RELEASING YOURSELF FROM SOCIAL ANXIETY DISORDER: So That It No Longer Defines or Confines You

F   E   A   R

False   Evidence   Appearing   Real

Mental health professionals are observing and reporting a meteoric rise in rates of anxiety disorders (both in children and adults). Anxiety disorders have a deep biological underpinning and can be described as chronic intermittent disorders. Interference in day-to-day functioning is an important criterion in the diagnosis of an anxiety disorder. In this article, I will be discussing Social Anxiety Disorder (SAD), a type of anxiety disorder that is also known as social phobia. Before specifically addressing SAD, it is important to keep mindful of:  

Anything you do that is helpful for managing overall states of anxiety will help in managing social anxiety. 

A regulated nervous system is key to long-term anxiety management; regardless of the nature of the stressor. 

Self-Care plays an important role in supporting treatment.

SOCIAL ANXIETY DISORDER CHARACTERISTICS & DIAGNOSIS

Social Anxiety Disorder (SAD) is characterized by an intense fear of and avoidance of social situations and a negative self-perception. Individuals with SAD are extremely self-conscious and they fear being negatively judged by others or becoming embarrassed. Feelings of inadequacy and low self-esteem are part of the clinical picture. The intensity of the fear can be so overwhelming that it interferes with one's daily activities, relationships and overall quality of life. Meeting new people, speaking in public, or even arranging to meet friends and colleagues for dinner or drinks can create an internal cascade and release of stress hormones, signaling panic. Diagnosis of SAD requires a period of 6 months or more of demonstrating the characteristics stated above. 

Of great concern is the current epidemic of isolation and loneliness that so many are currently experiencing, leading to mental and physical health complications and breakdowns. For those with SAD, the situation becomes more complicated. 

Individuals with SAD are not choosing isolation or to remove themselves from others, as would be the case for those with personality features involving extreme introversion.  

Due to fear and trepidation, they are avoiding social situations. They seek the same social connections as others; but are unfortunately debilitated by the intensity of their distress. Those with SAD tend to engage in protracted negative reflections before attending and after leaving social events. Whereas almost everyone self-reflects when it comes to interactions with others, the self-language and rumination of the individual with SAD tends to focus on the most negative aspects of the exchange. There is both anticipatory anxiety leading up to the social interaction and self-reflective anxiety afterward. 

Often misunderstood by friends, colleagues and family members who do not experience social anxiety and have little understanding as to how something that should be fun or, at least, not at all anxiety provoking, such as a birthday celebration gathering, can create such internal havoc and dysregulation in the individual with SAD. 

Often well-intentioned but largely misinformed, their response will be to minimize or downplay the reaction, offering simple suggestions to help the person get over the fear. Unfortunately, the minimization and downplaying of the distress and apprehension only serve to heighten feelings of inadequacy and shame. 

PHYSICAL SYMPTOMS OF SAD

The anxiety can trigger physical symptoms such as, but certainly not limited to: 

• rapid heart rate
• sweating 
• trembling or shaking
• difficulty speaking
• freezing  

PREVALENCE RATE & CAUSE 

Approximately 15 million adults in the USA are affected by SAD. If left untreated, social anxiety typically remains stable and persistent across one's lifespan. Without intervention, SAD does not tend to go away. It is unfortunately both common and debilitating, and its prevalence is growing fast. Most cases occur by the time the individual has reached 23 years old, with the experiencing of symptoms occurring in early adolescence. In young children, it can present itself as school refusal, tears and tantrums, and/or clinging to parents (as is often observed in those diagnosed with Separation Anxiety Disorder).

Genetics play a large role. A family history of anxiety disorders increases the risk. Additional factors can include past experiences with negative social interactions, bullying and trauma. 

