Social anxiety

Mild social anxiety is quite common. About one adult in every five is nervous about appearing in front of an audience. Social anxiety is also commonly linked to fear of being embarrassed or humiliated, eating in company, talking on the phone, particular group situations or fear of being the centre of attention. It’s usually most severe with people you know but who aren’t particularly close to you. You generally feel more at ease in the company of strangers and people who are close to you. 

Social anxiety becomes problematic when it begins to involve avoidance of social situations, intense nervousness, panic symptoms and poor self-esteem. Fear of social situations that disrupts daily life and ability to function occurs in about 10% to 15% of people at some point in life. According to population studies, overall it affects about 4% of adults. It usually appears at a young age but can also develop later in life. 

Often those with social anxiety fear that other people can see their symptoms, and they tend to be overly self-aware, which makes the symptoms feel even worse. Physical symptoms may include trembling of the hands, blushing, sweating, heart palpitations and nausea. Usually those with social anxiety perceive their symptoms to be more severe than they appear to other people. Often, others don’t even notice the anxiety or if they do, they consider it perfectly normal.

Self-care

• Overcoming the nervousness and fear requires facing the situations that cause anxiety. Try to put yourself in these kinds of situations gradually, starting from the easiest one. Success will strengthen your self-esteem and help you to face other situations that cause anxiety.
• Question your negative beliefs on anxiety. Can other people really see your signs of anxiety? Do they really want to humiliate you? Could it be that others don’t even pay attention to how you act in the situations causing anxiety, let alone think about it afterwards? 
• Question also your negative beliefs on the consequences of your failures. You could ask yourself “So what if I fail?”
• Try to learn different relaxation methods that may be useful in situations causing anxiety.
• Go through these situations in your mind and try to come up with successful endings to them.
• Exercise may ease symptoms of anxiety in those with a particular anxiety disorder.

When should you seek treatment?

If anxiety restricts your daily life and if different self-care methods do not ease the situation within a few months, it’s good to see a professional for an assessment. Seek help immediately if social anxiety already involves other psychological symptoms such as panic attacks, symptoms of depression, generalised anxiety or heavy use of intoxicants.

Treatment

Both psychotherapy and medication, either together or separately, are effective in the treatment of those with fear of social situations. Psychotherapy can take the form of individual or group therapy, while online therapy is effective too. 

In psychotherapy, the key is to understand the nature of the symptoms and to get rid of the avoidance behaviour. Depending on the nature and duration of the anxiety, the psychotherapeutic method chosen can be cognitive psychotherapy, psychoanalytic psychotherapy, trauma-focused psychotherapy, or behavioural therapy aiming at getting the patient gradually used to the fear. 

Medicinal treatment usually involves regular use of medicines that are also used in the treatment of depression. Physical symptoms limited to public appearance situations can be alleviated with drugs that reduce symptoms such as heart palpitations caused by hyperactivity of the sympathetic nervous system; these agents can be taken as and when necessary. Medication can alleviate the symptoms of social anxiety and lower the risk of recurrence of the disorder.

Information sources:

The Finnish Medical Society Duodecim: Terveyskirjasto, Terveysportti, Mielenterveystalo.fi (Mentalhub.fi)

FSHS Psychologist / 20 June 2023