Let’s Talk… about social anxiety

Photo: Bell

As a psychologist, I see so many misunderstood individuals who are, not only plagued by symptoms of mental illness, but who are also heartbroken at the fact that their friends and families do not understand the legitimacy of their problems. 

Based on what I have witnessed in my private practice, one of the most misjudged mental illnesses known to date is Social Anxiety or Social Phobia.  I can’t stress enough that Social Anxiety is a legitimate anxiety condition experienced by some 15 million Americans.  Essentially it is a crippling fear of being embarrassed, evaluated, judged, humiliated, and/or misunderstood.  Sure, when you experience something embarrassing you might say, “Ya, so what if I trip up on my words, or make a mistake with my restaurant order, or spill my coffee at the store, or answer the door to a stranger.  So what? Big deal!”  Well, I’m here to tell you that for individuals with Social Anxiety, it is a bigger deal than you could ever imagine.

Basically, socially anxious people treat embarrassing situations like they are legitimate life-or-death scenarios.  The manner in which they think about circumstances like, going to class, speaking in public, or even wearing a new outfit, is clinically limited.  If I were to dissect the thoughts of a truly socially anxious person, they’d look like this: “Everyone will be staring at me.” “Everyone will be harshly judging me.”  “They’ll think I’m stupid.” “I’ll look like an idiot.”  Now, yes, at some point all of us have engaged in this form of negative thinking, but I’m here to tell you that when social phobics do it, it is clinical and legitimately impairs their daily functioning.  These negative thoughts take over to the point where social phobics inevitably avoid many situations to reduce the risk of feeling embarrassed.  They’ll avoid anything and everything they cannot prepare for.  It’s “a good thing” if they are visiting a place they know well, but it is a completely different ball game when they exit their comfort zone.  On the rare occasion they do agree to go somewhere new or unfamiliar, they will ask agazillion questions beforehand, in an attempt to control the potential of being embarrassed.  If they do not feel they have any control over this potential, they will become very anxious and will not go to this new place, often making excuses and cancelling at the last minute.  Inevitably, you can imagine that individuals with Social Phobia gradually keep avoiding situation-after-situation until they isolate themselves.          

One of the most maddening things to see as a practitioner working with Social Anxiety is how misunderstood these people are.  Family and friends of social phobics often get annoyed and frustrated because they believe that the individual is “being ridiculous” in their concerns and preoccupations.  Truth is that their bodies are having very real, negative physiological reactions.  They are not joking or lying.  This is a legitimate disorder.  The other unfortunate thing I see among family members of these clients is, enabling.  In the face of their loved-one’s social anxiety, family members sometimes agree to, for example: pay the cashier, talk to the stranger, or answer the door, in lieu of their loved one.  This unfortunately does not help remedy Social Anxiety and instead, facilitates and maintains it.

No one really knows what causes Social Anxiety.  Outside of the heredity theory, some psychologists maintain that parenting has something to do with it. Some argue that overprotective parenting and critical parenting are the culprits.  Overprotective parents basically limit what their children are exposed to, thereby poorly nourishing traits like grit, resilience, and self-efficacy in social situations.  Secondly, some of my socially anxious clients have admitted that critical parenting in their childhood has made them particularly vulnerable and sensitive to any kind of scrutiny in adulthood.    

In the face of all of this, you might say, “Well, they should get help.”  Of course they should.  But, think about that for a sec.  Given the fact that their phobia is social, they have trouble leaving their comfort zone, even if leaving means getting help.  They’ll have trouble researching a mental health clinic, calling them, talking to them, and making the appointment.  In every single one of these steps, there is potential for embarrassment, making the option of doing nothing, more alluring.  It’s heart-breaking. Often times, individuals with Social Anxiety turn to alcohol because alcohol can almost immediately bring down their anxiety in social situations.  Of course, this raises the risk of alcohol dependency in this population.  Also, continued avoidance and isolation over many years can increase the risk of depression and suicide rates.    

My recommendation for treatment would be for a friend or family member to become aware of the nature of Social Phobia.  This will enhance compassion and decrease judgment and misunderstanding.  Then, it would be important that this friend or family member research proper treatment facilities.  The type of therapy Social Anxiety clients need is group therapy and exposure therapy.  Well, to be honest, group therapy is killing two birds with one stone when it comes to treating Social Anxiety.   For socially anxious clients being in a group alone exposes them to their fear.  Exposing anxious clients to that which they are afraid of enables the therapist to accompany them and help them reduce their anxiety right in the belly of the beast. 

In sum, Social Anxiety is a very real clinical disorder and is often misunderstood. The best thing you can do for a socially anxious person in your life is to begin understanding the nature of this condition, increase your empathy about it, and help them get the treatment they need.

Anna-Maria Tosco, or our Sassy Psychologist, has two masters degrees in the field of psychology and has studied and worked coast to coast. She has worked in both psychiatric and community settings in some of Montreal's most respected healthcare organizations and institutions, and has also given a variety of talks and workshops on neuroplasticity, meditation, and uncovering barriers to love.