Social anxiety disorder (SAD) is a common but under-diagnosed mental health condition experienced across different age groups and cultures. If you or someone you know has been diagnosed with SAD or you think you may be experiencing symptoms of the disorder, learning more about what to expect can help.
While the exact cause of SAD is unknown, it is believed to result from a combination of both genetic and environmental factors.
Imbalances in brain chemistry have been linked to SAD. For example, an imbalance in the neurotransmitter serotonin, a brain chemical that regulates mood and emotions, may play a role in the development of social anxiety disorder.
Over-activity of a structure in the brain called the amygdala has also been linked to social anxiety. People with SAD may be predisposed to an exaggerated fear response and, in turn, increased anxiety.
Several environmental factors may also increase your risk of developing SAD.
People with social anxiety disorder know that their fear is out of proportion to the actual situation, but they are still unable to control their anxiety. The anxiety may be specific to one type of social or performance situation, or it may occur in all situations.
Some of the situations that are common triggers include interacting with strangers, making eye contact, and initiating conversations. People with social anxiety disorder may experience cognitive, physical, and behavioral symptoms before, during, and after these social and performance situations.
Examples of cognitive symptoms:
- fearing situations where you don’t know other people
- worrying that you will be judged by others
- fear of becoming embarrassed or being humiliated
- thinking that others will notice your anxiety
- dreading upcoming events weeks in advance
Examples of physical symptoms:
- profuse sweating
- trembling hands
- muscle tension
- racing heart
Examples of behavioral symptoms:
- avoiding social/performance activities
- leaving/escaping situations
- using safety behaviors
The most commonly used evidence-based treatments for social anxiety disorder are medication and cognitive-behavioral therapy (CBT). Often these two forms of treatment are used together for best results. In addition to CBT, there are a number of other types of therapy that may be used, either in an individual or group format.
Talk therapies used in the treatment of SAD:
- cognitive-behavioral therapy (CBT)
- psychodynamic therapy
- interpersonal therapy (IPT)
- rational emotive behavior therapy (REBT)
- acceptance and commitment therapy (ACT)
1 – Cognitive behavioral therapy
(CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel. It is used to help treat a wide range of issues in a person’s life, from sleeping difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression. CBT works by changing people’s attitudes and their behavior by focusing on the thoughts, images, beliefs and attitudes that are held (a person’s cognitive processes) and how these processes relate to the way a person behaves, as a way of dealing with emotional problems.
An important advantage of cognitive behavioral therapy is that it tends to be short, taking five to ten months for most emotional problems. Clients attend one session per week, each session lasting approximately 50 minutes. During this time, the client and therapist are work together to understand what the problems are and develop new strategies for tackling them. CBT introduces patients to a set of principles that they can apply whenever they need to, and that’ll last them a lifetime.
2 – Social Skills
Improving your social skills is an important component of social anxiety disorder treatment. Various aspects of social skills may be impaired in those with SAD, mostly because you’ve never had a chance to practice.
In general, you will want to work on improving communication skills—whether that means learning how to make small talk or understanding others’ body language better.
3 – Laugh it off
Cultivate a good sense of humor and laugh, says Karen Lynn Cassiday, PhD, president-elect of the Anxiety and Depression Association of America and a clinical psychologist in Chicago. “Even if you do a fake laugh, you get an instant hit of dopamine,” says Dr. Cassiday. Dopamine is a brain chemical that controls feelings of reward and pleasure.
If you’re too tense to laugh on your own, try using technology, she suggests. For example, find a laugh track phone app. Just google phone apps for laughing.
In a study presented at a medical meeting, Loma Linda University researchers found that even anticipating a mirthful laugh reduces the stress hormone cortisol, which increases when you are anxious.
4 – Ground yourself
When anxiety hits, ”do something tangible,” says John Tsilimparis, MFT, a marriage and family therapist in Los Angeles and adjunct professor of psychiatry at Pepperdine University.
“Take your house keys out, run your fingers along the keys,” says Tsilimparis. “That sensation will give you ‘grounding.’ Pick up a paperweight, hold it in your hand. Or, get an ice cube. Hold it as long as you can do it.”
Why does this work? “Your brain can’t be in two places at once,” he says. The activity distracts you from the anxious feelings. “Your mind will shift from racing, catastrophic thoughts [that accompany anxiety] to the cold ice cube in your hand,” he says.
According to some research, using a virtual reality distraction system can reduce anxiety during dental procedures. Patients immersed in VR — a computer-generated realistic environment — reported less pain and anxiety than when they didn’t use it.
5 -Schedule relaxation
“Sit down and look at your schedule,” says Katherine Raymer, MD, ND, associate clinical professor of naturopathic medicine at Bastyr University, Seattle.
“Is there a time to put in a half hour to do whatever you do that is relaxing?” Dr. Raymer asks. That can be a walk, meditation, yoga, tai chi or anything you find relaxing.
Researchers trying to help shy men with social anxiety found that a period of relaxation helped them, lowering their heart rates after they interacted with people.
6 – Try lavender
Try lavender essential oil to calm yourself, Raymer says. “We have people put a drop of it on their collarbone,” she says. “The smell wafts up. The odor is very relaxing.” Or, you can rub it gently into your temple, she says.
In a 2012 study of women anxious about having a medical procedure, researchers found that those who inhaled lavender a half hour before the procedure were calmer than those who did not.
Again, don’t forget to check first with your doctor before using the essential oil lavender, Raymer says.
7 – Face the fear
“If something makes you scared, face it,” says Cassiday. If you feel shy, go out to social functions, she says. Scared of clowns? Go to the circus.
