Social Anxiety: Coping Strategies And Treatment Options

One in five people in the US develops a mental health issue every year, and social anxiety is one of the most widely reported conditions.¹

Many people think they are alone in dealing with social anxiety’s emotional, behavioral, and physical impacts, but that is simply not the case.  While you may feel self-conscious, fearful of being judged or saying the wrong thing, and anxious about certain social situations, some effective coping strategies and treatments can help.

What is social anxiety?

Social anxiety is sometimes called social phobia. It is an ongoing, intense fear of saying or doing the wrong thing in social situations that will lead to being judged, ridiculed, or embarrassed.

This fear lasts at least six months, and it can negatively impact a person's entire life, including what jobs they apply for, their ability to make friends, and how often they engage in community activities.²

While many people may perceive those with social anxiety as being shy or distant, the condition is more about the intense worry of being humiliated, rejected, or found to be 'not good enough.’

Some examples of when people might experience social anxiety include:

• Public speaking

• Making small talk with grocery store clerks or others in public

• Meeting new people

• Speaking up in class

• Being the center of attention

• Performing in front of groups

• Going on dates

• Attending social events

• Initiating phone calls or starting conversations

What are the signs and symptoms of social anxiety?

Many people feel some level of anxiety when they engage in social interactions.

What separates people with social anxiety is that their anxiety impacts what they choose to do to such a degree that it alters their entire life.

For instance, if you have social anxiety, you may cancel plans, avoid interacting with others, or if you do show up in public, you may have a physical reaction such as trembling, sweating profusely, and freezing up when trying to talk.

Other signs and symptoms³ of social anxiety include but are not limited to:

• A racing heart

• Shutting down and letting others carry the conversation for you, even if you want to engage

• Long-term anxiety in the weeks and months leading up to an event

• Hot flashes and neck rashes

• Using drugs or alcohol to cope with your social fears

In fact, there are three categories of social anxiety symptoms: physical, emotional, and behavioral (sometimes called ‘social’).⁴

How prevalent is social anxiety in the US?

According to the Social Anxiety Association, you have a 13% chance of developing social anxiety at some point in your lifetime, and about 7% of people suffer from the disorder at any given time.⁵ It affects 15 million Americans and is the third leading mental health issue in the country.⁶ ⁷

Women have a higher risk of developing social anxiety than men. The National Institute of Mental Health (NIMH) data from 2001 to 2003 shows that  8% of women and 6.1% of men in the US experienced the condition in the past year.²

Social anxiety also occurred at higher rates among younger adults than older adults. The prevalence by age was:

• 9.1% of 18- to 29-year-olds

• 8.7% of 30- to 44-year-olds

• 6.8% of 45- to 59-year-olds

• 3.1% of those 60 and over

NIMH states that 31.3% of those cases were mild, 38.8% were moderate, and 29.9% were serious.

Adolescents were even more likely to experience social anxiety than adults. The lifetime prevalence among adolescents aged 13 to 18 was 9.1%, including 11.1% of females and 7% of males. In fact, 75% of people with social anxiety experience their first symptoms between ages 8 to 15.⁸

Who is at risk of developing social anxiety?

One of the steps to understanding how to overcome social anxiety is learning just why it manifests in the first place. Both genetics and life experiences play a role in its development.

Key risk factors for social anxiety include⁹ ¹⁰:

• A family history of anxiety, through genetic factors and/or modeling

• Traumatic experiences, such as abuse or bullying

• New social pressures like public speaking or job leadership responsibilities

• A controlling, overprotective, or emotionally withdrawn parent during childhood

• An overactive part of the brain called the amygdala

• Learned anxiety from being judged or embarrassed in public

• Conditions that affect interactions, such as stuttering

There are some emerging associations between inhibition or shyness during your childhood overlapping with social anxiety disorder, starting during your teenage years.¹¹ In addition, about 20% of people have what’s called 'sensory processing sensitivity,’ which is a heightened nervous system response to stimuli.¹²

These Highly Sensitive People (HSPs) also may have a higher risk of developing the condition in the form of overstimulation avoidance, although further research is being conducted.¹¹ ¹³

How is social anxiety treated?

Talk therapy or psychological therapy with a counselor helps you find strategies to better manage your social anxiety symptoms. Cognitive behavioral therapy (CBT) is a commonly used, evidence-based treatment for the condition.¹⁴

CBT is a type of therapy aimed at breaking the negative thought loop of social anxiety and helping you reshape your thoughts to change your experiences. The premise is that thoughts affect emotions, and replacing negative or inaccurate thoughts with helpful thinking patterns and behaviors can reduce social fears.

CBT includes exercises like role-playing and practicing in session and what it's like to be exposed to different social situations in real life.

Therapists also teach you muscle relaxation and breathing techniques so that you can begin to feel more in control of your body and emotions.

Medications are used to help treat social anxiety disorder as well. These include:

• Selective Serotonin Reuptake Inhibitors (SSRIs): These help increase the hormone serotonin in the brain and include Zoloft and Paxil.¹⁰ ¹⁵ ¹⁶

• Beta-Blockers: These work by blocking a stress hormone called norepinephrine to help relieve the symptoms of social anxiety, such as shaking, sweating, and rapid heartbeats. Propranolol is a beta-blocker commonly used to treat social anxiety and performance anxiety.¹⁷

• Benzodiazepines: These work quickly by stimulating certain brain cells responsible for sending calming signals, but they tend to lead to drowsiness and sometimes dependence and addiction. This is why they are typically prescribed for short-term use only.¹⁸

What natural remedies can you use to help manage social anxiety?

