March 4, 2022 • 17 mins
Does the thought of going to a party or meeting new people make you sweat, tremble or feel queasy? You may have social anxiety disorder. It’s more common than you think—and the good news is that it’s treatable. Dr. Saltz tells how to get more comfortable in social situations.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight, and advice. Some people really struggle
with meeting or being around new people. They may think
to themselves, I am really shy, But sometimes what is
going on is more than being shy. And so today
(00:47):
I'm answering a question from a listener who finds meeting
new people truly challenging. Social anxiety disorder is actually fairly common,
with the population experiencing it in their lifetimes. Are you
feeling afraid of being judged by others? Are you self
(01:08):
conscious in everyday social situations? Do you find going to
a cocktail party really difficult? Do you avoid meeting new
people due to fear or anxiety? And if you felt
this way for at least six months, these feelings might
make it hard for you to do everyday tasks like
(01:28):
talking to people at work or for kids, talking to
other kids at school, and it's possible that you have
something more akin to social anxiety disorder. Social anxiety disorder
is an intense, persistent fear of being watched and judged
by others. This fear can affect work, school, and other
(01:54):
daily activities. It can even make it hard to make
and keep friends. The good news is, though, that social
anxiety is treatable diagnostically. It is a common type of
anxiety disorder. A person with social anxiety disorder feel symptoms
of anxiety or fear in situations where they may be
(02:16):
scrutinized or evaluated or judged by others, like public speaking,
meeting new people in dating scenarios, being on a job interview,
answering a question and class allowed, or having to talk
to a cashier in a store. Doing everyday things like
(02:38):
eating or drinking in front of other people can be
an issue, and for some even using a public bathroom
can cause anxiety or fear due to thoughts about being humiliated,
being judged, or even being rejected. The fear that people
with social anxiety disorder have in social situations is sometimes
(03:00):
so intense that they feel it's really beyond their control.
They feel overwhelmed. For some people, this can get in
the way of even going to work or school or
doing everyday things. They may be able to do these activities,
on the other hand, but experience a lot of fear
or anxiety when they do. People with social anxiety disorder
(03:25):
may worry about engaging in social situations for weeks before
the social situation happens. Sometimes they end up avoiding places
altogether or events altogether that caused distress or generate feelings
of embarrassment for them. Some people with the disorder do
(03:46):
not have anxiety related to social interactions, but have it
only during performances. They feel symptoms and anxiety and situations
like giving a speech or competing in a sports game,
or dancing in front of other people. Social anxiety disorder
usually starts during late childhood, and it can be mistaken
(04:10):
for extreme shyness or avoidance of situations. It occurs more
frequently in females than in males, and this gender difference
is more pronounced in adolescence and young adults. Without treatment,
social anxiety disorder can last for many years or even
(04:31):
a lifetime. Specific symptoms when you're in a social situation
can be blushing, sweating or trembling when you're suddenly in
that situation, having a rapid heart rate, feeling like your
mind is going blank, or feeling sick to your stomach.
(04:54):
Some people experience being very stiff with their body posture,
like are frozen, or speaking with an overly soft voice
that's difficult to hear. Another symptom is finding it difficult
to make any eye contact or to be around people
you don't know, or talking to people in any sort
(05:15):
of social situation, even if you feel like you really
want to. Another symptom is feeling self conscious or the
fear that people will be judging you negatively and therefore
avoiding places where there are other people. The risk for
social anxiety disorder runs in families, but no one knows
(05:38):
for sure why some family members have it but others don't.
Researchers have found that several parts of the brain are
involved in fear and anxiety, and that genetics influences how
these areas function and that may play a role in
the development of this disorder. Also, stress and the environment
(06:01):
itself can play a role. For example, if you're in
a highly stressed situation, or if you're an environment where
there is harsh criticism. With that, let's get to my
listeners question and ask how can I help, dear doctor Salts.
(06:23):
I know that the pandemic has been so hard for
most people, partially due to being more isolated and having
to socially distance, having to work from home and not
going out to places, But for me, it has been
a huge relief. I have had two years of not
(06:43):
feeling anxious about going out, about having to make small
talk and meet new people. I feel like I got
permission to avoid all these things that for years have
made me uncomfortable. Now my place of work is saying
we need to come back, people are asking me to
(07:05):
do things. My family is asking me to get together
and do it with other people that I don't know
and don't feel comfortable meeting. It has made me realize
I do have a problem because the fear I have
about doing any of these things is over the top,
Like I feel panicky just thinking about it, never mind
(07:28):
doing it. Why is this so hard for me? And
is there anything I can do to make it better?
