Social anxiety is rooted in the fear of humiliation, embarrassment, rejection, criticism, or shame, in social situations and is fairly common. Many people experience at least some anxiety when they need to speak in front of a large audience or introduce themselves to a group of strangers at a party, for instance. This anxiety becomes problematic when it is frequent and intense, and leads to the avoidance or dread of situations that one would otherwise enjoy.
Am I socially anxious or simply an introvert? Introversion is a temperamental tendency on the continuum from introversion to extraversion. Introverts tend to need more time alone to recharge, enjoy fewer but deep relationships, do more listening and observing, and be quite self-aware. If you are an introvert, you may enjoy social situations, but also find them energy-demanding, and you may find the external stimulation distracting.
This is very different from social anxiety, where one wants to engage in and enjoy social situations, but anxiety gets in the way through:
Fear of negative emotions and self-criticism: believing that embarrassment has to be incredibly painful and that it will last; and the amplification of the emotion through self-criticism.
Low self-esteem: believing that you are not as interesting or smart as others (comparisons are common), weird or socially awkward, or incompetent. The fear is that this will be revealed in the social interaction.
Intense physiological arousal: you may have prepared a wonderful presentation and feel confident in what you have to say, but then feel unable to deliver it well as you are overcome with shaking, sweating, your heart racing, etc.
Poor social skills or confidence in one’s social skills: you may have avoided social situations to such an extent that you feel that you do not have the skills to initiate conversation at a party, for example.
The costs of social anxiety can be high within the professional domain, as it can cause you to avoid certain tasks and not be recognized for advancement. It can also take a toll on your personal life by increasing the risk of loneliness (difficulty finding friends, a life partner if one wants one, or maintaining connection with meaningful others).
If this is the case for you, look no further; CBT is an effective treatment!
Treatment
Changing thoughts:
The root of social anxiety is the fear that others will think poorly of us, whether it is the fear of appearing stupid, nervous, weird, or uninteresting; or simply of not being able to just be ourselves, and that we would not be able to cope with that. In social situations, we can have thoughts or beliefs like:
Others are critical and I must please them.
I must look the way I feel.
My worth is determined by what others think of me and everyone must like me.
If an interaction goes badly, it is my fault. If it goes well, the other person is skilled!
I can tell what other people think of me by looking at them.
Others notice and remember everything I do or say that is not good or perfect.
Others don’t experience social anxiety. I am odd and weird.
If I say or do something stupid, it means that I am stupid, or at the least, this is what others will think.
If I go blank, it will be awful and I won’t be able to continue.
There are clear thought biases in social anxiety that reinforce unhealthy beliefs. An example is the social comparisons we make, which typically pin our own weakness against somebody else’s strengths, or attentional biases where one interprets neutral social cues as negative, and perceives negative cues more than positive ones. No one has ever said “Wow, you look really uncomfortable! You should leave the party” or “You went blank momentarily in your talk, you really don’t know what you are talking about”; it is usually our own mind that says these things.
These thinking patterns can be changed with cognitive re-structuring techniques, where we ask questions such as: What is the evidence for this? What is another way to look at this? What would I tell a friend who had this thought or what would my friend tell me? Do I really know what someone else is thinking? What is the worst thing that could happen, really? How would I cope if it did happen?
Changing behaviors:
Many of the thoughts that maintain social anxiety can be tested through behavioral experiments. As an example, one can run a survey and see if others also feel anxious before a presentation. If you believe that others can see when you are anxious, you can videorecord yourself giving a presentation and see; or do jumping jacks with weights to elicit being out of breath, having your heart race, hands trembling, etc., and videorecord yourself giving a talk to see how much it shows or not.
Additionally, desensitization is done by engaging in the feared situations progressively and systematically. For instance, for a fear of public speaking, one can start by practicing in front of a mirror, then in front of family, then a small group of friends, etc. Another possibility is direct exposure and desensitization to embarrassment. You can watch your therapist do something embarrassing (e.g., wear a red nose; ask for the time with their phone in hand or where the metro is while standing in front of the station) and see the reaction of others; and, if ready and willing, engage in these behaviors yourself, so that you can learn that embarrassment is not the end of the world and is not something to be feared.
Through these changes in thoughts and behaviours, you can conquer your social anxiety and start to fully enjoy others!
Optional additional treatment strategies
Relaxation and proper breathing, to better cope with the physiological symptoms of social anxiety.
Mindfulness and Acceptance: Learning to be in the here and now, and to suspend judgment (i.e., instead of labeling experiences as “good” or “bad”, accepting them the way they are).