Social anxiety disorder (SAD)

“Eventually our anxiety is compounded and made unbearable by our belief that if we were just smarter, stronger, or better, we’d be able to handle everything.”

Brené Brown

Ananya, a fourteen years old girl, attended her friend’s birthday celebration. She returned home hurriedly, threw on her designer shoes and locked herself in a room. She felt people were mocking her dress sense, particularly about her expensive shoes. She was in the room for two days and did not come out. For a normal person, it could be interpreted as Ananya being hyper-reacting. In the realm of medical terms, this is known as Social Anxiety. A mental health issue that is more common in teenagers. Social anxiety is a condition of mind in which a person is constantly concerned about the style of dressing, appearance and feels constantly anxious despite looking most attractive. This anxiety is not only limited to dressing sense, but also about other aspects of one’s personality and life. This anxiety is reinforced by the anxiety of getting ridiculed by society, people, or any other social gatherings where they go. Social anxiety in adults or a teenager can lead to withdrawing from the people around them.

In the same way, Tarun, a 20-year-old was to be the one to address the audience in the elocution contest. When he got on stage, he began sweating heavily and his heart rate intensified. He experienced numbness on his feet and hands. The pain was beyond his control and he was forced to step away from the stage.

It is also possible to brush it off as nervousness, but it’s much more and can be a Social Phobia, which is an anxiety that is often related to people or gatherings.

What is social anxiety?

According to National Institute of Mental Health (NIMH)¹, Social anxiety disorder is an extremely common anxiety disorder. The person suffering from social anxiety disorder may experience feelings of anxiety or fear in situations in which they might be scrutinised, assessed, or judged by others, for example, talking in public and making new acquaintances, dating and going through a job interview, or answering a question in a class or speaking to a cashier at the shop. Things that are routine like drinking or eating in front of other people or using public restrooms could trigger anxiety or fear because of fears of being judged, humiliated or judged.

“You don’t have to control your thoughts. You just have to stop letting them control you.”

Dan Millman

Social Phobia

The fear of social anxiety, also known as “Social Phobia” is far too costly to be conscious of appearance or stage fright. It’s a constant anxiety of being in a social setting or a crowd of new individuals, public speaking, or a crowd or any other individual. Fear of constantly being judged and being scrutinised and watched every minute is one of the primary signs of Social Anxiety Disorder.

Symptoms of Social Anxiety Disorder (SAD)

• Anxiety or fear that is excessive in some or all social situations
• Excessive blushing
• Rapid speech or stammering due to nervousness
• The fear that you will be judged by other people
• Being embarrassed after saying something and feeling ashamed or embarrassed later
• A trembling feeling
• Palpitations
• Feeling uncomfortable when meeting new people
• Attention to detail when you finish an activity.
• Extreme sweating
• Sometimes, to find oneself in confusion about what to say or what to say during a social gathering
• Uncomfortable in crowds, and/or at social gatherings
• Too much focus on the appearance, dress
• Overthinking other opinions or what others might think of you
• The constant fear of being ridiculed by other people
• Do not like being the talk of the town or the centre of attention

Causes of Social Anxiety Disorder

• Over thinking
• Over emphasising the situations in the mind
• Some bad experience from the past
• Very safe guarded brought up child hood
• Lack of socialising with people since childhood
• Stress, anxiety and depression are some of the causes of Social Anxiety

Diagnosis of Social Anxiety Disorder

Now and then, experiencing Social Anxiety is not uncommon, however, if it becomes a constant issue in everyday activities where social events are inevitable, then consulting an expert in Mental Health is an absolute requirement. Your healthcare provider will determine if another condition is responsible for your anxiety, or whether you suffer from social anxiety as well as a different mental or physical health issue. After a thorough examination, the mental health professional will recommend the best treatment option based on your needs.

Your doctor may decide to diagnose you in light of;

• Physical exam to assess whether any medication or medical condition can cause anxiety symptoms.
• Discuss your symptoms and the frequency they are present and in what circumstances
• Questionnaire assessment method
• A review of the list of scenarios to determine whether they cause you to be anxious
• Self-report questionnaires on the signs of anxiety in social situations.
• Criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)², released by the American Psychiatric Association

DSM-5 criteria for the diagnosis of social anxiety disorder

• An ongoing extreme fear or anxiety about certain social situations because you fear that you will be judged poorly, embarrassed, or snubbed
• Avoidance of social situations that trigger anxiety or dealing with them with intense anxiety or fear
• Anxiety that is in contrast to the circumstance
• Stress or anxiety that interferes with your daily life
• Anxiety or fear that is not explained better by the medical condition or medication, or substance abuse

Psychometric assessments like the Social Interaction Anxiety Scale (SIAS) are used to screen for social anxiety. You can take the SIAS on the TickTalkTo app.

Treatment for Social Anxiety Disorder

Treatment is contingent on how much social anxiety disorder impacts the way you function within your everyday life. The most commonly used treatment for social anxiety disorders is psychotherapy (psychological counselling or talk therapy) or medications, or combinations of both for quicker and better outcomes.

Psychotherapy and counselling

Psychotherapy is a well-established method that has seen significant improvements in the majority of people suffering from social anxiety disorders. In therapy, you are taught how to identify and alter your negative self-talk and learn skills that will help you improve your confidence in social situations.

CBT (Cognitive Behavioural Therapy)

Cognitive treatment based on behavioural principles (CBT) is the best kind of psychotherapy to treat anxiety. It’s extremely efficient whether conducted in isolation or groups.

