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How to Deal With Persistent Social Anxiety

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Some people seem to float through life like less symmetrical George Clooney’s — for these lucky few, life is a series of social interactions untouched by awkwardness.

For the rest of us life, to varying degrees, is studded with uneasy, uncomfortable, socially bizarre moments that make our hearts race, our palms sweat, and our mouths dry up. Most of the time, these reactions are normal response to a new, high-stakes, or unexpected situation.

But for an estimated 10% of the population these social jitters transcend into something more pernicious: periods of general, persistent, obsessive worry about how other people’s’ judgement, which impacts daily routines and can wreck havoc on our personal or professional development.

Franklin Schneier, a special lecturer at Columbia University who has been treating patients with general social anxiety (as well as its more severe cousin, social anxiety disorder) for more than 30 years.

He explains what social anxiety is, its impact, and outlines a few coping strategies.

This interview has been condensed and edited for clarity.

What is social anxiety?

Social anxiety is not a disorder in and of itself — it’s a symptom or an emotion. I would think of it as fear of being in an interpersonal or public situation, and of receiving a negative evaluation from other people.

To meet the criteria for a disorder, social anxiety has to be interfering with one’s life in a significant way, or causing significant distress. Unlike blood pressure, this isn’t clearly definable. We don’t have a number we can assign, but we have a subjective sense of when it’s interfering enough to be considered a disorder.

What are some of these indicators?

Most people with social anxiety disorder who are seeking treatment find they are stuck in some way. Maybe they’d like to move up in their job to a position that involves speaking up in groups, but are blocked by anxiety, and so they avoiding dealing with it and don’t get that leadership role. Or maybe in their personal lives, they feel socially isolated. They want to be dating, but are too fearful of it, and so they aren’t making connections.

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Social anxiety causes people to get stuck in a vicious cycle where they have excessive fears of certain situations, and so they avoid these situations altogether, which means they never get the opportunity to challenge their perception of what would happen. So the fear grows, and leads to more avoidance.

What are strategies for breaking this cycle?

Behavioral therapy seeks to identify the types of thoughts that are occurring in order to recognize which ones might be excessive or irrational. [Through exercises such as] role play, patients learn to gradually take on more difficult situations, along with strategies for coping. This includes using thoughts to manage anxiety — to train the mind not to focus on the worst possible outcome, but instead on what you might get out of the situation.

People with social anxiety also tend to be drawn to negative social stimulus in the environment. They’ll hone in on that one face that looks angry, for example. If they’re giving a speech, and look out into the audience where 70% of the people are neutral or nodding and one person is scowling, they’ll focus on that one person. There’s some evidence that, using tools such as computer games, the mind can be trained to subconsciously shift its focus to more positive stimuli.

The other main approach has been medication. SSRI medication [a category that includes antidepressants, such as Zoloft and Prozac] have been shown to be effective for social anxiety disorder and depression.

What are some common misconceptions about the condition?

People who have it sometimes don’t think of it as a condition worthy of treatment. They think, “I’m just socially awkward — it’s just who I am.” But recognizing it’s something you can change leads people to seek help.

Social anxiety also doesn’t occur in isolation. People with social anxiety are more prone to depression and substance or alcohol abuse, and so it can be hard to tease out cause and effect.

How is social anxiety related to shyness?

Shyness is far more common than social anxiety disorder. As much as half the population says they’re shy. It’s often described as an ambivalence to social situations, but it’s not necessarily something that particularly distressful unless it’s very severe. It doesn’t typically lead to the same problems as social anxiety.

Is there an upside to social anxiety?

As with so many things, moderate levels of social anxiety can be valuable. It can help prepare people for challenging situations. Someone who is a bit anxious is more likely to, for example, practice and refine a speech, than someone who is more relaxed. In general, it’s possible to channel nervous energy into improving performance.

Low-levels of social anxiety can also help people behave with one another. If you don’t care about what people think about you, you are going to be obnoxious. Like with so many other disorders, low-levels of social anxiety isn’t necessarily bad.