college classes because she knows that in some of her classes the professor will instruct them to go around the room and introduce themselves. Just thinking about sitting there, waiting to introduce herself to a roomful of strangers who will be staring at her makes her nauseous. She knows she won’t be able to think clearly because her anxiety will be so high, and she is sure she will leave out important details.  Her voice might even quiver and she will sound scared and tentative. The anxiety is just too much to bear – so she skips the first day of class to avoid the possibility of having to introduce herself.

Social Anxiety Disorder is the third largest psychological problem in the world today. Psychologist Dr. Thomas Richards, founder of the Social Anxiety Institute in Arizona, uses the above case to illustrate how SAD can affect the daily lives of individuals who suffer from it.

Let’s take a look at the causes and symptoms of SAD, and, more importantly, the most effective treatment for this condition.

How do I know if I have Social Anxiety Disorder?
Some famous people have come forward to discuss their experience with SAD with the hope that more people will seek help and overcome their symptoms (currently only 25% of people with the disorder ever receive treatment).

Singer Barbra Streisand has become more open over the last 10 years about her experience with SAD, as well as actors Kim Basinger and Sir Laurence Olivier. Khalil Greene, a shortstop for the St. Louis Cardinals was placed on the disabled list in 2009 because of Social Anxiety Disorder and NFL player Ricky Williams, winner of the Heisman Trophy, has publicly described the effects of SAD on his football career.

Social Anxiety Disorder usually begins during the teenage years, although it may start in childhood and it is believed to be the result of a combination of factors, both genetic and environmental. Researchers have discovered that an imbalance in the neurotransmitter serotonin, a brain chemical that regulates mood and emotions, may play a major role in the development of SAD.

Environmental factors such as having an overly critical, controlling or protective parent, being bullied as a child or intense family conflict can also increase your risk of developing SAD. It tends to run in families so you may not need to look very far for the origins in your own life.

The emotional symptoms of SAD include:

  • Excessive self-consciousness and anxiety in everyday social situations
  • Fear that you’ll act in ways that will embarrass yourself
  • Extreme fear of being watched or judged by others
  • Fear that others will notice that you’re nervous
  • Fear and dread of upcoming events days or weeks in advance

The physical symptoms include:

  • Blushing
  • Sweating or hot flashes
  • Trembling or shaking (including shaky voice)
  • Upset stomach, nausea (i.e. butterflies)
  • Racing heart or tightness in chest
  • Feeling dizzy or faint

What is the best treatment for Social Anxiety Disorder?

The following list will reduce your symptoms of Social Anxiety but it’s very important to use these tools consistently for the greatest benefit. As difficult as it might be, it’s your own hard work that makes the biggest difference.

  1. Challenge your negative thoughts: People with SAD have negative thoughts and beliefs that cause their anxiety to heighten. Challenging these negative thoughts is the first way to reduce the symptoms. Therapists use “Cognitive Behavioral Therapy” to accomplish this during therapy sessions and it is the most effective treatment for this condition. Learning to challenge thoughts such as: “If I speak in the meeting (in class, etc.) I know I’ll end up looking like a fool” or “My voice will start shaking and I’ll humiliate myself” is key. For example, do you know for sure what people are really thinking? Can you predict the future to know that things will go terribly wrong? Obviously none of us are mind readers or fortune tellers and these thoughts just serve to increase anxiety. Pay more attention to these thoughts and challenge them every single time they come up.
  2. Face your fears:  One of the most important things you can do to overcome SAD is to face the social situations you fear rather than to avoid them. In the case of Jillian, she skipped the first day of classes to avoid introducing herself. As difficult as it may be, if she can learn to take the step of facing her fear, the next time will be less difficult.
  3. Make small, but significant lifestyle changes: Getting enough sleep, taking long walks/exercising, eating well and limiting caffeine (which is a stimulant that increases anxiety) will reduce SAD symptoms and improve your overall self-worth.  Check in with yourself – are you living a lifestyle that promotes stress and anxiety or reduces it? Be honest!
  4. Learn relaxation and breathing techniques: When your body becomes anxious, you begin to breathe more quickly.  This throws off the balance of oxygen and carbon dioxide in your body and causes dizziness, feelings of suffocation, increased heart rate and muscle tension.  Learning how to slow down your breathing is essential to managing your symptoms. Practice breathing and relaxation exercises in advance so you can use them when you feel your anxiety begin to rise.
  5. Consider medication: If you have tried the above techniques with only limited success, you may want to consider medication – specifically a type of medication called “Selective Serotonin Reuptake Inhibitors” (SSRI’s). Medicines such as Paxil, Zoloft, Lexapro and Prozac fall into this category. Because the chemicals in the brain are partly to blame for the anxiety you feel, addressing this chemical imbalance is an important part of your treatment

Final thoughts:
If you recognize yourself in this article, you’re not alone. Social Anxiety Disorder is a common medical condition that requires treatment – it is not a sign of personal weakness. Consider addressing your social anxiety today so you don’t have to live life avoiding things that have the potential for bringing you joy and fulfillment.

Diane Lykes is a Principal of Synergy Counseling Associates in Albany where she specializes in individual and couples counseling, educational training and clinical consultation.  She can be reached at 466.3100 or l[email protected].

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