Certainly not everyone likes to be around other people as
much as some people do, and many people are having
some sort of anxiety reintegrating back into a social setting
(07:49):
having been away for two and a half years. Some
people do prefer to be with just one or two
people having meaningful conversation rather than small talk, and also
do like their time alone to recharge their batteries. But
one tip off in your question is that you are
(08:10):
not just speaking of preference. You're speaking of fear and panic,
and that points in a different direction than being introverted
or shy. It speaks to the possibility that you have
social anxiety disorder. Some people who have social anxiety disorder
go along in life pushing themselves to do enough social things,
(08:34):
not with enjoyment, but enough exposure that they don't feel
flooded with fear each time, and they don't realize that
they have a problem. People who have removed themselves during
the pandemic with great relief and no longer being desensitized
to social interactions on a day to day basis have
(08:57):
become more symptomatic upon a knee to return to normal socializing.
One way for you to go and help yourself is
little by little, pushing yourself to again desensitize by doing
a little something social, meeting one new person every few days,
(09:18):
going to a store and speaking for a moment with
somebody at the store, speaking with someone who works there,
for example, saying hello to someone on the street, working
your way a little bit at a time, but pushing
yourself back up again to a more normal social interaction schedule.
(09:39):
But another path is to go to a professional because
it does sound like you have social anxiety and a
professional can make a proper diagnosis and offer a good
treatment plan because in fact, social anxiety disorder is treatable
and once treated, it could open up a whole new
(10:00):
and much more enjoyable world for you. After the break,
we'll come back and discuss what treatment can look like.
How can I help with Dr Gail Salts will be
back after the short break, so back to discussing social
(10:28):
anxiety disorder and its treatments. It's generally treated with psychotherapy
or medication, or both. Cognitive behavioral therapy CBT is a
research supported type of psychotherapy. It's commonly used to treat
social anxiety disorders. Specifically, it teaches you different ways of thinking,
(10:52):
of behaving, and of reacting to situations to help you
feel less anxious and fearful. It can also help you
learn and practice social skills, which actually is a very
important part of treating social anxiety disorder. Exposure therapy is
a c BT method that focuses on progressively confronting the
(11:16):
fears that underlie any anxiety disorder to help you engage
in activities that you've been avoiding. Exposure therapy is sometimes
used along with relaxation exercises, and sometimes you can deliver
c BT therapy in a group therapy format to offer
(11:37):
unique benefits, because in fact, group therapy is an exposure
of its own kind. Another treatment option for social anxiety
disorder is acceptance and commitment therapy, which takes a slightly
different approach than c BT to negative thoughts and uses
strategies like mindfulness and goal setting to reduce anxiety and fear.
