Compassionate Treatment for Social Anxiety Disorder

The symptoms of social anxiety disorder are psychological, behavioral, and physiological responses that continue to contribute to worsening the symptoms themselves over time.

The most common are listed below:

Psychological

• Excessive fear of being judged, embarrassed, or humiliated in social settings
• Significant anticipatory anxiety about upcoming social events, sometimes beginning days before
• Self-consciousness and heightened self-monitoring during interactions
• Believing the worst possible outcome will happen in each social setting
• Reviewing previous social encounters to assess errors or mistakes
• Worrying that others will observe you exhibiting signs of anxiety such as blushing, shaking, or sweating

Behavioral symptoms

• Avoidance of all forms of social interactions or events, or enduring them in extreme distress
• Avoidance of situations involving some form of performance, evaluation, or public display
• Difficulty initiating or sustaining conversations
• Difficulty making eye contact with others
• Using substances or alcohol to help cope with socially stressful situations

Physiological symptoms

• Blushing
• Trembling or shaking
• Sweating
• Racing heart and shortness of breath
• Stomach discomfort
• Muscle tension
• Dizziness
• Difficulty thinking clearly

A major source of discomfort related to physical symptoms for those who suffer from social anxiety is the belief that others will recognize their physiological reactions, creating a vicious cycle where the fear of being recognized as anxious results in the same physical symptoms that cause greater levels of self-consciousness.

The causes of social anxiety disorder lie in a combination of genetics, biological and physiological characteristics, and how we experience our environment, including:

• Genetics — There is a strong genetic link to anxiety disorders, including social anxiety disorder; a family history of anxiety disorders greatly increases the likelihood of developing one.[6]
• Brain structure and function — Research has shown high sensitivity in the brains of those with social anxiety disorder, specifically the amygdala, which processes threats, and may be responding to social cues with the same intensity it would to physical danger.[7]
• Environmental factors  — People who have experienced embarrassing moments, humiliation, social rejection, or bullying as children or adolescents may be more likely to develop social anxiety disorder.[8] Parents modeling anxious behavior and a culture that places great importance on social evaluation may also influence this process.[9]
• Behavioral factors — Avoiding social situations, using “safety” behaviors such as preparing excessively for social interactions, and engaging in post-event processing (replaying past social interactions looking for mistakes) are both symptoms of social anxiety disorder and mechanisms that help reinforce it.[10]

Many people with social anxiety disorder wait many years before deciding to seek clinical assistance due to their tendency to normalize their avoidance behaviors and their conclusion that anxiety is merely a part of their personality. 

Clinical help is appropriate if your social anxiety disorder:

• Interferes with your ability to perform job duties or form and maintain social relationships
• Is causing you to avoid most social interactions
• Has led you to use alcohol or substances as a means to deal with social anxiety
• Is causing anticipatory anxiety before social events
• Is causing you to miss opportunities, professionally, socially, or personally
• Has led to depression or other mental health disorders
• Has caused loved ones to express concern regarding your level of isolation or avoidance

Social anxiety disorder typically does not improve without treatment and usually gets worse over time.[11] Getting treatment earlier rather than later leads to far superior results than delaying until symptoms worsen.

Treatment for social anxiety disorder at Agape starts with a comprehensive clinical evaluation, which includes assessing a client’s triggers for anxiety, their degree of avoidance, any co-occurring conditions, and what they hope to achieve through treatment. 

Each treatment plan reflects the unique needs and recovery goals of each client, and may include:

• Cognitive-Behavioral Therapy (CBT) — Currently recognized as the standard evidence-based therapy for treating social anxiety disorder, CBT targets the cognitive distortions associated with the client’s fears of negative social evaluation, such as overestimating others’ potential negative evaluation and catastrophizing others’ intentions based on ambiguous cues. CBT also helps clients dismantle their avoidance behaviors and replace them with tolerance and confidence.
• Exposure Therapy — Involves systematically exposing clients to feared social situations under controlled conditions where they learn to reduce their fear responses and replace avoidance with tolerance.
• Social Skills Training — Designed to teach clients necessary skills such as communication, assertiveness, and conversation in a supportive, safe environment where they can practice interacting.
• Group Therapy — Often especially effective in treating social anxiety disorder since it creates a safe, supportive environment where clients can interact socially among peers. Through direct participation in group settings, clients confront their fears of social interaction while developing meaningful connections with other group members.