No-Bullshit Treatment For Social Anxiety Disorder 2019
Wait, isn’t social anxiety disorder or social phobia the same thing as shyness?
Many people require treatment for social anxiety. It becomes a disorder when it interferes with your life and makes you unable to do certain things.
Social anxiety itself is normal. It’s normal to feel anxious before giving a presentation or asking someone out on a date, for example. Fear of rejection and embarrassment is quite common. It’s also normal and perfectly okay to be shy or introverted.
It becomes an issue when your social anxiety interferes with your normal daily life.
Social anxiety disorder is a very real condition wherein the patient suffers from intense fear related to social situations in such a way as to pose a hindrance on that person’s life. Social anxiety might make it difficult or impossible to work or attend school. It can also leave a person very isolated and result in a lack of social skills.
In my case, I basically didn’t learn social skills until I realized I was suffering from an illness and started learning how to manage it.
I remember my first encounter with severe social anxiety quite clearly.
I was six years old, standing frozen in place at the corner of the playground at recess. The thoughts going through my mind ran along the lines of:
They don’t like me.
I don’t belong here.
I’m not welcome on their playground.
The children won’t see me if I stay perfectly motionless.
It’s safer this way.
This string of inner dialogue along with its associated fear of ridicule set the tone for the next twenty years of my life.
They called me painfully shy. They complained that I wasn’t participating in class. My mother reinforced the idea that teachers were marking my personality. To my knowledge, no one ever considered that the level of anxiety I was experiencing in social situations was not in fact normal. That maybe my personality was hiding beneath a cloud of mental illness.
That sounds like me or someone I know. Where do we go from here?
As someone who’s struggled with social anxiety disorder since the age of six, I’ve tried everything from religious incantations to tea tree oil to deal with my anxiety. These things do not help.
I was in my twenties when I picked up a book on the subject of overcoming social anxiety, and finally learned that this is an actual diagnosis and you can get actual treatment.
P.S. The book was called Painfully Shy. I highly recommend it to anyone who struggles with social anxiety.
I was too anxious to speak, so I brought my doctor a handwritten note outlining my symptoms. Ultimately she recommended some pills and put me on a waiting list for therapy.
Let’s talk about medication.
If you’re experiencing acute (short-lived and intense) panic attacks, there are prescription drugs that specifically target the nervous system and can help to calm you down in the moment. Benzodiazepine (benzo) class drugs, like clonazepam or lorazepam, are very effective for some people. These are meant to be used infrequently, and should only be used in conjunction with therapy so that you don’t rely on them indefinitely. (The body gets used to these and they tend to become less and less effective the more you use them.)
Different drugs affect people in different ways, so please take any anecdotal opinions by unqualified civilians like me with a grain of salt. Talk with a doctor, dingus. Dr. Dingus. Dingus man. Doctor Dingus Man. Excelsior? RIP Stan.
For a longer term solution, there are some SSRIs and SNRIs that list anxiety disorders among the conditions they’re used to treat. Most recently I had a lot of success with fluoxetine (Prozac). It allowed me to make phone calls, which is helpful when I need to book my follow up appointments or talk awkwardly with my relatives. Escitalopram (Lexapro) is another one the doc recommended to me. It made me too sleepy, but different drugs affect people in different ways and it’s helped a lot of people make progress in overcoming their social anxiety. It usually takes a bit of trial and error to find the right medication and dosage.
I wouldn’t recommend relying solely on meds in the case of social anxiety disorder, since you can effectively retrain your nervous response with the right therapy and practice. But it is a legitimate and potentially effective course of treatment, and should be considered an option especially if you have trouble getting yourself to therapy.
Taking therapy seriously was my first step to real progress.
I’ve found cognitive behavioural therapy an extremely beneficial treatment for social anxiety disorder.
It wasn’t until I started cognitive behavioural therapy based sessions with a psychologist that I started to see myself making some real progress.
Thoughts create feelings.
Your thoughts are powerful things. They play a role in creating reality and not in a law-of-attraction-woo type way. Thoughts create emotions. Emotions play a role in how you view the world.
If you say to yourself that you’re stupid you are going to feel bad. Thinking positively won’t fix your problems but it can give you the confidence to try.