(12:02):
Compared to CBT, a CT is a newer form of psychotherapy,
so there's less data available. Less research has been done
on its effectiveness, but it looks like it also is
quite effective. I hope that was helpful. It's important to
(12:23):
know that different therapies work for different types of people,
so it's helpful to discuss what form of therapy might
be right for you with whoever you go to see
for an evaluation. Additionally, medication can be used to treat
social anxiety disorder. Different types of medication can be effective,
including various antidepressants like selective serotonin we have take inhibitors
(12:46):
and serotonin or pernepherin reuptake inhibitors. But some people who
have limited social anxiety to sort of like for talks
or public events, can find that something called beta blockers,
which limits how much your heart rate can increase and
how much your blood pressure can increase, and some physical
symptoms can be useful and anti anxiety medications such as
(13:10):
benzo da zepines, which can't be used on a regular
basis because they're addictive, but can be used for one
off events like giving a talk. S s R eyes
and s n R eyes are used usually to treat depression,
but they're also used to treat anxiety disorders, including social
anxiety disorder. What's important to know about them, however, is
(13:33):
they can take several weeks to start working. Antidepressants also
can cause side effects headache, nausea, or difficulty sleeping, but
for the most part, side effects are not severe, and
if you start with a low dose and it's increased slowly,
are often tolerable. As I mentioned, beta blockers can help
(13:54):
control some of the physical symptoms of social anxiety disorders,
such as rapid heart rate, even s, sutting, and tremors,
and are commonly a medication of choice specifically for performance anxiety,
whereas the benzo diazepines, which are at the anti anxiety
sedative medications, are powerful and they begin working right away
(14:16):
to reduce anxiety feelings. They are very effective and rapidly
decreasing anxiety. But as I mentioned, they can be addictive
and people build up a tolerance to them, and then
they need more and more and a higher dose to
get the same effect, so you don't want to use
them regularly. They should only be prescribed for a brief
(14:37):
period of time or for a one off event. Psychotherapy
and medication, as I mentioned, takes time to work. Many
people need to try more than one medication before finding
the best one for them. The psychiatrists can work with
you to find the best medication, the best dose, and
how long the treatment should last. People with social anxiety
(15:01):
disorder usually get the best results with a combination of
medication and CBT or another type of psychotherapy. Many people
with social anxiety find support groups helpful. In a group
of people who all have social anxiety disorder, you can
get unbiased and honest feedback about how other people in
(15:23):
the group see you. This way, you learn that your
thoughts about judgment and rejection are not true or that
they're greatly amplified. You also can learn how others with
social anxiety disorder approach and come together about the fear
of social situations. Support groups are available both in person
(15:48):
and online, but any advice you receive from a support
group member you need to use cautiously because it doesn't
replace whatever your health care provider is recommend name. A
good way to help yourself or someone you love who
might be struggling with social anxiety disorder is to educate yourself,
(16:09):
research the signs as I've mentioned, learn about treatment options,
and be aware of current research, because experiencing social anxiety
disorders symptoms really requires an honest conversation about how you're
feeling with someone you trust. If your anxiety or the
(16:30):
anxiety of someone you know, starts to cause problems in
everyday life, like avoiding social situations at school, at work,
or with family and friends, then it's time definitely to
seek professional help. Do you have a problem I can
help with. If so, email me yet. How can I help?
(16:51):
At Seneca women dot com. All centers remain anonymous and
listen every Friday too. How can I help with me?
Doctor Gail Saultz
These are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight, and advice. Some people really struggle
with meeting or being around new people. They may think
to themselves, I am really shy, But sometimes what is
going on is more than being shy. And so today
(00:47):
I'm answering a question from a listener who finds meeting
new people truly challenging. Social anxiety disorder is actually fairly common,
with the population experiencing it in their lifetimes. Are you
feeling afraid of being judged by others? Are you self
(01:08):
conscious in everyday social situations? Do you find going to
a cocktail party really difficult? Do you avoid meeting new
people due to fear or anxiety? And if you felt
this way for at least six months, these feelings might
make it hard for you to do everyday tasks like
(01:28):
talking to people at work or for kids, talking to
other kids at school, and it's possible that you have
something more akin to social anxiety disorder. Social anxiety disorder
is an intense, persistent fear of being watched and judged
by others. This fear can affect work, school, and other
(01:54):
daily activities. It can even make it hard to make
and keep friends. The good news is, though, that social
anxiety is treatable diagnostically. It is a common type of
anxiety disorder. A person with social anxiety disorder feel symptoms
of anxiety or fear in situations where they may be
(02:16):
scrutinized or evaluated or judged by others, like public speaking,
meeting new people in dating scenarios, being on a job interview,
answering a question and class allowed, or having to talk
to a cashier in a store. Doing everyday things like
(02:38):
eating or drinking in front of other people can be
an issue, and for some even using a public bathroom
can cause anxiety or fear due to thoughts about being humiliated,
being judged, or even being rejected. The fear that people
with social anxiety disorder have in social situations is sometimes
(03:00):
so intense that they feel it's really beyond their control.