It can help, too, to understand that when you worry about what might happen — such as no one will talk to you at the party — your anxiety just rises. Your anxious worry is about the uncertainty, she says. “What a worrier really wants is a promise that everything is going to be OK.”
But uncertainty is part of life, she says. Exposure therapy, or facing the fear, helps you learn to live with risk and uncertainty.
8 – Social Anxiety Disorder Linked to High Serotonin Levels
the main drugs used to treat social anxiety now are SSRIs (Selective Serotonin Reuptake Inhibitors). These drugs supposedly work by increasing the levels of serotonin in your brain. The theory was that people who suffer from social anxiety disorder have a low “chemical balance” of serotonin, an important neurotransmitter.
Yet a recent study has found that the opposite is true! People who have social anxiety actually produce too much serotonin in the fear part of the brain, the amygdala. This means that all the drugs people have been taking SHOULD have made them feel more anxious, instead of less!
Now here’s the most confusing part of the whole thing: the SSRI drugs did actually help!… Scientists just have no idea why anymore. (Part of it could be the placebo effect.)
9 – Nutrition
One of the too-quickly overlooked approaches to decreasing social anxiety is making positive changes to your lifestyle. Your brain exists inside of your body, which means it is highly influenced by what you put in it and how you treat your physical health.
This section could be an article on its own, or maybe a whole book. There’s so much to learn and study when it comes to the effect food has on your mood.
Here’s a few quick bullet points:
Eat unprocessed whole foods.Processed foods usually have a lot of unhealthy things added in, like sugar, salt, preservatives and bad types of fat/oil. This is why you should be careful buying so-called “healthy foods” that come in boxes, cans or bottles. If it’s a whole piece of food – like an apple, carrot or piece of steak – then it’s much more likely to be good for you.
Lower the refined carbs and sugar.The Surprising Truth about Wheat, Carbs, and Sugar–Your Brain’s Silent Killers.” I try to eat a diet that resembles paleo, which is mainly meat, fish, eggs, lots of vegetables, nuts, some fruits, etc. I rarely eat carbs like bread, pasta, rice, noodles, pastries, potatoes, etc… whereas a lot of people make carbs the center of every meal!
Eat more veggies(that are not potatoes or corn!). Cruciferous vegetables like broccoli, kale and brussels sprouts are exceptionally good for you. Right now I drink a smoothie with kale, blueberries and protein powder almost every day.
Eat the good types of fat.Contrary to what health “experts” have said the past 10 years, low fat doesn’t mean healthy. Your brain needs fat to function well. Not the fat you find in a McDonald’s burger… but fat rich in omega 3 found in wild salmon, sardines, herring, anchovies, and mackerel. Other good types of fat are coconut oil (I almost always cook with this now), olive oil, avocados, grass-fed butter, and so on.
Avoid so-called “healthy” vegetable oils like canola, soya and corn.
Eat fermented foods.Fermented foods contain probiotics, a very good type of bacteria. A recent study found that the fermented foods you eat, the less anxious, worried or neurotic you probably are. What are some good fermented foods?
Sauerkraut, pickles and kimchi. (Although make sure it’s unpasteurized or “raw” because the process of pasteurization kills all the good bacteria due to the high heat.)
Dairy foods like yogurt and kefir also contain a lot of probiotics, just make sure the label says it “contains live and active cultures.”
Kombucha tea is another fermented drink that’s becoming more popular.
I personally love coffee,and drink it almost every morning. However, most doctors recommend decreasing or eliminating coffee if you have anxiety, so you should experiment and see if cutting out caffeine helps you. (I actually often make Bulletproof coffee at home, where I blend in coconut oil, grass fed butter and some raw honey into my coffee. Sounds weird I know, but it’s delicious and good for your brain.)
10 – Natural Supplements
Beyond your basic diet, which should be the foundation for your nutrition, you can take some supplements and vitamins to improve your mood and health. I’m definitely not an expert here, but I can share with you the general recommendations for anxiety.
If you want to keep it basic:
Zinc, Magnesium, Vitamin D, Vitamin B6 and B12 can help improve your mood and make you feel relaxed. Low levels of these have been linked to depression.
There are also herbs like Chamomile, Valerian Root, St. John’s Wort and Passionflower which are claimed to reduce anxiety, though there is little scientific evidence behind it. You can buy these as tea or capsules and see if they help you.
Avoid the supplement Kava, it’s been shown to decrease anxiety but using it often can cause liver problems.
11 – Exercise & Sleep
These are two very important elements of your lifestyle. By lifestyle I mean your daily or weekly habits.
Exercise is proven to improve mental well being…
“Scientists have found that regular participation in aerobic exercise has been shown to decrease overall levels of tension, elevate and stabilize mood, improve sleep, and improve self-esteem. About five minutes of aerobic exercise can begin to stimulate anti-anxiety effects.”
When you exercise, endorphins are released in your brain. This is a natural painkiller which helps you feel great and relaxed. Exercise also increases GABA in your brain, which has been shows to decrease anxiety. And it decreases cortisol, a chemical in your body that comes from stress.
Finally, exercise is great for relieving physical and mental tension, and it makes it easier to go to sleep. (Anyone who has exercised hard before can tell you this is true.)
Now let’s talk about sleep…
Staying up late and getting too little sleep is something which I’ve been guilty of too often. This is bad because a lack of sleep can make you feel more nervous and on edge.
According to a study by UC Berkeley, being sleep deprived increases anticipatory anxiety a lot. This means you will feel a lot more anxious BEFORE a social situation if you don’t get enough sleep. “People who are anxious by nature are the same people who will suffer the greatest harm from sleep deprivation,” said Matthew Walker, a professor of psychology and neuroscience at UC Berkeley.
And that’s not to mention how much harder it is to talk to people when you are feeling low on energy, tired and unfocused.