Read more in “Do Positive Affirmations Work? Thoughts.”
Feelings affect behaviour.
Some common behaviours associated with social anxiety disorder include:
- Ordering groceries so you don’t have to go to the store.
- Waiting for the next bus because this one has too many people on it.
- Eating cold ravioli because there might be people near the microwave.
- Quitting your job and pursuing any form of entrepreneurial venture you can think of so you can stay home and live vicariously through your slowly dying Sim.
Maybe that’s just me.
Why do socially anxious people behave in these ways? It is a direct result of the emotions that they’re feeling, which are a direct result of the thoughts that they are thinking. And of course it goes the other way – emotions affect thoughts, too.
These elements tie together in cognitive behavioural therapy to address the thoughts and take control over the behavior and, in turn, the emotions.
Behaviour reinforces thoughts.
In the same vein behaviors affect emotions. It’s an endless cycle.
Thought: They don’t like me.
Behaviour: Not playing with the other kids.
Thought: They don’t like me.
And so forth.
When you shrink back from the world you’re communicating to your brain that you’re small and that the world is scary.
Try this simple exercise to reinforce the connection between behaviour, thought, and emotion.
Stand up – let’s be real, just ease up on the slouching for a second.
Hands on your hips.
Feet shoulder width apart.
Head up and gaze slightly upward.
Throw in a half smile.
You absolutely look like a jackass, but right now you’re sending a message to your brain that you are confident and in control. If you ever need a little pick-me-up, strike a power pose and hold that for like 20 seconds.
Exposure therapy isn’t pleasant but it works.
Also known as avoiding avoidance. The idea behind exposure therapy is to do the things that you generally avoid because they cause anxiety. If you do them repeatedly until they become normal, then you’ll have taught your brain that there’s nothing to be afraid of.
- Make a list of the places, situations, or activities that you’re avoiding because of social anxiety.
- Rank them in order of the amount of anxiety they cause.
- Then very gradually start to work your way up the list.
- The key word here is gradually.
It’s important to approach exposure therapy in a controlled environment with the help of a therapist. They can explain the treatment process more thoroughly, and also hold you accountable.
How might one gain access to this therapy I speak of?
One-on-one therapy with a licensed psychologist is one option.
If you can, get a referral through your doctor or visit a local mental health resource center. If talking with people causes too much anxiety, don’t be afraid to write down what you need to communicate.
I’ve found the mere act of visiting a therapist to be a helpful exercise in facing my fear, and a good counselor really can make a world of difference if you do your part.
Group therapy takes the spotlight off but still gets you off your couch.
If you can track down a local social anxiety therapy group run by a qualified mental health professional, these can offer effective treatment as well.
You might find it helpful, as I have, to sit down with a few people who also struggle with social anxiety. Even if just to remind yourself that you’re not alone. Not by a long shot.
If you don’t have access to local mental health resources, here are some online treatment options.
BetterHelp matches you with a professional counselor so you can message them anytime or schedule live sessions. I’ve used this service with some success, but it can take some trial and error to find a therapist you connect well with. It’s less expensive than private in-office counseling sessions, but still not chump change. BetterHelp’s prices range from $45 to $65 per week.
There are also self-study options available. Dr. Thomas Richards is the Great American Psychologist who founded the Social Anxiety Institute, and I can wholeheartedly recommend his extensive online therapy program. Currently the program costs ~$299 for a lifetime membership, but the first week is free.
I don’t mean this to be an exhaustive list of options, but just some of the things I’ve found useful on my own journey. Feel free to share any other treatment plans or resources that have helped you!
The single most important thing I’ve learned is…
ANTs: Automatic negative thoughts and feelings are liars who want to bring you down. They’re literally the illness trying to propagate itself, like any other disease. But you’re stronger and awesomer than them. This is an oversimplification, but – challenge them. They’re squishy.
Don’t take my word for it. I’m just a civilian with social anxiety disorder. I’m not a professional, and you should absolutely speak with one if you are looking to overcome your own social anxiety.
Sometimes it helps a little just to know you’re not alone. We’re in this together. Comments and questions are always welcome. Thanks for being here.