July 9, 2021 • 17 mins
Stores and restaurants are re-opening, and companies want their employees to return to the office. For many people, that’s a cause for concern—and social anxiety is on the rise. Dr. Saltz tells how to ease back into a more-normal social life.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees 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. While most everyone is
in agreement that it is wonderful news that most places
in the United States have opened back up post pandemic,
and that high rates of vaccinations have made socializing much
safer now for some people, but getting back to socializing
(00:51):
is fraught with new and surprising anxiety about having any
social interactions. Having worked hard, hard for a year and
a half to avoid all social interacting and having this
change being enabled by fear of contagion and illness, it
hasn't been easy to flip the switch and go back
(01:15):
to your old ways, as least as easy as many
had assumed it would be. I'm hearing from many people
struggling with feeling nervous about getting back together with others,
about shopping, going to dinner with friends, even stumbling on
those they know in the parking lot. I'm hearing from
(01:38):
parents whose children are also uncomfortable going back to previous
social groove, hanging out with other friends, being in school together,
and trying to make chit chat. There are more people
struggling with social anxiety than before the pandemic. Some of
them have had difficulty in this arena before, and that's
(02:01):
before the pandemic, and now it's cropped back up again,
and some are having anxiety they didn't even have before.
So that's why today I'm answering the question I got
from a listener about social anxiety post pandemic. Actually, social
anxiety disorder, also known as social phobia, is an anxiety
(02:25):
disorder involving discomfort around social interaction and concern about being
embarrassed and judged by others. This discomfort will be experienced
as fear and anxiety, and it will be accompanied by
physical symptoms like sweating or shortness of breath, tremors, jittery feelings,
(02:50):
maybe rapid heartbeat, and even nausea. For some, it can
range in severity from a discomfort which can be worked
around and adapted too, to a virtually disabling fear interfering
with multiple areas of life. The discomfort that people with
social anxiety disorder experience can generalize to routine activities such
(03:16):
as eating in front of others or using a public restroom.
These people want to be with people and want to
participate in social situations, but their anxiety can become unbearable.
Social anxiety can lead to isolation and impact development in kids,
(03:40):
or cause anyone to lose social skills, which can then
serve to intensify their already existing social anxiety. Other anxiety
disorders can also go along with social anxiety, and social
anxiety can lead to topression due to loneliness and isolation
(04:04):
and an inability to make social contexts. Some people may
end up using drugs or alcohol in an effort to
reduce their anxiety in social situations. Social anxiety is not
the same as shyness nor introversion. Shyness and introversion are
(04:26):
normal and that they're common personality characteristics which can be
very endearing, but can be misconstrued as sociophobia. Shyness is
a quality which many people actually find attractive, especially those
who are less socially confident. It may be more comfortable,
(04:48):
and you might seek out somebody who's shy if you
feel less socially confident. A shy person does not represent
a threat and may be easier to approach. Introversion is
a choice and a preference for solitary activities, for deep
thinking and contemplation, quiet solitude, and the company of a
(05:12):
small number of meaningful social contacts rather than a large
quantity of shallow contacts. Introverts gain their energy and recharge
with some alone time, and extroverts tend to gain their
energy from social time with other people. But being shy
(05:34):
or introverted has nothing to do with the fear of
being judged harshly by others, with the apprehension about socializing
because of concerns that it won't go well and fears
of the potential for criticism. Neither do they tend to
(05:54):
be plagued after a social interaction with reviewing how it went,
thinking about perceived flaws in themselves and in the social interaction.
That is a special hell reserved for those with social anxiety.
Typically about seven to ten percent of the populations struggle
(06:17):
with social anxiety at any one time, so you can
hear it's not that rare, but post pandemically it seems
that number is even rising. That is likely because usually
social anxiety presents in the mid teens, and it often
(06:37):
runs in families, But it can also occur after a
traumatic event. And really, this year and a half of
social withdrawal has been such an abrupt change, with so
much hardship and loss that it has been traumatic or
many people at various levels now trying to return to
(07:03):
pre pandemic socializing may trigger a great deal of apprehension
after not doing it much at all under the threat
of sickness and death. In fact, to actually have social
anxiety disorder, you really need to have several of the
eight symptoms listed in the Diagnostic and Statistical Manual five,
(07:27):
and they should be socially limiting for you to qualify.