They feel overwhelmed. For some people, this can get in
the way of even going to work or school or
doing everyday things. They may be able to do these activities,
on the other hand, but experience a lot of fear
or anxiety when they do. People with social anxiety disorder
(03:25):
may worry about engaging in social situations for weeks before
the social situation happens. Sometimes they end up avoiding places
altogether or events altogether that caused distress or generate feelings
of embarrassment for them. Some people with the disorder do
(03:46):
not have anxiety related to social interactions, but have it
only during performances. They feel symptoms and anxiety and situations
like giving a speech or competing in a sports game,
or dancing in front of other people. Social anxiety disorder
usually starts during late childhood, and it can be mistaken
(04:10):
for extreme shyness or avoidance of situations. It occurs more
frequently in females than in males, and this gender difference
is more pronounced in adolescence and young adults. Without treatment,
social anxiety disorder can last for many years or even
(04:31):
a lifetime. Specific symptoms when you're in a social situation
can be blushing, sweating or trembling when you're suddenly in
that situation, having a rapid heart rate, feeling like your
mind is going blank, or feeling sick to your stomach.
(04:54):
Some people experience being very stiff with their body posture,
like are frozen, or speaking with an overly soft voice
that's difficult to hear. Another symptom is finding it difficult
to make any eye contact or to be around people
you don't know, or talking to people in any sort
(05:15):
of social situation, even if you feel like you really
want to. Another symptom is feeling self conscious or the
fear that people will be judging you negatively and therefore
avoiding places where there are other people. The risk for
social anxiety disorder runs in families, but no one knows
(05:38):
for sure why some family members have it but others don't.
Researchers have found that several parts of the brain are
involved in fear and anxiety, and that genetics influences how
these areas function and that may play a role in
the development of this disorder. Also, stress and the environment
(06:01):
itself can play a role. For example, if you're in
a highly stressed situation, or if you're an environment where
there is harsh criticism. With that, let's get to my
listeners question and ask how can I help, dear doctor Salts.
(06:23):
I know that the pandemic has been so hard for
most people, partially due to being more isolated and having
to socially distance, having to work from home and not
going out to places, But for me, it has been
a huge relief. I have had two years of not
(06:43):
feeling anxious about going out, about having to make small
talk and meet new people. I feel like I got
permission to avoid all these things that for years have
made me uncomfortable. Now my place of work is saying
we need to come back, people are asking me to
(07:05):
do things. My family is asking me to get together
and do it with other people that I don't know
and don't feel comfortable meeting. It has made me realize
I do have a problem because the fear I have
about doing any of these things is over the top,
Like I feel panicky just thinking about it, never mind
(07:28):
doing it. Why is this so hard for me? And
is there anything I can do to make it better?
Certainly not everyone likes to be around other people as
much as some people do, and many people are having
some sort of anxiety reintegrating back into a social setting
(07:49):
having been away for two and a half years. Some
people do prefer to be with just one or two
people having meaningful conversation rather than small talk, and also
do like their time alone to recharge their batteries. But
one tip off in your question is that you are
(08:10):
not just speaking of preference. You're speaking of fear and panic,
and that points in a different direction than being introverted
or shy. It speaks to the possibility that you have
social anxiety disorder. Some people who have social anxiety disorder
go along in life pushing themselves to do enough social things,
(08:34):
not with enjoyment, but enough exposure that they don't feel
flooded with fear each time, and they don't realize that
they have a problem. People who have removed themselves during
the pandemic with great relief and no longer being desensitized
to social interactions on a day to day basis have
(08:57):
become more symptomatic upon a knee to return to normal socializing.
One way for you to go and help yourself is
little by little, pushing yourself to again desensitize by doing
a little something social, meeting one new person every few days,
(09:18):
going to a store and speaking for a moment with
somebody at the store, speaking with someone who works there,
for example, saying hello to someone on the street, working
your way a little bit at a time, but pushing
yourself back up again to a more normal social interaction schedule.
(09:39):
But another path is to go to a professional because
it does sound like you have social anxiety and a
professional can make a proper diagnosis and offer a good
treatment plan because in fact, social anxiety disorder is treatable
and once treated, it could open up a whole new
(10:00):
and much more enjoyable world for you. After the break,
we'll come back and discuss what treatment can look like.
