Social anxiety disorder

 

What social anxiety is

People with social anxiety disorder get so anxious and distressed in social situations that they often 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, our usual response is to want to get away from the situation that is making us 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, CBT will help you to learn:

  • to better understand the symptoms, causes and impact 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)
  • 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 usually best to start with psychological treatment, however some people need additional assistance to help manage their anxiety, so your doctor may prescribe antidepressant medication for this purpose.

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.
  • Call Open Arms – Veterans & Families Counselling (formerly VVCS):  1800 011 046.
  • 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.

The High Res website has tools that can help you manage your anxiety and deal with unhelpful thoughts

Take Action: Relax Your Body and Slow Your Breathing to reduce social anxiety

Social anxiety causes a range of physical symptoms that are unpleasant and make it difficult to think clearly.

The Progressive Muscle Relaxation tool teaches you how to tense and relax different muscle groups in your body. The Controlled Breathing tool teaches you how to slow your breathing rate. These tools will help you manage the physical symptoms of anxiety, so you can feel calmer and release tension from your body.

These tools take some practice at first. When you’re starting out it’s best to practice one (or both) of these tools, when you are feeling calm and you are on your own. Once you’ve learnt the skills you can use them to calm yourself down before, during or after social situations - whenever you feel anxious.

You can also access these tools on the High Res app to use on the go.

Take Action: Learn to Think Differently about social situations

The way that you think influences the way you feel. Thinking about social situations in an unhelpful way can make you feel more anxious and more likely to withdraw from others.

Use the Reassess Your Thoughts tool to help you to identify the thoughts about social situations that are making you feel stressed, then start to reassess unhelpful thoughts.

When you’re starting out it’s a good idea to learn the helpful thinking tools when you are on your own and thinking about a situation that is bothering you but isn’t too overwhelming. Once you’ve learned the skills you can apply them to more challenging situations. With practice, you’ll be able to apply these skills when you’re in the midst of social situations.

This tool is also available on the High Res app to use on the go. Look for Quick Ways to Re-assess Your Thoughts. 

Jack’s story...

"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.