Those are the fear or anxiety that is specific to
social settings, mostly in which a person feels noticed, observed,
or scrutinized. In an adult, this could include something like
(07:49):
a first date, a job interview, meeting someone for the
first time, delivering a talk, or publicly speaking in a
class or meeting. And in children, those phobic or avoidant
behaviors have to occur in a setting with peers. In
other words, that's not about adult interactions, but really a
(08:13):
peer to peer and it would be expressed in terms
of age appropriate distress, which for a child might be
clinging to a parent, cringing, crying, or otherwise displaying obvious
fear or discomfort. The second thing is typically the individual
will fear that they will display their anxiety and then
(08:35):
experience social rejection. Third, the social interaction will consistently provoke distress. Fourth,
social interactions are either avoided as a result or painfully
and reluctantly endured. Fifth, the fear and anxiety will be
(08:57):
grossly disproportionate to the actual situation. Six, The fear, anxiety,
or distress around social situations will persist for six months
or longer. That's important. In other words, social anxiety disorder
really doesn't get diagnosed unless it's gone on for some time.
(09:19):
Seven It causes personal distress, and it impairs your ability
to function in one or more areas. That could be
work or it could be interpersonal an Eighth, the fear
or anxiety cannot be attributed to another medical disorder, or
(09:39):
to substance use or the bad side effect of another medication.
It's important to understand these because you can see that
you may be having social anxiety without qualifying or a
social anxiety disorder, and that will tell you something about
whether it's something that maybe you can work on yourself,
(10:01):
or whether it's something that would be better suited to
have you be evaluated and try to work on with
a professional. How can I help with? Dr? Gayl Salts
will be back after this short break, so what about
(10:26):
the larger number of us that are having some of
this going on as we try to get back to
pre pandemic life. Let's get to our listener question for
today and see how can I help, dear doctor Saltz.
My office is saying that by September one, everyone will
(10:47):
need to return to the office. I am finding myself
increasingly nervous about this because as of now, even going
to the drug store and being with unmasked shoppers is
making me uncomfortable. Last weekend, our neighborhood had a block party,
a summer tradition that everyone felt we could do this year.
(11:10):
I went, but was so apprehensive beforehand and then kept
having these awkward moments of not wanting to shake hands
with people and hug anyone really, but not knowing what
to do about it and what they were going to do,
so it all just felt super uncomfortable, and now I
(11:30):
feel like I don't even want to go to a
gathering because I can't imagine having to endure that again.
But I also know work at the office in person
is coming and I really need to go back. What
can I do to manage my anxiety about all this reentry?
First off, I will say to you, dear listener, that
(11:52):
you have loads of company. Many people, maybe even most,
are having some level of anxiety around the social aspect
of returning to life pre pandemic. Do I shake hands
while I insult them? If I don't want to hug hello,
will it feel all weird and awkward because it is
(12:14):
weird and awkward? The answer is maybe, And that's okay
because it's happening all around and you are far from
the only one feeling that way. In fact, the first
thing that can be helpful is saying something out loud,
which just allows you both, for all of you there,
(12:38):
to laugh a bit, to feel your common discomfort and
be a little more empathic towards each other. So, for example,
if you prefer not to hug start with, I'm not
ready to dive back into hugging yet you know still adjusting.