In CBT which is based on exposure, you build toward facing the scenarios that you are most afraid of. This will help you improve your ability to cope with social gatherings, and help you build confidence in dealing with stressful situations. It is also possible to participate in role-playing or training to improve your social abilities and increase your comfort and confidence in your interactions with other people. Experimenting with situations of social interaction in small amounts helps to overcome your fears and ultimately overcome your anxieties.

Medication and Treatment

Many medications are commonly prescribed to treat social Anxiety Disorders. To decrease the chance of adverse negative effects, your Psychiatrist might start you on a low dosage of medication, and then gradually increase your dosage until you reach the full dosage. It can take anywhere from a few weeks to a few months of treatment to allow the symptoms to begin to improve.

Your physician may prescribe additional medications to treat symptoms of social anxiety for example;

Antidepressants

If depression also persists, as does social anxiety disorder then antidepressants can be a component of the treatment.

Anti-anxiety drugs

While they’re often effective quickly, they can also be addictive and sedating, which is why they’re usually prescribed only for temporary usage.

Beta-blockers

Beta-blockers can be prone to bias when it comes to the treatment of SAD. They are effective in blocking the stimulant effects of the hormone epinephrine (adrenaline). They can decrease the heart rate, blood pressure, heart pounding, and shaking of the muscles and voice. Due to this, they can be most effective when employed infrequently to manage symptoms in a specific situation like making an address. They aren’t recommended for the general treatment of anxiety disorders such as social.

Hope is the most important thing

The majority of treatment options for mental health issues are based on a trial-and-error basis due to insecurity. Don’t give up when the treatment isn’t able to show results right away. Keep going with therapy and medications over weeks or even months. The development of new skills to help you manage your anxiety will take time. For certain people, the symptoms of social anxiety can diminish over time and the medication may be stopped. Some may require medications for a long time to avoid the possibility of a relapse. Be in touch with your physician and keep track of any anxiety problems. This will help in conversations and helps to avoid the possibility of relapse.

Lifestyle shifts

Though social anxiety disorder usually requires assistance from an experienced medical professional or psychotherapist, you can test one of these methods to manage situations that may cause symptoms:

• Learn stress-reduction skills.
• Practice mindfulness
• It is important to practice living in the moment
• Do not over-emphasize the problems in your head
• Stop thinking too much
• Being physically active or exercising regularly will help release positive hormones
• Sleep enough.
• Take a balanced and healthy diet.
• Avoid alcohol.
• Avoid or limit caffeine.
• Be social by reaching out to those who you are comfortable with.

Begin with baby steps and practice

The first step is to think about your fears to determine what situations trigger you the most stress. Gradually, you can practice these techniques until they reduce your anxiety. Begin by taking small steps and setting goals for your day or week in situations that aren’t too overwhelming. The more you work at it and practice, the less anxious you’ll be.

Try practising these scenarios:

• Smile at people even if you don’t know them. A smile is always greeted with a smile, and not with a grin.
• Make sure you give genuine compliments to those who are around you
• Reading books helps you gain more knowledge and also provides information about the latest developments.
• In the initial stage stay close family member or friend while you go to a celebration or gathering at which there aren’t many people, or feel uncomfortable.
• Be sure to be the first person to introduce yourself to others and walys make an eye contact while talking to the people.
• Being attentive is an excellent habit. Keenly pay attention and observe how people speak. This will aid you.
• Display an interest in other people.
• Stay up-to-date with the most recent trends in all discussed subjects to ensure you don’t feel secluded in a crowd discussing specific topics.

Prepare yourself for social situations

Being social while you’re anxious can be difficult. However difficult it may appear initially be, you shouldn’t stay away from situations that cause you to feel anxious. When you face these types of circumstances, you’ll develop and strengthen your ability to cope. Social gatherings are a common thing to attend. Find ways to socialize with the people in your vicinity.

These techniques can help you get ready for situations that cause you to be nervous:

• Get ready for a conversation, for instance by studying recent events and identifying interesting stories that you can speak about.
• Make sure you are focusing on the personal qualities that you appreciate about yourself.
• Practice relaxation exercises.
• Learn stress management techniques.
• Set achievable social goals.
• Be aware of the frequency with which uncomfortable situations that you’re afraid to face occur. It’s possible to observe that the scenarios you’re afraid of typically don’t happen.
• If embarrassing situations happen Remember that the emotions will fade and you’ll be able to manage situations until they pass. 
• Don’t drink to calm your nerves. It might work for a short time however over time, it can cause you to feel even more anxious.

Support and Coping techniques

These techniques for dealing with stress can reduce anxiety

• Regularly stay in touch with extended family and friends.
• Find a nearby or well-known support group and join that interest you and where you find like minded people.
• Join a club that provides opportunities to enhance your public speaking and communication skills.
• Engage in hobbies when you’re feeling stressed.
• Get into some social work activities that will instil a sense of belonging, confidence and make you feel good throughout.

As time passes over time, these strategies will help you manage your symptoms and help prevent repeat relapses. Be reminded that you’re able to manage your anxiety and that anxiety will pass quickly and the negative outcomes you are worried about are not likely to come.

Online counselling can help

The shift to online counselling platforms is the newest trend. There are a variety of platforms that provide excellent counselling services. Continue your treatment even during the times of the pandemic from the comfort of your home. Online counselling is equally effective when treating social anxiety disorders and other mental health problems.

The success of therapy depends a lot on your commitment as well as the expertise of the psychologists and psychiatrists. TickTalkTo has curated list of therapists like Dr. Ankita Garg, Era Sharma, Thasneem Kauser, Neeraj Sharma and Jiniya Dikshit, who can help you with anxiety disorders. Download the app and start your therapy journey now.

Humans are social beings, hence begin to mingle and socialise!