Social anxiety can become a self-perpetuating trap. Is there really a treatment for this fear of social situations?
Charlie is a clever and curious 27-year-old man who works as a data analyst for a social media marketing company. He loves history and spends a lot of time thinking and reading about different historical places and periods. One of his favorites is ancient Rome, and he dreams of visiting Italy one day. To friends and colleagues, he seems like a regular guy, if perhaps a little aloof at times. It can be a challenge to get him to come out for drinks or social events.
There is a party at work soon, a mixer with drinks and a little speech to welcome a new team member at the end of the workday. Most find these mixers pleasant enough, but Charlie has been dreading it for weeks.
Whenever he thinks of it, his heartbeat quickens, and a knot forms in his stomach. He can still remember the last one a few months ago. He tried to make conversation at first, asking questions about his coworkers’ hobbies like he’d read in an article about conversation techniques. But it was like his mind was filled with fluff, and after a couple of questions, he couldn’t think of anything else to say. He imagined how silly and awkward he must sound and quickly retreated to the corner to look fixedly at his phone until it felt like he’d been there long enough to make his excuses and head home.
Social Anxiety
Charlie suffers from social anxiety. He’s okay with close friends or people he knows well, but with new people or large groups his mind either races or it feels like he’s disconnected or floating.
Either way, the words just don’t seem to come and he feels awkward and embarrassed. He imagines people judging him and sometimes reviews interactions in his mind over and over again for days afterward. He used to get so nervous he would have panic attacks, but his doctor prescribed him something, and that’s mostly under control now. Charlie reads self-help articles and has gotten advice from close friends, but it’s very hard to remember any of the things they say at that moment.
At this point, he’s mostly resigned himself to spending time alone or in small groups and communicating through email and chat.
Unfortunately, for someone like Charlie, avoidance and solitude can cause several problems:
1. Avoiding stressful social situations can bring a feeling of relief that reinforces that these things are scary and avoidance is justified.
2. Unused social skills can become rusty and make socializing harder in the future.
3. Without attention, social connections fade leading to fewer social opportunities and a growing sense of isolation.
4. Social connection is a key part of mental health. Almost everyone needs a sense of community and connection to be healthy, even those for whom this is difficult or draining.
Dealing with Social Anxiety
For the reasons just listed, social anxiety can become a self-perpetuating trap of avoidance and isolation. For many of my clients, the anxiety gets in the way of seeking help, and when they finally do see a therapist like me, there is often a lot of momentum to their isolation.
Social connections may have withered or become tenuous, and their anxiety has only grown over time.
For this reason, I typically start clients off with mindfulness training and incremental exposure.
* Mindfulness training focuses on bringing attention to the present moment (rather than speculation about other people’s thoughts or judgments) and maintaining an attitude of relaxed acceptance towards one’s emotions, even one’s intense emotions. This is an important first step toward moving through the resistance and avoidance that can hold social anxiety in place.
A simple mindfulness exercise is to count 10 breaths and try to notice the emotions and sensations that are happening in the body. Ask yourself “What am I feeling right now?” and then really try to “breathe and make space for” whatever shows up.
Note, mindful attention can cause your feelings to temporarily intensify, especially if you hold tension in your body and/or tend to suppress your emotions. This is a normal part of the process and not something to be concerned about.
* Incremental exposure means taking small incremental steps to expose oneself to situations that make one anxious. The idea is to trigger an amount of anxiety that is manageable, typically at an intensity between a 4 and 7 out of 10. This is called the “window of tolerance.” Then does one’s best to tolerate or even accept (i.e., relax in the face of) this feeling until the intensity begins to diminish. This teaches the emotional brain that this situation is safe or at least not as scary as was thought. Over time, things will gradually become easier and more challenging situations can be sought.
If you decide to try this, it is recommended to start with a small step and one that is right for you. For example, for one person a good first step might be going to a coffee shop and having tea or coffee in a public space. For another person, it might be talking with a friend over the phone or on a video call. A third person might have someone over for dinner. It depends on your level of comfort and what for you feels “challenging but tolerable”.
Of course, these recommendations are highly simplified. In future articles, I’ll dive more deeply into mindfulness, exposure, and other difficulties that people commonly face.
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