This is a way of validating your emotions, which is
(13:00):
good thing. Always. It's okay to know you feel nervous, apprehensive,
and to let others know if this is how you feel,
it's likely to encourage them to be willing to share
their feelings as well, and you'll both feel supported in
having company. At the same time, it's important for you
(13:24):
to distinguish in your mind what's truly about safety versus
pure anxiety. So if your office, for example, has set
up what you know to be a reasonably safe situation,
for example, most of the office is vaccinated and anyone
(13:44):
with symptoms is told to stay home, then you can
tell yourself that the nerves you're having are anxiety, a
feeling state, not a reality. Once you've denoted something anxiety related,
the one thing you don't want to do is avoid
(14:05):
Avoidance actually makes anxiety grow. You can go slow, so,
for example, if you are more comfortable starting back with
just one in person meeting a day, you can tell
yourself you're easing in, you're taking baby steps. But the
key is to take steps at all, because as you
(14:30):
do something and then see that you are okay, you
are actually desensitizing yourself to the anxiety state, and that
will help your anxiety to diminish. Try writing down what
worries you try to realistically assess what's a reality and
(14:52):
what's a fear, and then make some plans to have
something to say about your comfort level and the choices
you'd like to make out loud to people as you
encounter them as the days go on. Use some relaxation
techniques to keep your body and subsequently your mind more
(15:15):
relax for example, using five minutes of deep breathing, doing
some form of aerobic exercise for thirty minutes a couple
times a week. Try practicing muscle relaxation techniques for a
few minutes each day, even a few minutes of practicing
(15:36):
meditation with each day or two. Try to do something
in person a little more. Say hi to the cashier,
strike up a chat in the grocery aisle, speak to
the person in the elevator. The more you do, bit
by bit, the more over time your anxiety will abate.
(16:02):
I hope that was helpful. As with any issue related
to the mind, sometimes there are things you can be
doing for yourself to help yourself out of the feeling state.
Or to at least tolerated. But if your social anxiety
comes with a whole host of physical symptoms sweating, nausea,
(16:24):
shortness of breath, palpitations, and if your apprehension and dread
beforehand is so large and looming that it's impairing your
ability to do things things that you want to do.
For example, you won't go to work, you won't shop
in a store, you're not able to go out with friends,
(16:46):
then you may need to see and would benefit from
seeing a mental health professional. There are types of therapies,
especially cognitive behavioral therapy, but also for example, psychodynamic psychotherapy
that can treat social anxiety, sometimes with a lot of symptoms.
(17:06):
Medication is really helpful and allows you to gain more
from doing the therapy, so you don't need to stay
on medication In the long run. Treatments for social anxiety
are not long lived and can make all the difference
in the world. Do you have a problem I can
(17:28):
help with? If so, email me yet how can I help?
At Seneca women dot Com. Fall Centers remain anonymous and
listen every Friday to how can I help with me?
Dr Gail's Salts
Bees 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. While most everyone is
in agreement that it is wonderful news that most places
in the United States have opened back up post pandemic,
and that high rates of vaccinations have made socializing much
safer now for some people, but getting back to socializing
(00:51):
is fraught with new and surprising anxiety about having any
social interactions. Having worked hard, hard for a year and
a half to avoid all social interacting and having this
change being enabled by fear of contagion and illness, it
hasn't been easy to flip the switch and go back
(01:15):
to your old ways, as least as easy as many
had assumed it would be. I'm hearing from many people
struggling with feeling nervous about getting back together with others,
about shopping, going to dinner with friends, even stumbling on
those they know in the parking lot. I'm hearing from
(01:38):
parents whose children are also uncomfortable going back to previous
social groove, hanging out with other friends, being in school together,
and trying to make chit chat. There are more people
struggling with social anxiety than before the pandemic. Some of
them have had difficulty in this arena before, and that's
(02:01):
before the pandemic, and now it's cropped back up again,
and some are having anxiety they didn't even have before.
So that's why today I'm answering the question I got
from a listener about social anxiety post pandemic. Actually, social
anxiety disorder, also known as social phobia, is an anxiety
(02:25):
disorder involving discomfort around social interaction and concern about being
embarrassed and judged by others. This discomfort will be experienced
as fear and anxiety, and it will be accompanied by
physical symptoms like sweating or shortness of breath, tremors, jittery feelings,
(02:50):
maybe rapid heartbeat, and even nausea. For some, it can
range in severity from a discomfort which can be worked
around and adapted too, to a virtually disabling fear interfering
with multiple areas of life. The discomfort that people with
social anxiety disorder experience can generalize to routine activities such
(03:16):
as eating in front of others or using a public restroom.
These people want to be with people and want to
participate in social situations, but their anxiety can become unbearable.
