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Social anxiety disorder

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What is social anxiety?

People with social anxiety disorder get so anxious and distressed in social situations that they try to avoid those situations altogether. People can have social anxiety in any situation where they might become the focus of attention and worry about what other people are thinking about them. Usually, this means worrying about being judged negatively by other people, or worrying about behaving in an embarrassing way. A person with social anxiety disorder might be scared of one specific situation (like speaking up in a meeting at work) or lots of different situations (like giving a speech, being watched while writing, eating in front of people). There are three parts to social anxiety: physical sensations; actions and avoidance; thoughts and beliefs. Each of these is discussed in more detail below.

Physical sensations

When we are exposed to a physical threat, our bodies automatically gear up to fight or run away – this is called the fight-or-flight response. We become more alert, our heart starts racing, our muscles tense up, we sweat more, and breathe more quickly. These changes are designed to protect us from danger. They help us to run quickly or fight the “enemy”. But sometimes our fight-or-flight response is activated when it’s not actually helpful (that is, when there is no real danger). When people with social anxiety find themselves in a situation where they are worried they will be judged, their fight-or-flight response is triggered, and they might have some or all of these sensations:

  • racing heart
  • blushing
  • dizziness or feeling faint
  • sweating or hot flushes
  • trembling or shaking
  • mind going ‘blank’
  • nausea or butterflies in the stomach.

Actions and avoidance

Because the feelings associated with the fight-or-flight response are so unpleasant, people’s usual impulse is to want to get away from the situation that is making them anxious. A person with social anxiety might start making up excuses or reasons to avoid eating in public, making a speech or whatever the situation is that makes them anxious. While this might seem sensible, avoiding these situations is actually counterproductive because it stops you from learning that they’re not really dangerous and that even if you get anxious, you can handle it.

Thoughts and beliefs

People with social anxiety often have unhelpful thoughts about their own behaviour or how they are being judged by others. For example:

  • “They must think I look silly and sound pathetic.”
  • “I am going to stuff this up.”
  • “I won’t know what to say.”
  • “Everyone can see how anxious I am.”

You are not alone

If you think that social anxiety might be affecting your life, you are not alone. Social anxiety is one of the most common types of anxiety, and about one in twelve people, [1] or almost 2 million Australians will experience it at some point in their lives. Some research suggests that social anxiety might be even more common in veterans; at one stage or another about one in seven Vietnam veterans have been affected by it [2]. However the rates of current social anxiety is lower in serving members [3] than the community average. Many people with social anxiety suffer from other mental health problems as well; compared to the average person, someone with social anxiety is almost 5 times more likely to have depression, and almost three times as likely to have a problem with drugs or alcohol. [4]

What treatments can help me?

One of the most effective treatments for social anxiety disorder is cognitive behavioural therapy (CBT). This approach recognises that the way we think and act affects the way we feel. With the help of a therapist, through CBT you will learn:

  • to better understand the symptoms, causes and effects of social anxiety
  • to challenge your fears and worries related to the social situations that bother you (e.g., worries that you might say the wrong thing during a job interview and the interviewers will think you’re an idiot)
  • to face the situations that you’re afraid of and usually avoid, in a gradual and manageable way
  • assertiveness and conversational skills (if necessary)
  • a range of relaxation activities including breathing exercises and other strategies to help you manage the physical symptoms of anxiety.

It is generally best to start with psychological treatment however some people need a little extra help to get their anxiety under control, so your doctor may prescribe antidepressant medication to help you manage.

Where do I get help?

  • A GP is always a good place to start when trying to overcome social anxiety, as he or she can make referrals for specialists, and support your efforts with medications if necessary.
  • This website has information on a range of professional care that is available to current and former serving members.

Self-help resources

There are a number of resources you could use on your own or preferably together with your therapist to help you address some of the symptoms of social anxiety.

I reckon I was OK until high school. It was there that I started to get really anxious if I had to do a presentation to the class. I’d worry about it for days and the night before I couldn’t sleep. When it came to the presentation, I’d be sweating, blushing, my mouth would go dry... it was like torture. It felt like everyone in the class was laughing at me. Other social situations were really difficult too. Read Jack's full story here.

 

[1] McEvoy, P. M., Grove, R., & Slade, T. (2011). Epidemiology of anxiety disorders in the Australian general population: Findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45, 957-967.

[2] O'Toole, B. I., Marshall, R. P., Grayson, D. A., Schureck, R. J., Dobson, M., Ffrench, M., . . . Vennard, J. (1996). The Australian Vietnam veterans health study: III. Psychological health of Australian Vietnam veterans and its relationship to combat. International Journal of Epidemiology, 25, 331-339.

[3] McFarlane, A. C., Hodson, S. E., Van Hooff, M., & Davies, C. (2011). Mental health in the Australian Defence Force: 2010 ADF Mental Health and Wellbeing Study: Full report. Canberra: Department of Defence.

[4] Merikangas, K.R., Swanson, S.A. (2010). Comorbidity in anxiety disorders. Behavioural Neurobiology of Anxiety and Its Treatment, 37-59.

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