MANAGING SOCIAL ANXIETY

If you believe SAD describes you, then do not be disheartened. There are actions you can take right now to help. First and foremost is to seek psychological treatment. By working with a skilled mental health professional, you will increase your chances for success. Anxiety disorders, especially SAD, are difficult to treat on their own. With so many treatments available today, especially ones rooted in trauma therapy, there is no reason for you to suffer alone and not get the help needed to live a full and joyful life. Also, there are well documented lifestyle habits that help mitigate the effects of anxiety. These are not quick fixes but they are helpful in rewiring and regulating the setting within your brain; the amygdala, that quickly and erroneously warns of danger. 

Current research in neuroscience is supporting that the practices of mindfulness, meditation and yoga help regulate a dysregulated mind and body. Furthermore, advances depicting the power of neuroplasticity show us that the brain and neuronal patterns can change at any age. 

If neurons that fire together, wire together, then perhaps what we need now is a new pattern of neuronal firing to lead to new wiring. This is the pathway to anxiety management. Imagine not only not feeing anxious when meeting new people or interacting socially but actually LOOKING FORWARD TO IT! This is a game-changer. This can become your new pattern. 

Let's read further and delve deeper into these interventions. 

PSYCHOTHERAPY 

Your best first step (for you or your child who has SAD) is to schedule an appointment with a mental health provider whose specialties include the assessment and treatment of anxiety and anxiety related disorders. 

Cognitive-behavioral therapy (CBT) is typically the gold-standard.  It is one of the subcategories of talk-therapy. Your treating therapist will in all likelihood recommend exposure therapy (which we will discuss in the next section), and may recommend trauma based therapy (in addition to talk therapy or instead of), a support group and/or a medication consultation with a psychiatrist to determine if medication may be suitable for your (or your child's situation). Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), may be helpful. 

Children with SAD can also benefit from CBT but, depending on age, their therapy may be Play Therapy; a form of therapy specialized for young children. 

 EXPOSURE THERAPY 

Exposure therapy is an intervention in which anxious individuals strategically "expose" themselves to their fears. It is the antidote to avoidance behaviors (which only serve to strengthen the fear). In therapy, an agreed upon plan is created to help you move in small, forward steps in the direction of your fear in order to conquer it. In circumstances such as social anxiety, I like to advise my clients to find a trusted family member or friend to help you with your exposure therapy. YOU DO NOT HAVE TO DO THIS ALONE. Reach out and ask for help. Do not view yourself as a burden. MOST people enjoy helping. 

A non-anxious, accountability partner who agrees to go with you to the next social function, exercise class or lecture can make all the difference in the world. Create a plan beforehand and communicate your needs to this trusted individual. For example, you can say, "When you see me freeze while speaking, please step in and take over the conversation." This allows for the safety net needed to help reduce the possibility of perceived embarrassment. 

Gradually work your way up to increased social interactions. Initially, start slow. Begin with less intimidating events. 

As you gain more confidence, you will take on more challenging situations. For example, if there is an outdoor workout class you would like to attend, ask your accountability buddy to join you. Together, you will do this and, as a bonus, you will get a great workout. 

Over time, as you gradually "expose" yourself to these situations (and as your mirror neurons watch your accountability partner navigate social circumstances), you may find yourself feeling more confident and motivated to move forward in these settings.

 YOGA  

Yoga, a deeply rooted, healing practice emphasizing the mind-body connection, incorporating postures, breathing, and meditation, originated thousands of years ago and may be one of the most healing interventions you can weave into your life to significantly reduce anxiety, stress, tension and dysregulation. Yoga both strengthens the nervous system while simultaneously calming it. A stronger and calmer nervous system is one of the greatest gifts you can give yourself. 

Using magnetic resonance spectroscopic imaging, researchers at Boston University School of Medicine (BUSM) found that practicing yoga may elevate gamma-aminobutyric (GABA) levels. 

Why is this important? Because GABA is a natural brain relaxant that helps you feel good. Higher levels of GABA translate into elevated feelings of calm.