Social anxiety can lead to isolation and impact development in kids,
(03:40):
or cause anyone to lose social skills, which can then
serve to intensify their already existing social anxiety. Other anxiety
disorders can also go along with social anxiety, and social
anxiety can lead to topression due to loneliness and isolation
(04:04):
and an inability to make social contexts. Some people may
end up using drugs or alcohol in an effort to
reduce their anxiety in social situations. Social anxiety is not
the same as shyness nor introversion. Shyness and introversion are
(04:26):
normal and that they're common personality characteristics which can be
very endearing, but can be misconstrued as sociophobia. Shyness is
a quality which many people actually find attractive, especially those
who are less socially confident. It may be more comfortable,
(04:48):
and you might seek out somebody who's shy if you
feel less socially confident. A shy person does not represent
a threat and may be easier to approach. Introversion is
a choice and a preference for solitary activities, for deep
thinking and contemplation, quiet solitude, and the company of a
(05:12):
small number of meaningful social contacts rather than a large
quantity of shallow contacts. Introverts gain their energy and recharge
with some alone time, and extroverts tend to gain their
energy from social time with other people. But being shy
(05:34):
or introverted has nothing to do with the fear of
being judged harshly by others, with the apprehension about socializing
because of concerns that it won't go well and fears
of the potential for criticism. Neither do they tend to
(05:54):
be plagued after a social interaction with reviewing how it went,
thinking about perceived flaws in themselves and in the social interaction.
That is a special hell reserved for those with social anxiety.
Typically about seven to ten percent of the populations struggle
(06:17):
with social anxiety at any one time, so you can
hear it's not that rare, but post pandemically it seems
that number is even rising. That is likely because usually
social anxiety presents in the mid teens, and it often
(06:37):
runs in families, But it can also occur after a
traumatic event. And really, this year and a half of
social withdrawal has been such an abrupt change, with so
much hardship and loss that it has been traumatic or
many people at various levels now trying to return to
(07:03):
pre pandemic socializing may trigger a great deal of apprehension
after not doing it much at all under the threat
of sickness and death. In fact, to actually have social
anxiety disorder, you really need to have several of the
eight symptoms listed in the Diagnostic and Statistical Manual five,
(07:27):
and they should be socially limiting for you to qualify.
Those are the fear or anxiety that is specific to
social settings, mostly in which a person feels noticed, observed,
or scrutinized. In an adult, this could include something like
(07:49):
a first date, a job interview, meeting someone for the
first time, delivering a talk, or publicly speaking in a
class or meeting. And in children, those phobic or avoidant
behaviors have to occur in a setting with peers. In
other words, that's not about adult interactions, but really a
(08:13):
peer to peer and it would be expressed in terms
of age appropriate distress, which for a child might be
clinging to a parent, cringing, crying, or otherwise displaying obvious
fear or discomfort. The second thing is typically the individual
will fear that they will display their anxiety and then
(08:35):
experience social rejection. Third, the social interaction will consistently provoke distress. Fourth,
social interactions are either avoided as a result or painfully
and reluctantly endured. Fifth, the fear and anxiety will be
(08:57):
grossly disproportionate to the actual situation. Six, The fear, anxiety,
or distress around social situations will persist for six months
or longer. That's important. In other words, social anxiety disorder
really doesn't get diagnosed unless it's gone on for some time.
(09:19):
Seven It causes personal distress, and it impairs your ability
to function in one or more areas. That could be
work or it could be interpersonal an Eighth, the fear
or anxiety cannot be attributed to another medical disorder, or
(09:39):
to substance use or the bad side effect of another medication.
It's important to understand these because you can see that
you may be having social anxiety without qualifying or a
social anxiety disorder, and that will tell you something about
whether it's something that maybe you can work on yourself,
(10:01):
or whether it's something that would be better suited to
have you be evaluated and try to work on with
a professional. How can I help with? Dr? Gayl Salts
will be back after this short break, so what about
(10:26):
the larger number of us that are having some of
this going on as we try to get back to
pre pandemic life. Let's get to our listener question for
today and see how can I help, dear doctor Saltz.
My office is saying that by September one, everyone will
(10:47):
need to return to the office. I am finding myself
increasingly nervous about this because as of now, even going
to the drug store and being with unmasked shoppers is
making me uncomfortable. Last weekend, our neighborhood had a block party,
a summer tradition that everyone felt we could do this year.
