Most of us have experienced stage fright at some point in our lives—that anxiousness when you are about to perform or give a speech. You’re standing on stage and hundreds of eyes are focused only on you. Your palms begin to sweat. Your heart races. Your mouth gets dry. Remember that feeling?
Now, imagine that feeling not only when you’re on stage but when you’re having dinner with a friend in a crowded restaurant. Over there—the guy in the booth next to the kitchen—he’s horrified by the way you chew your food. Everyone’s watching you and judging you. Would you want to put yourself in this situation?
These are the things people with social anxiety disorder deal with every single day, and with the holidays coming, things are even tougher.
What is social anxiety disorder?
According to the Anxiety and Depression Association of America, social anxiety disorder affects roughly 15 million American adults. It is also called social phobia.
Dr. Adeola Adelayo, a psychiatrist with Banner Behavioral Health Hospital in Scottsdale, AZ., says it creates a crippling anxiety that makes it nearly impossible for the sufferer to take part in any social activity or event.
“It is a fear or anxiety when you have to perform or be in a social setting,” Dr. Adelayo said. “In every social situation, they feel judged or critiqued.”
In most cases, Dr. Adelayo explains, social anxiety is a genetic problem, but there are cases where a bad experience can lead to becoming anxious in a social setting. Usually, it starts in pre-adolescence and can be very disabling.
“With stage fright, you can maybe avoid the situation. With social anxiety, it occurs in almost all aspects of a social situation in which one feels watched which is tough to avoid in daily life,” Dr. Adelayo said. “It affects a person’s ability to succeed in life as a key aspect to being human is being social.”
And, when people have these feelings of discomfort in a social situation, physical symptoms typically follow, Dr. Adelayo explains. They may start feeling flushed and sweaty. Their heart can start racing, and they may even have difficulty breathing. Some people feel dizzy and, at the extreme, can pass out from the physical symptoms.
The knowledge of the body’s reaction to these situations causes a cycle of avoidance of the situation, so the physical symptoms do not occur. Often, the person may really want to do the social activity, but the fear of being critiqued coupled with the physical response keeps them away.
How is social anxiety disorder treated?
Dr. Adelayo notes social anxiety is a medical condition, and it needs to be treated like one. It’s beyond just being shy, introverted or nervous about a social situation.
People with social anxiety are often desperate to do the things other people do. The biggest concern with leaving it untreated is the sense of isolation it causes for the sufferer, which in turn, leads to more emotional and psychological problems, including depression, substance abuse or, at the extreme, suicidal intentions.
The good news is social anxiety is treatable in very much the same way depression is treated. A mental health provider will complete an evaluation with the patient to determine what biological, psychological and social symptoms are present, the severity and determine the best course of treatment.
One major tool used is cognitive behavior therapy. As an example, Dr. Adelayo said the therapist helps the patient see that the worst-case scenario is not as bad as they are building it up to be and this can be very anxiety relieving.
“The way you think affects the way you behave,” Dr. Adelayo said. “So, if you change the way you’re thinking about a situation, then it changes the way you respond to it.”
She also explains that people with social anxiety never get to practice what they try to avoid. However, the more you practice being in a social setting, the easier it becomes. The therapist helps them work through the situations causing the anxiety and give them adaptive coping strategies to combat the anxiety.
If the symptoms are severe enough, medications may be recommended while counseling is continued for practice of skills.
Social anxiety and the holidays
When you think of the holidays, you usually think of getting together with friends and family to celebrate. When you have social anxiety, the holidays may bring a host of other issues.
“Holidays are often when people with social anxiety start abusing drugs or alcohol to get through,” Dr. Adelayo said. The social expectations are a lot during the holidays.
Dr. Adelayo offers these tips to her patients to help them get through the holidays:
- Prepare. Do not overwhelm yourself with commitments and understand that you don’t have to attend every gathering. Decide before the holidays begin which social events you want to or have to attend and stick to those. Once you have decided, you can work with a therapist using cognitive behavior therapy to help you get more comfortable with attending the events you have chosen.
- If you take medicines, you want to make sure you take the proper dose. And, make sure to attend your therapy sessions, so you can work through various scenarios that could happen.
- Take a friend. This person is your sidekick and is someone who knows you have social anxiety. They’re there to help you if you need it.
- If it’s a family event, volunteer to arrive early. You can help with preparation and build a comfort level for when the rest of the party arrives. You become part of the preparation and hosting and not stepping into something you’re not comfortable with. It also can help boost self-esteem.
Dr. Adelayo also says using positive affirmations can help. Go ahead and give yourself a pep talk before you go. Tell yourself sweaty palms and a racing heartbeat are OK. It’s just your body’s reaction and not a reason to freak out.
How you can help
You may know someone who has social anxiety. If you want to know what you can do to help them during the holidays, Dr. Adelayo says there are a few things you can do.
If the social anxiety is crippling and stops them from doing things they enjoy doing, suggest they get help. Let them know there is nothing wrong with speaking to a therapist and let them know you’ll support them.
You can also offer to be their wingman. Dr. Adelayo describes this as someone there to help dissolve the heightened sense of scrutiny. You don’t have to speak for them or butt in to every situation, but there’s comfort knowing you are there.
Dr. Adelayo also reminds you the person isn’t just shy or antisocial. It’s important to remember social anxiety is much more, she says.
“This is beyond shyness. Once again, social anxiety is a medical condition and, if it’s severe enough, can be and needs to be treated,” Dr. Adelayo said. “There is help for it, and there is nothing wrong with seeking help to live a happy and healthy life.”
