May is Mental Health Awareness Month.
For Kristen Rogers, entertainment was a nightmare.
A chance encounter with a colleague made her heart pound so hard she thought it would jump out of her chest. Her mind went blank – she stammered and tried to converse while pools of sweat pooled under her arms. Even spontaneous conversations with close friends or family caused this type of extreme anxiety.
But the consequences were even worse.
“At the end of these interactions, I always felt very embarrassed and ashamed and would spend hours or days wondering why the other person must think I was stupid or incompetent,” Rogers said. “I was so excited, stressed and physically ill – it was an unfortunate cycle.”
Rogers was a teenager when the symptoms began, and they only increased as she grew older. She didn’t date or make many new friends – she didn’t even dance at concerts because she was afraid of everyone watching her. I condemn them.
Rogers suspected she was just a scared person. But when she started seeing a psychiatrist in 2020, she learned it wasn’t just anxiety — she had social anxiety disorder.
What is Social Anxiety Disorder?
Social anxiety disorder (SAD) is the persistent, intense fear of social or performance situations in which a person expects to be watched, judged, or humiliated. For people with SAD, everyday activities such as talking to new people, eating in public, or giving a presentation at work can trigger debilitating anxiety and fear.
“If you have social anxiety disorder, fear of being exposed as inadequate or worrying that others will judge you hinders your life,” said Ellen Hendriksen, Ph.D., psychologist and author of “How to Be Yourself: Quiet Your Inner Critic and Rise Above Social Anxiety.”
Hendriksen said people with social anxiety suffer from stress, impairment or both. In this context, stress refers to discomfort, stress, fear and excitement before, during and/or after a social interaction. Impairment means that social anxiety prevents you from doing things you want to do. “If you turn down a promotion at work because it would require you to go to remote offices and talk to a lot of strangers, then that is a detriment,” said Hendriksen.
People with SAD also experience physical reactions such as blushing, rapid heartbeat, nausea, tremors, lightheadedness, and difficulty speaking in social situations.
“You might feel your stomach tightening, you might turn red, you might sweat — all the classic physical fight-or-flight symptoms,” Hendriksen said.
The symptoms of SAD can vary from person to person and change over time. And while it’s completely normal to feel nervous or anxious from time to time, SAD is a chronic condition that requires treatment.
The root of social anxiety
Social anxiety disorder is not caused by one thing. Instead, SAD is usually a combination of biology, life experiences, and learned patterns, according to Laura Johnson, LMFT, LPCC, cognitive behavioral therapist and author of “Social Anxiety For Dummies.”
In terms of biology, Johnson said people with SAD may be born with a tendency to inhibit. “Social anxiety could be related to an overactive amygdala, the part of the brain that controls your fear response.”
A family history of SAD can also increase the risk. One study found that people with a first-degree relative (parent, sibling) with SAD were up to six times more likely to develop the disorder.
And since SAD usually begins in childhood or early teens, negative life events such as abuse, neglect, or growing up with an illness that attracts unwanted attention, and the way your parents raised you, can be risk factors for SAD.
“Your parents may have influenced the development of social anxiety by modeling anxious behavior, being overprotective, or being critical, among other things,” Johnson said.
Women and social anxiety disorder
SAD affects both men and women, but research shows that women are more likely to suffer from SAD – and have more severe symptoms, as well as higher levels of social anxiety and a greater number of social anxiety – compared to men.
“Many women are subtly – and sometimes not so subtly – taught from a young age to be sociable and personable and not to take up too much space. This can lead them to be overly conscious of how they come across, question their own opinions and hold back in conversations, especially in environments like the workplace where men can dominate or interrupt discussions, which can further increase self-doubt,” Johnson said.
Although SAD typically develops earlier in life, major life events such as moving to a new city or being diagnosed with an illness can trigger symptoms for the first time in adulthood.
“Middle-aged women have likely been suffering from social anxiety disorder for decades. The most important thing to know is that social anxiety disorder is fed and maintained by avoidance. Therefore, it is important that you try to face your fears and reflect on where you have incorporated avoidance into your life,” said Hendriksen.
Social anxiety never goes away – but it can get better
The most common treatments for social anxiety disorder are prescription medication and cognitive behavioral therapy (CBT), which involves identifying and reframing negative or irrational thoughts over time.
“The most effective treatment is cognitive behavioral therapy, especially if it involves exposure,” Johnson said. “This means gradually facing the situations you fear rather than avoiding them, while learning to respond differently to the thoughts that trigger the fear.”
Exposure exercises are about identifying fears and worst-case scenarios in social situations and trying them out to see if the outcome is really as bad as the person with SAD thinks. “It’s about facing our fears, and our feared outcomes are almost always worse than what actually happens. Even if the worst case scenario occurs, we must remember that we can cope and deal with life’s challenges,” Hendriksen said.
For Rogers, CBT made a big difference. “Cognitive behavioral therapy saved my life in many ways,” she said. “I had some early life experiences that really instilled perfectionism in me. Part of that was undoing that and finding relationships and people who are much more open-minded about not everything having to be perfect all the time.”
It’s been six years since Rogers started therapy, and she no longer suffers from social anxiety every day. When she does, it’s not nearly as intense as it used to be. “Sometimes I still choose other ways to avoid conversations or feel weird because I don’t always have something to say when I meet someone, but most of the time I try to start a conversation, whether with strangers or with colleagues,” she said.
Rogers’ advice for anyone struggling with SAD: Find a good cognitive behavioral therapist. “The process can be painful and challenging and sometimes you may not want to hear what the therapist has to say, but it really does get better.”
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