Five Ways To Manage Social Anxiety

Social anxiety disorder, also called social phobia, is a condition that affects millions of people worldwide and can have unique effects on their everyday life and mental health. Problems related to an individual’s professional, social, and personal life can arise due to the symptoms of social anxiety disorder. If you or someone you know is living with social anxiety, recognizing its impact and taking steps to manage the condition can lead to increased quality of life. 

Several scientifically supported methods are available for managing social anxiety disorder to improve connections with loved ones, increase work performance, and positively impact other aspects of daily life. Below, explore five approaches that could be beneficial as part of a comprehensive plan for managing social anxiety disorder.

What is social anxiety?

Social anxiety disorder (SAD) is an anxiety disorder that affects how a person feels and behaves around others. SAD is an acronym also used for seasonal affective disorder, which is a distinct and different condition. In this article, SAD is used exclusively to reference social anxiety disorder.

People with SAD may feel anxious or uncomfortable in social situations, such as meeting new people, giving a speech, or going to social events. They may also struggle with low self-esteem because of these symptoms. 

The primary characteristic of SAD, as listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is an intense fear of being judged by others. Individuals with the disorder may be self-conscious in public. They may endure social situations with significant discomfort or avoid them altogether. When they must attend an event, they may experience anticipatory anxiety or imagine the worst outcome possible occurring during their interactions. According to the Anxiety and Depression Association of America (ADAA), the physical and psychological symptoms of the disorder can lead to an anxiety attack in some social situations.  

Anxiety and social cues

A significant difference exists between SAD and the concept of “shyness” or nervousness. Shyness can be a normal part of life that may go away over time. Social anxiety disorder isn’t shyness. The condition is a mental illness that causes severe, persistent fear that can significantly impact an individual’s life. As explained by the Substance Abuse and Mental Health Services Administration (SAMHSA), “Depending on the severity, some people may find it difficult to go through common, everyday experiences, such as making eye contact, attending gatherings, dating, using public restrooms, starting conversations, or going to work and school” when they’re living with social anxiety disorder. 

Causes of social anxiety disorder  

The cause of social anxiety disorder is not fully known. However, certain risk factors are thought to contribute to its development, including having a family member with the disorder, altered brain chemistry, and challenging life experiences.  

People with SAD may have specific genes that make them more prone to anxiety disorders. They may also have an imbalance of certain chemicals in the brain, such as serotonin. Serotonin is a neurotransmitter that helps control mood. Low levels of serotonin are linked to anxiety and depression. Abnormalities in the structure and function of certain brain regions—caused by biological and genetic factors—have been connected to social anxiety disorder specifically.

Life experiences and environmental factors also play a role in the development of SAD. For example, people who have experienced trauma or been ridiculed or bullied are more likely to develop SAD. Having parents or other close family members with anxiety disorders may also increase the risk. 

Symptoms of social anxiety disorder

The behavioral signs and symptoms of social anxiety disorder can vary from person to person. However, they often become noticeable during the teenage years or early adulthood. According to the Diagnostic and Statistical Manual of Mental Disorders, to have social anxiety disorder diagnosed, an individual must have experienced symptoms for at least six months. 

The most common symptoms of this condition include the following: 

• Intense fear of social situations, such as meeting new people, public speaking, or going on dates 
• Avoidance of social situations out of fear of embarrassment 
• Intense anxiety in anticipation of a social situation
• Physical symptoms like trembling, shallow breathing, rapid heart rate, sweating, blushing, and stomach upset 
• Fear that others will notice the physical symptoms (particularly what the individual believes are the more noticeable or negative ones)

These symptoms can interfere with school, work, and personal relationships. They can also lead to alcohol or substance use as people try to self-medicate their anxiety.

Treatments

Managing anxiety that arises out of the fear of being judged may be difficult to treat, leaving those with the condition isolated and uncomfortable in social situations. Because they may be averse to everyday interactions, people with social anxiety might have difficulty seeking care. Even if they know how to treat social anxiety disorder, the fear of judgment may prevent them from reaching out for help. 

According to the Anxiety and Depression Association of America, close to “5% of people with social anxiety disorder seek treatment in the year following initial onset, and more than a third of people report symptoms for 10 or more years before seeking help.” If you believe you’re living with social anxiety, a healthcare professional can provide you with screenings and determine whether further testing (e.g., a physical exam, social anxiety inventory), a diagnosis, and psychological treatment would benefit you.  

Experts have identified several research-backed psychological treatments that can help individuals reduce symptoms of—and potentially overcome—social anxiety. While you may have identified your own techniques for relieving anxiety (for example, physical exercise, support groups, or social skills training), the methods below may be able to work in conjunction with your current routine. 

Medications

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications for social anxiety disorder. SSRIs increase serotonin levels, a neurotransmitter that helps control mood, appetite, and sleep, in the brain. They may effectively reduce symptoms such as fear, physical manifestations of fear, avoidance behavior, and difficulty speaking in social settings for some people. Serotonin and norepinephrine reuptake inhibitors (SNRIs) have also been proven effective in treating social anxiety disorder. 

Benzodiazepines are another type of medication used to treat social anxiety disorder. These anti-anxiety medications work by increasing levels of gamma-aminobutyric acid (GABA) in the brain, reducing overactivity in nerve cells associated with fear and panic. Benzodiazepines can be effective for managing severe symptoms, but they may also cause side effects, such as drowsiness or confusion. In addition, these medications may have a risk of dependence. Talk to your doctor about these risks if you have been prescribed a benzodiazepine medication. 