Herbs like passionflower may have a calming effect on the central nervous system.¹⁹ Some studies have suggested that certain essential oils may help people ease their anxiety, including lavender oil and CBD, an essential oil found in the non-intoxicating variety of the cannabis plant.²⁰ ²¹

It's important to always check with your healthcare provider before using natural remedies for social anxiety. Some of these remedies may interact with medications you use or exacerbate certain health conditions.

Are there coping strategies to help you overcome social anxiety?

Yes! If you've been wondering how to reduce social anxiety using self-help strategies, there are several that seem to help people cope better.

Breathe

Slow breathing exercises help bring on a state of calm and relaxation. They slow down sympathetic nervous system activation and increase the calming parasympathetic nervous system response.

Performing breathing exercises for 10 to 20 minutes per day can enhance relaxation and reduce anxiety.

Try meditation

Meditation has been found to increase gray matter in areas of your brain related to putting things in proper perspective and emotional regulation.²² Just as importantly for people with social anxiety, meditation can decrease the size of the brain's amygdala, which is responsible for the 'flight or fight' response that often gets triggered in stressful situations.

Exercise

During exercise, chemicals are released that help calm the body and mind.²³ Regular movement can even stimulate parts of your brain that help you control anxious fight or flight responses.

Tai chi is particularly good at helping ease anxiety, as it combines breathing, movement, and meditation.²⁴

Engage in your passions

Having a sense of purpose in life has been shown to help people recover better from negative experiences through better regulation of regions in the brain responsible for processing fear and anxiety.²⁵

Engaging in the passions that give you a sense of purpose usually involves goal setting, which helps keep you focused on what you like rather than on negative self-talk.²⁶ Concentrating on taking one step at a time can help reduce your overwhelming feeling and make you feel good about each small accomplishment.

Practice facing your fears

Making a decision to step back and be the observer of your fears helps you in a few ways.²⁷ First, you get to know your exact triggers better. Second, it helps you realize that you are not your fears but rather the observer of them. In other words, you're in control, not your fears.

Facing your fears also shows you that your worries about what will happen don't usually come to fruition, and even if some of them do, you'll be okay.

It may not seem like it now, but brain scientists have shown the amazing benefits of facing your fears.²⁸ Similar to what happens during meditation, the more people face fears, the more they can put these experiences in the proper perspective and begin changing their inner state from fearful and anxious to calm and collected.

HealthMatch hack: Brain scans show that building new patterns can be helped by rewarding yourself as you're attempting to change your habits.²⁹ For instance, you might watch a funny movie after attempting to socialize or bake your favorite healthy snack.

Focus on 'realistic thinking'

Social anxiety causes people to believe that the amount of danger they're in is bigger than it actually is. Practicing realistic thinking is one of the best ways to start seeing social situations as less threatening. Ask yourself often:

• Is it my job to make people happy or make them like me?

• Is it really that important that I might say something that comes out a little awkward?

• Is it my fault that people might be judging me, or is that something they need to deal with themselves? Also, are they even judging me, or are they just trying to get to know me better?

• What do people without social anxiety say about the experiences we share?

• What are some coping mechanisms I can take into each challenging social situation?

Overall, remember that you don't have to be perfect or make anyone else happy. Instead, try to turn the tables a bit in your head and think about whether or not you enjoy the company of certain people. Consider if they make as much effort to be kind and considerate towards you as you do towards them.

How can you help a friend, colleague, or family member who suffers from social anxiety?

Helping your friend, family member, or colleague with social anxiety is really about making them feel comfortable and safe from judgment.

How to help someone with social anxiety

1. Inform them ahead of time of detailed plans, so they can mentally prepare. Examples might include telling them who will be attending an event and what, if any, contribution they're expected to make.

2. Break up the pressure they feel to perform by including physical activity during work or social gatherings. These might include taking a walk, 'stretching time' for everyone during a work meeting, or combining a social gathering with an activity that diffuses some attention from the social interactions, such as a creative or sports activity.

3. Be welcoming and kind. Thank them for any information they offer, praise their choices, and express interest in any topics they may bring up.

4. Avoid lecturing them about how they just need to 'loosen up' and try not to focus attention on any anxiety-induced physical reactions or awkwardness they may have during social interactions.

5. Show empathy if they open up to you about their anxiety by listening and being patient.

When should you see a doctor about social anxiety?

Anxiety is a normal, healthy part of life, so it can be difficult to know when to talk to your doctor about it.

If social anxiety is making you feel stuck and overwhelmed, it's time to seek professional help. This is especially true if you've stopped enjoying hobbies and other daily activities, and your anxiety has lasted more than six months.

In particular, if you're experiencing symptoms such as ongoing negative self-talk, low self-esteem, substance abuse, isolation, or thoughts of suicide, contact your doctor right away.¹⁰ The Social Anxiety Association recommends finding a specialist with experience in the field.⁵

The good news is that thousands of research studies back up the power of social anxiety-focused CBT to change your life for the better and help free you from the grips of anxiety and fear.

The lowdown

Whether you're looking for how to cope with social anxiety, how to stop social anxiety symptoms during intense situations, or even how to cure social anxiety altogether, there are many options available to help you move forward along a path of healing and self-acceptance.

You are not alone, and there are many avenues of support, including your family doctor,  a psychologist or counselor, and contacting a helpline or other similar service. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline can help connect you with compassionate, caring people who have been where you are.³⁰ They will work to help you find the tools and resources needed to better manage your social anxiety.