Social
anxiety
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Q:
I think I may have some sort of social anxiety syndrome but I don't
know how to remedy it. Whenever I am in front of a group and say the
“spot light” is on me, I get very nervous and start to perspire, turn
red and become a very embarrassed person. What can I do to get over
this nervousness in order to relax and be a calm person while trying to
deal with situations in front of groups of people? |
 A: Many people prefer to avoid being in the “spot light”
and get nervous in front of groups of people. However, this alone does
not mean you have a social phobia, also known as social anxiety
disorder. According to the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV), a requirement for this diagnosis is
that “the avoidance, anxious anticipation, or distress…interferes
significantly with the person’s normal routine, occupational (academic)
functioning, or social activities or relationships.” In short, this
means that the symptoms must negatively affect your life in some way.
If you have this problem, you are
certainly not alone. In fact, social phobia is thought to be the third
most prevalent mental disorder, exceeded only by major depressive
disorder and alcohol dependence. What’s more, it is likely the most
prevalent of all the anxiety disorders.
With social phobia, people have a
fear of being evaluated negatively by others. They then get stuck
because they simply avoid the situations that make them nervous. This
becomes a cycle of avoidance causing people to not live up to their
potential.
Whether or not you truly have
social phobia, the anxiety-based symptoms of perspiration, nervousness,
and flushing are troubling—and embarrassing. So there are several
approaches your therapist might take to help improve your symptoms.
One technique is to look at the
underlying beliefs you have about the evaluations of others. For
example, what would it mean to you if people evaluated your
presentation negatively? And specifically, what would that negative
evaluation say about you as a person? A cognitive therapist would look
at these beliefs and find ways to challenge them so you could replace
them with healthier beliefs about your performance. For example, if
some people did, in fact, see you negatively, would it be awful? As in,
would it be the worst thing that could ever happen? Likely not. Also,
would a negative evaluation destroy your value as a human being and a
member of society? Also, no. Your therapist can help you find more
appropriate and realistic thoughts which will be less devastating to
your self-confidence. By replacing your false beliefs with healthier
beliefs about the significance of your performance, your nervousness
will decrease.
An additional technique used by
many therapists is to encourage the client to confront the situation
they fear until the anxiety symptoms reduce. This can be done in the
therapist’s office simulating social situations through role-plays and
imagery-based exercises. After some successes in this way, therapists
may suggest some real life experiences in which you could speak to a
group of people. First, perhaps to some friends about a topic you feel
very comfortable with. Next, to a small group with whom you are less
familiar, like a classroom setting, 12-step group, Toastmasters, or a
networking group. The next step would be to take a greater risk and
speak in front of an even larger group. Your therapist can lead you
through these steps, exploring your feelings and beliefs at each step
along the way.
Your therapist might also
encourage you to see a psychiatrist for a medication evaluation. Often,
social phobia responds to psychotropic medications as well. You’ve
probably seen the advertisements on television which claim as much.
While treatment with medication is often helpful, it may not address
the cause of the anxiety, i.e., beliefs about the judgment of others.
So when you stop taking the medication, your symptoms could return. For
this reason, it’s most effective to treat social phobia with talk
therapy in addition to pharmacological treatment.
Your therapist may have several
other techniques as well. The most important factor is that you are
motivated to make a change. Any type of therapy is hard work, but worth
the effort.
William Feuerborn, M.S.W.,
L.C.S.W. is a licensed psychotherapist in private practice in Long
Beach. He has much experience helping clients with depression, anxiety,
or relationship issues improve their lives. 562.889.4675. This article
was originally printed in Blade
Magazine.
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