How can I help with Dr Gail Salts will be
back after the short break, so back to discussing social
(10:28):
anxiety disorder and its treatments. It's generally treated with psychotherapy
or medication, or both. Cognitive behavioral therapy CBT is a
research supported type of psychotherapy. It's commonly used to treat
social anxiety disorders. Specifically, it teaches you different ways of thinking,
(10:52):
of behaving, and of reacting to situations to help you
feel less anxious and fearful. It can also help you
learn and practice social skills, which actually is a very
important part of treating social anxiety disorder. Exposure therapy is
a c BT method that focuses on progressively confronting the
(11:16):
fears that underlie any anxiety disorder to help you engage
in activities that you've been avoiding. Exposure therapy is sometimes
used along with relaxation exercises, and sometimes you can deliver
c BT therapy in a group therapy format to offer
(11:37):
unique benefits, because in fact, group therapy is an exposure
of its own kind. Another treatment option for social anxiety
disorder is acceptance and commitment therapy, which takes a slightly
different approach than c BT to negative thoughts and uses
strategies like mindfulness and goal setting to reduce anxiety and fear.
(12:02):
Compared to CBT, a CT is a newer form of psychotherapy,
so there's less data available. Less research has been done
on its effectiveness, but it looks like it also is
quite effective. I hope that was helpful. It's important to
(12:23):
know that different therapies work for different types of people,
so it's helpful to discuss what form of therapy might
be right for you with whoever you go to see
for an evaluation. Additionally, medication can be used to treat
social anxiety disorder. Different types of medication can be effective,
including various antidepressants like selective serotonin we have take inhibitors
(12:46):
and serotonin or pernepherin reuptake inhibitors. But some people who
have limited social anxiety to sort of like for talks
or public events, can find that something called beta blockers,
which limits how much your heart rate can increase and
how much your blood pressure can increase, and some physical
symptoms can be useful and anti anxiety medications such as
(13:10):
benzo da zepines, which can't be used on a regular
basis because they're addictive, but can be used for one
off events like giving a talk. S s R eyes
and s n R eyes are used usually to treat depression,
but they're also used to treat anxiety disorders, including social
anxiety disorder. What's important to know about them, however, is
(13:33):
they can take several weeks to start working. Antidepressants also
can cause side effects headache, nausea, or difficulty sleeping, but
for the most part, side effects are not severe, and
if you start with a low dose and it's increased slowly,
are often tolerable. As I mentioned, beta blockers can help
(13:54):
control some of the physical symptoms of social anxiety disorders,
such as rapid heart rate, even s, sutting, and tremors,
and are commonly a medication of choice specifically for performance anxiety,
whereas the benzo diazepines, which are at the anti anxiety
sedative medications, are powerful and they begin working right away
(14:16):
to reduce anxiety feelings. They are very effective and rapidly
decreasing anxiety. But as I mentioned, they can be addictive
and people build up a tolerance to them, and then
they need more and more and a higher dose to
get the same effect, so you don't want to use
them regularly. They should only be prescribed for a brief
(14:37):
period of time or for a one off event. Psychotherapy
and medication, as I mentioned, takes time to work. Many
people need to try more than one medication before finding
the best one for them. The psychiatrists can work with
you to find the best medication, the best dose, and
how long the treatment should last. People with social anxiety
(15:01):
disorder usually get the best results with a combination of
medication and CBT or another type of psychotherapy. Many people
with social anxiety find support groups helpful. In a group
of people who all have social anxiety disorder, you can
get unbiased and honest feedback about how other people in
(15:23):
the group see you. This way, you learn that your
thoughts about judgment and rejection are not true or that
they're greatly amplified. You also can learn how others with
social anxiety disorder approach and come together about the fear
of social situations. Support groups are available both in person
(15:48):
and online, but any advice you receive from a support
group member you need to use cautiously because it doesn't
replace whatever your health care provider is recommend name. A
good way to help yourself or someone you love who
might be struggling with social anxiety disorder is to educate yourself,
(16:09):
research the signs as I've mentioned, learn about treatment options,
and be aware of current research, because experiencing social anxiety
disorders symptoms really requires an honest conversation about how you're
feeling with someone you trust. If your anxiety or the
(16:30):
anxiety of someone you know, starts to cause problems in
everyday life, like avoiding social situations at school, at work,
or with family and friends, then it's time definitely to
seek professional help. Do you have a problem I can
help with. If so, email me yet. How can I help?
(16:51):
At Seneca women dot com. All centers remain anonymous and
listen every Friday too. How can I help with me?
Doctor Gail Saultz
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