The physical practice of yoga can be viewed as a moving meditation, connecting breath with movement. Pranayama is the formal practice of managing the breath, and a steady, rhythmic breath is central to yoga. Its consistent practice yields compounding results, meaning each and every time you participate in this moving meditation, you're decreasing the negative effects of stress. The Ujjayi (or ocean) breath is the most common form of breath control used in yoga. It can help bring calmness to your mind and body.

Here is a basic guide to accessing this breath:

• Get into a comfortable seated position.

• Breathe in through your nose and exhale through your mouth. Imagine you are fogging a mirror with your breath.

• When breathing, inhale to contract the diaphragm to create space for your lungs to expand, and when you exhale, relax the diaphragm and gently push the air from your lungs.

• Inhale and exhale to a slow count of 4.

Yoga has a powerful effect on both mind and body, regardless of your present level of health or fitness. A fairly inexpensive and easily accessible intervention with a plethora of benefits and few  (if any) side-effects if practiced responsibly, yoga has been shown to promote good health in as little as a few hours per week.  Whether practiced privately or within a group setting, in-studio or on-line, yoga's popularity has made it increasingly available. Perhaps, before your next anticipated "stressful" social situation, scheduling a 60-minute yoga class beforehand may offer you the calm feelings you need to confidently feel your best at this event. 

MINDFULNESS & MEDITATION

The enigmatic practice of meditation, rooted in deep cultural and religious history as a pathway toward enlightenment, has found itself in modern times more commonly used to manage stress and induce relaxation. Meditation is a mental training involving quieting and slowing down the mind. Mindfulness describes a specific manner of living that is cultivated through this system.

Meditation allows you to slow down; to go inwardly, accessing deeper insights. In contrast to a time-out, it’s more of a time-in.  The combination of mindfulness and meditation is a powerful antidote to stress and anxiety! Incorporating a daily practice will go along way in helping to re-regulate your nervous system. When your nervous system is regulated, spikes in anxiety significantly decrease. This will be your best ally in social situations. 

There are many different types of meditation, mostly falling under the categories of guided and unguided (or silent). The relaxation component of meditation, in its many forms, provides long-lasting health benefits to the mind and body, including increasing volume in brain regions, reducing anxiety and depression, and improving immune function.

While there is not a universally accepted or "best" method, there are components to meditation that are consistent across practices. They include: focused attention, breath awareness, quiet and comfortable setting, and an attitude of non-judgment or "observer." The "best" meditation is the one that is "best" for you and the one that you will consistently do. As you move away from the distracting and critical inner-dialogue to a state of mind of non-judgment and acceptance, you will help reduce the more debilitating aspects of SAD, which is the negative and ruminative self-talk. 

A quiet place and a comfortable seat are all you need to begin this practice.

• Sit or lie comfortably.

• Focus your attention on your breath and on how your body moves with each inhalation and exhalation.

• Breathe naturally.

• Notice when your mind and thoughts wander and bring your attention back to your breath.

• Add Aromatherapy. Aromatherapy is the use of essential oils or other aromatic plant compounds for healing and wellness. Certain fragrances have been shown to have a clinically quantifiable effect on mood. Incorporating aromatherapy into your meditation practice may help facilitate feelings of calm and relaxation through its primary processing pathway, the olfactory system.The olfactory bulb (an essential structure of the olfactory system) is directly connected to the amygdala and hippocampus. For purposes of relaxation, lavender is typically the aromatherapy expert's go-to scent. 

        Aromatherapy Bonus

Once your brain and nervous system pair your relaxed state with a certain scent,    you will be able to take this scent with you (by adding a few drops to a cotton ball) to the anticipated stressful social event and obtain the relief needed just by smelling and inhaling the scent. The scent's  molecules will travel from the olfactory nerves directly to your brain and especially to your hippocampus and amygdala (the memory and emotional center). The pairing of the relaxation-scent should help bring immediate relief. Be patient, however, it takes time to create the association. 