Thought to be particularly effective for the performance anxiety type of social anxiety disorder, beta blockers are used to treat physical symptoms, such as tremors and palpitations. Beta blockers block adrenaline receptors in the body, which may reduce these physical symptoms without affecting mental processes or emotions.

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.

Psychotherapy

Through psychotherapy, people with social anxiety disorder may gain mental health relief and improved emotional stability. Therapy provides clients the opportunity to develop their social skills, identify the sources of their feelings, and address symptoms of potential comorbid mental health conditions. Below are several types of therapy that may be useful in treating social anxiety. 

Cognitive-behavioral therapy 

Cognitive-behavioral therapy (CBT) is the most frequently prescribed treatment for SAD and involves practicing techniques to challenge negative thoughts and replace them with more helpful beliefs. By reframing the thought patterns that are underlying negative feelings and behaviors, participants may alleviate symptoms of social phobia. This form of talk therapy also guides clients in developing alternative coping strategies for high-anxiety situations such as public speaking or a crowded social gathering.

Other social anxiety treatments based on the principles of CBT include the following:

• Dialectical behavior therapy (DBT)
• Eye movement desensitization reprocessing (EMDR), acceptance and commitment therapy (ACT)
• Interpersonal psychotherapy (IPT)

These forms of behavioral therapy provide different but effective approaches to managing symptoms of social anxiety while helping clients develop positive relationships with others.

Acceptance and commitment therapy (ACT) 

Acceptance and commitment therapy (ACT) is a form of talk therapy focused on acceptance and mindfulness. Mindfulness is the ability to be connected to the present moment without judgment. Acceptance means recognizing and accepting thoughts, feelings, and symptoms without trying to change them. ACT aims to help people live in the present moment and make value-based choices, even in the face of complex thoughts and feelings. 

Acceptance and commitment therapy can be used alongside other techniques, like progressive muscle relaxation (PMR). In addition to challenges related to mental health, issues connected to physical health can occur in individuals with social anxiety disorder. Because muscle tension can be one of the physical symptoms of the condition, intentionally tensing various muscle groups and relieving that tension can be beneficial. It’s recommended that these routines be done for at least 20 minutes, with studies showing this amount of time is effective against the types of stress that techniques like progressive muscle relaxation reduce.  

Another effective companion to ACT is breathing exercises. Because social anxiety can lead to hyperventilation, deep breathing can be beneficial in reducing anxious feelings and returning a person’s breathing to a normal pattern. While there are a number of ways to complete these exercises, the majority focus on slow, deep breaths and sustained exhales. 

ACT works by potentially helping people change the way they relate to their thoughts and feelings. For example, people with SAD often try to avoid or control their anxiety-related thoughts and feelings. This avoidance can lead to more anxiety and distress over time. A mental health professional practicing ACT can help an individual become more aware of their thoughts and feelings without trying to control or change them.

Research shows that ACT is an effective treatment for SAD. For example, in one study, people who received ACT reported less social anxiety and better quality of life after treatment than those who received no treatment.

Psychodynamic treatments

Psychodynamic treatments are an alternative to manage symptoms of social anxiety disorder. They focus on uncovering unconscious thoughts, feelings, and behaviors that underlie the anxious experiences associated with social interactions.

This form of treatment examines how a person's unique history contributes to their current behavior and looks for new ways to manage emotional conflicts. During psychodynamic sessions, individuals may benefit from talking openly and honestly about their thoughts, feelings, and relationships, as doing so can foster an atmosphere of trust between patient and clinician.

Those with social anxiety tend to use psychodynamic treatments to focus on cognitive restructuring. In the process, they learn skills through techniques like assertiveness training, which can explicitly target anxiety-related experiences associated with daily living.

This modality may be beneficial for those who have experienced unresolved conflicts concerning interpersonal interactions, as it centers on understanding underlying processes to recognize issues that may be causing distress.

Exposure therapy 

Exposure therapy is an effective treatment for social anxiety disorder (SAD), which helps individuals confront their fear of specific situations, animals, ideas, or objects. This type of therapy aims to get someone out of their “comfort zone” by slowly exposing them to the situation or object they are avoiding. 

Exposure may allow clients to gain mastery over a fear they previously felt anxious about. This technique can also help them change anxious thoughts and beliefs toward fears, allowing them to manage their social anxiety disorder more effectively. Exposure therapy can be especially helpful if someone’s social phobia is causing them to withdraw from certain social situations.

Following exposure treatments, clients may gain increased self-confidence, improved skills in managing distress, and coping strategies that reduce extreme avoidance behaviors. Additionally, research has found that when combined with cognitive restructuring techniques found in cognitive-behavioral therapy (CBT), exposure therapy can be particularly powerful in helping individuals overcome their fears in stressful situations.

Alternative support options 

Some people with social anxiety disorder may avoid in-person treatments due to their fears. In these cases, they may not seek support at all. Online therapy through a platform like BetterHelp may be a solution to this barrier. 

Through online cognitive-behavioral and interpersonal treatments, clients can learn coping skills that may reduce their symptoms and improve their health. Some advantages of online social anxiety therapy include improved quality of life and relationships, knowledge of healthier ways to address stress, increased self-awareness and confidence in social situations, and an enhanced ability to cope with upsetting emotions. Through an online platform, clients can choose between phone, video, or live chat sessions and choose to attend therapy anonymously if they prefer. 

In addition to these benefits, research has also shown that online therapy is a lasting solution for SAD compared to other interventions. Specialized forms of therapy, such as cognitive-behavioral therapy and exposure therapy, are available online.