(11:10):
I went, but was so apprehensive beforehand and then kept
having these awkward moments of not wanting to shake hands
with people and hug anyone really, but not knowing what
to do about it and what they were going to do,
so it all just felt super uncomfortable, and now I
(11:30):
feel like I don't even want to go to a
gathering because I can't imagine having to endure that again.
But I also know work at the office in person
is coming and I really need to go back. What
can I do to manage my anxiety about all this reentry?
First off, I will say to you, dear listener, that
(11:52):
you have loads of company. Many people, maybe even most,
are having some level of anxiety around the social aspect
of returning to life pre pandemic. Do I shake hands
while I insult them? If I don't want to hug hello,
will it feel all weird and awkward because it is
(12:14):
weird and awkward? The answer is maybe, And that's okay
because it's happening all around and you are far from
the only one feeling that way. In fact, the first
thing that can be helpful is saying something out loud,
which just allows you both, for all of you there,
(12:38):
to laugh a bit, to feel your common discomfort and
be a little more empathic towards each other. So, for example,
if you prefer not to hug start with, I'm not
ready to dive back into hugging yet you know still adjusting.
This is a way of validating your emotions, which is
(13:00):
good thing. Always. It's okay to know you feel nervous, apprehensive,
and to let others know if this is how you feel,
it's likely to encourage them to be willing to share
their feelings as well, and you'll both feel supported in
having company. At the same time, it's important for you
(13:24):
to distinguish in your mind what's truly about safety versus
pure anxiety. So if your office, for example, has set
up what you know to be a reasonably safe situation,
for example, most of the office is vaccinated and anyone
(13:44):
with symptoms is told to stay home, then you can
tell yourself that the nerves you're having are anxiety, a
feeling state, not a reality. Once you've denoted something anxiety related,
the one thing you don't want to do is avoid
(14:05):
Avoidance actually makes anxiety grow. You can go slow, so,
for example, if you are more comfortable starting back with
just one in person meeting a day, you can tell
yourself you're easing in, you're taking baby steps. But the
key is to take steps at all, because as you
(14:30):
do something and then see that you are okay, you
are actually desensitizing yourself to the anxiety state, and that
will help your anxiety to diminish. Try writing down what
worries you try to realistically assess what's a reality and
(14:52):
what's a fear, and then make some plans to have
something to say about your comfort level and the choices
you'd like to make out loud to people as you
encounter them as the days go on. Use some relaxation
techniques to keep your body and subsequently your mind more
(15:15):
relax for example, using five minutes of deep breathing, doing
some form of aerobic exercise for thirty minutes a couple
times a week. Try practicing muscle relaxation techniques for a
few minutes each day, even a few minutes of practicing
(15:36):
meditation with each day or two. Try to do something
in person a little more. Say hi to the cashier,
strike up a chat in the grocery aisle, speak to
the person in the elevator. The more you do, bit
by bit, the more over time your anxiety will abate.
(16:02):
I hope that was helpful. As with any issue related
to the mind, sometimes there are things you can be
doing for yourself to help yourself out of the feeling state.
Or to at least tolerated. But if your social anxiety
comes with a whole host of physical symptoms sweating, nausea,
(16:24):
shortness of breath, palpitations, and if your apprehension and dread
beforehand is so large and looming that it's impairing your
ability to do things things that you want to do.
For example, you won't go to work, you won't shop
in a store, you're not able to go out with friends,
(16:46):
then you may need to see and would benefit from
seeing a mental health professional. There are types of therapies,
especially cognitive behavioral therapy, but also for example, psychodynamic psychotherapy
that can treat social anxiety, sometimes with a lot of symptoms.
(17:06):
Medication is really helpful and allows you to gain more
from doing the therapy, so you don't need to stay
on medication In the long run. Treatments for social anxiety
are not long lived and can make all the difference
in the world. Do you have a problem I can
(17:28):
help with? If so, email me yet how can I help?
At Seneca women dot Com. Fall Centers remain anonymous and
listen every Friday to how can I help with me?
Dr Gail's Salts
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