EMOTIONAL SUPPORT DOG

An emotional support dog can be a valuable companion for someone with social anxiety. Dogs offer unconditional love and non-judgmental support. They easily inspire conversation in social settings and can help you meet and talk with others while allowing the focus to be on your cute and eager companion and off of you. Dogs also provide a comforting presence, helping to reduce feelings of isolation and loneliness. 

Loving and living with a pet is good for your nervous system and brain. Most of us do not need research to support this claim. We know firsthand the benefits we feel when petting, interacting and/or playing with, and caring for our companion animals. However, just because we feel it to be true, it's helpful to know that science confirms this. When petting, playing or cuddling with your pet, an increase in the release of oxytocin can take place. This contributes to the strong emotional bond and attachment you will share with your pet that serves to improve well-being and positive feelings.

Oxytocin, often referred to as the "love hormone" or the "bonding hormone," is released when we interact with our pets. Its release helps us feel more connected to others, empathic, trusting, and generous. Additional health benefits include the lowering of heart rate and blood pressure, more regulated breathing and overall stress relief. 

Positive interactions with our pets help stimulate the release of dopamine, the neurotransmitter associated with pleasure and reward. Simply being in the presence of your pet can release dopamine. Dopamine also plays a role in learning, motivation, mood, sleep, and concentration.

While oxytocin and dopamine are important, interacting with our pets also boosts endorphins (your body's natural painkiller) and serotonin, which help to ward off depression and depressive feelings, as well as reduce anxiety. 

While I help outline the benefits of an emotional support pet, it is important to note that for practicality purposes adopting a dog will not be for everyone. There is a considerable amount of commitment, care and financial resources that are needed to keep your dog healthy and happy. Although most love the idea of a companion canine, the added stress of caring for one may end up being counterproductive in the management of anxiety. 

THE GIFT OF SOCIALLY CONNECTING 

Be kind and patient with yourself. You did not ask for this condition. And the mission here is not to transform you into a social butterfly. Your goal is to be you and bring the best you in your engagement with others and your world. If anxiety is part of the equation, then with acceptance, allow it to be. However, you will not want it to dominate your essence or your life. It can tag along and quietly hang out. Many have lived highly productive and joyful lives knowing they are managing their levels of anxiety. Or, you may find that its effects on your life have become so imperceptible that it no longer requires any effort on your part to manage it.  Either way, it no longer defines or confines you. Success has been achieved! 

Practice self-compassion and self-care and remind yourself that with time, effort and support, you can overcome SAD. Acknowledge and celebrate each success in your forward movement. Before you know it, you will be finding yourself more peacefully engaging with others and reaping the rich benefits of social connections. 

The information presented in this blog is intended for general knowledge and is not a substitute for medical advice or treatment. As with most things in life, there isn't a magic pill or "cure-all" but there are strategies to help regain control of your life.

REFERENCEs

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Anxiety and Depression Association of America. (2022, October 28). Anxiety Disorders - Facts and Statistics. https://adaa.org/understanding-anxiety/facts-statistics

Boston University. "Yoga May Elevate Brain GABA Levels, Suggesting Possible Treatment For Depression." ScienceDaily,  22 May 2007

Morrison, A. S., Mateen, M. A., Brozovich, F. A., Zaki, J., Goldin, P. R., Heimberg, R. G., et al. (2019). Changes in empathy mediate the effects of cognitive-behavioral group therapy but not mindfulness-based stress reduction for social anxiety disorder. Behav. Ther. 50, 1098–1111. doi: 10.1016/j.beth.2019.05.005

Radtke, S. R., Strege, M. V., and Ollendick, T. H. (2020). “Exposure therapy for children and adolescents with social anxiety disorder,” in Exposure Therapy for Children with Anxiety and OCD, eds T. S. Peris, E. A. Storch, and J. F. McGuire (Amsterdam: Elsevier), 193–219.

Rapee, R. M., and Spence, S. H. (2004). The etiology of social phobia: empirical evidence and an initial model. Clin. Psychol. Rev. 24, 737–767.

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