Social Anxiety and How to Manage It

Anxiety has been documented in the human species for centuries, with writings dating back as far as ancient Greece. Though uncomfortable, anxiety is not necessarily a “bad” emotion. It is normal in certain circumstances and even healthy at times. It can indicate when something isn’t right, guiding one away from an object, activity, or event that may not be safe and heightening senses to react better to a situation⁷. However, when anxiety becomes too intense, it may be more harmful than helpful. Continue reading to learn about intense anxiety, specifically in social settings, and some interventions that may help decrease the impact of intense anxiety^{3, 7}.

What is Social Anxiety?

Currently, clinically diagnosed social anxiety, also known as social phobia, is characterized by intense fear or anxiety in one or more social situations when there is a possibility one may be scrutinized by others. In children, it must occur with peers and adults. The social situations must almost always cause intense fear or anxiety. To be diagnosed, the fear and anxiety experienced are out of proportion to the situations and cause significant distress or impairment in social, occupational, or other important areas of functioning. Social situations are either avoided or endured with intense discomfort, and these intense symptoms must be present for at least six months. The intensity of symptoms can be reduced, however, with interventions that have been shown, over time, to be effective^{6, 7, 8}.

How to Manage Social Anxiety

There are many reasons someone may have difficulty being in social situations. The first step is to identify why^{6, 7}. Did the difficulty with social situations occur after a real or threatened emotionally or physically harmful event? Do large crowds or being around others bring back memories from those events that are difficult to manage? Does someone have a heightened sense of taste, touch, sound, or vision, that makes social situations overwhelming? Is there some cognitive decline that makes the complexities of social situations more difficult? Determining the reason for social anxiety is necessary to know how to determine what changes can be made to decrease the intensity of anxiety that is felt. If someone has difficulty determining the cause of intense anxiety in social situations, seeking out a friend, a health care provider, or a counselor that one feels comfortable talking to about this struggle can be helpful^{1, 6, 7}.

Management Techniques

There are specific techniques that may help decrease anxiety in social situations. The techniques that will work for a person depend on what has caused the anxiety and how well someone can implement the techniques. For example, the use of deep breathing may be helpful. This sounds simple, and it can be, but it can also be very effective as it decreases the heart rate and provides the brain with something tangible to focus on instead of the present anxiety. Start by breathing in for five seconds, holding the breath for three seconds, then breathing out for seven seconds.

Another effective technique is Grounding. This can be done by describing an object or one’s surroundings with all five senses to help one be present and calm anxious thoughts4. If someone has difficulty being able to manage anxiety on their own, seek out a mental health professional who can assist in the development of techniques that will work for their specific circumstances to improve quality of life^{6, 7}.

When to Consider Medication for Social Anxiety

If the anxiety is so intense that using techniques alone is not helpful, there are medications that may help. Medication will not cure anxiety, and the specific medication that may be offered depends on the presenting symptoms, what other medications a person may be taking, medical conditions that could alter the effects of medications, and how the body can process the medication. A primary care office may be able to prescribe one of these medications, or the doctor may refer an individual to a medical provider who specializes in helping those with anxiety disorders^{5, 6, 7}.

Social anxiety can have a significant impact on many people’s lives, but there are ways to manage the symptom intensity. If you need help with social anxiety, you are not alone. Please talk to your family, friends, a health care provider, or a mental health professional for support^{5, 6, 7}.

Sarah Bemish is a Nurse Practitioner at Elliot Behavioral Health Services and a graduate of Rivier University in Nashua, New Hampshire. She has been working in the field of mental health since 2007. She believes in a holistic treatment approach and in partnering with individuals to assist them to develop long-term mental wellness.

References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Psychiatric Disorders (5th ed). Washington, D.C.
2. Crocq MA, Crocq L. (2000). From Shell Shock and War Neurosis to Posttraumatic Stress Disorder: A History of Psychotraumatology. Dialogues Clinincal Neuroscience. Vol2(1):47-55. doi: 10.31887/DCNS.2000.2.1/macrocq
3. Crocq MA. (2015) A History of Anxiety: From Hippocrates to DSM. Dialogues Clinical Neuroscience. Vol 17(3):319-25. doi: 10.31887/DCNS.2015.17.3/macrocq.
4. National Alliance of Mental Illness. (2023). Self Help Techniques for Coping with Mental Illness. Retrieved from: Self-Help Techniques for Coping with Mental Illness | NAMI: National Alliance on Mental Illness
5. National Institute of Mental Health. (2022). Social Anxiety Disorder: More Than Just Shyness. Retrieved from: Social Anxiety Disorder: More Than Just Shyness - National Institute of Mental Health (NIMH) (nih.gov)
6. Rose GM, Tadi P. (2022). Social Anxiety Disorder. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK555890/
7. Ströhle A, Gensichen J, Domschke K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Dtsch Arztebl International. Vol 155(37):611-620. doi: 10.3238/arztebl.2018.0611. PMID: 30282583; PMCID: PMC6206399.
8. Substance Abuse and Mental Health Services Administration. (2016). DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t12/
9. Surís A, Holliday R, North CS. (2016). The Evolution of the Classification of Psychiatric Disorders. Behavioral Science, 6(1):5. doi: 10.3390/bs6010005. PMID: 26797641; PMCID: PMC4810039.