SOCIAL ANXIETY PROGRAM Information for Clients and Families
SOCIAL ANXIETY Information for Clients and Families CONTENTS 1. Definition of Social Anxiety. 1 2. Types of Social Anxiety. 2 3. Causes of Social Anxiety. 3 4. Other conditions.. 4 6. Treatments. 5 7. Tips for families & friends. 6 8. Reading references.. 7 9. Websites. 7
Does this sound familiar? I skipped a lot of classes in high school because I was so afraid the teacher would ask me a question in front of my classmates. I knew if he did, I would start shaking and blushing. I was very lonely but I couldn t go anywhere - - like parties or other social events because there are always new people there. What would I say? What would I do? Even if they seem nice, they re sure to notice my fear. Going out for lunch with my co-workers should be so easy it sure seems easy to others! But to me it was pure torture! I d worry about not knowing what to say or of saying something stupid. What is Social Anxiety Disorder? Social anxiety disorder is the fear of social situations and the interaction with other people that can automatically bring on feelings of judgment, self-consciousness, criticism and evaluation. In other words, social anxiety is the fear and anxiety of being judged and evaluated negatively by other people, leading to feeling inadequate, embarrassed, humiliated and depressed. If a person usually becomes anxious in social situations, but seems fine when they are alone or with certain safe people, then social anxiety may be the problem. Social anxiety disorder (social phobia) is much more common than past estimates have led us to believe. Literally millions of people suffer from this disorder. However, compared to other anxiety disorders, social anxiety has received less attention in the media. One group of experts called social anxiety the neglected anxiety disorder, although this has changed in recent years. Individuals with social phobias often believe that no one else shares their problem. This belief could not be further from the truth! Recent studies suggest that as many as 2 3% of the population is significantly affected. Another 20% or more have less distressing forms of social anxiety because they are able to avoid the situations or endure them with dread. Research surveys have, in fact, consistently listed one social phobia, the fear of public speaking, as the #1 fear in this country. 1
What types of social anxieties are there? The social and performance situations feared by people with social anxiety disorder vary greatly, but the most common ones are Public speaking Conversations with unfamiliar people Talking with authority figures Dating Being assertive Also, some individuals with social anxiety disorder are Afraid of being the centre of attention Afraid of urinating in public places (usually only men have this fear) Afraid of eating or drinking in front of other people Fearful of intimate sexual situations Afraid of writing in public taking tests In contrast to specific social phobias, people with a more generalized social anxiety fear a wide variety of what may seem to be unrelated situations involving other people. However, the common theme in both the specific and generalized forms of social anxiety is the fear of disapproval. The individual with a generalized social phobia dreads many, if not all situations in where there is a chance of making a mistake or behaving foolishly in front of other people. 2
Possible causes of Social Anxiety There are no definite answers about the causes of this disorder, but there is good scientific research as to what factors may contribute to it. Like most other psychological disorders, social anxiety disorder is not caused by just one thing but likely results from a combination of factors including genetics, experiences in your family and other experiences you have had. Is Social Anxiety in Your Genes? Scientific research in the last 30 years indicates that social anxiety probably has a genetic component, at least for some people. Twins studies have found that if one twin socially anxious, the other is also likely to be socially anxious. This likelihood increases if the twins are identical twins (come from one egg and have identical genes) than if they are fraternal twins (come from separate eggs). Someone with social anxiety disorder is about three times as likely to have a family member with the same disorder as someone who does not have any problems with anxiety. It does appear that social anxiety runs in families, however, having a predisposition to the disorder does not mean you are stuck with the disorder, merely that you have an increased likelihood of being shy. The life experiences you have strongly influence whether or not you will be socially anxious and how severe that social anxiety will be. How does our family environment affect Social Anxiety? A great deal of what we know about ourselves, of other people and how the world works we learned from our family while we were growing up. Our basic beliefs about life start to form in early childhood such as whether or not we can trust other people, whether life is under our control or whether we are at the hands of fate and wither events happen to us in a predictable or unpredictable fashion. We also start to learn whether we are valuable and worthwhile individuals. We learn these lessons by watching and listening to those around us. If one or both parents have social anxiety, then their child may learn to be socially anxious by watching how their parent handles social situations. Several studies have found that the families of people with social anxiety tend not to socialize with other families. Parents can also teach children avoidance as a coping strategy by refusing invitations themselves or suggesting avoidance when the child is anxious. 3
How do important experiences play a role a social anxiety? A child or adolescent who is different in some way from his or her peers may start to develop social anxiety when the onset typically appears. Some adults with social phobia remember discomfort giving reports or talking in front of class. In fact, current thinking about childhood anxiety disorder suggests that some school phobias (refusal to go to school) may be an early form of social phobia. Other conditions: Sometimes, the first time someone with social anxiety seeks help is for something entirely different. Depression and panic disorder are examples of disorders that may first make people with social anxiety seek help from their doctor. People who feel persistently sad and a loss of enjoyment that interferes with daily life may be suffering from depression. It is not uncommon for individuals with social phobias to experience panic attacks. Panic attacks are sudden surges of anxiety symptoms which typically include rapid heart rate, shortness of breath, dizziness, sweating, tingling sensations and usually feeling that one is going crazy, losing control or dying. However, for people with social anxiety, the primary concern is not the panic attack itself but the opinions of others who might witness their anxious behaviour. Some people with social anxiety disorder may use alcohol or other drugs as a way to self-medicate to help them through social situations. It is estimated that about ¼ of all people with social anxiety abuse alcohol. Although drugs and / or alcohol may seem to help initially, they eventually become another problem in the life of the person with social anxiety disorder. Appropriate treatment for social anxiety disorder may reduce alcohol and drug dependence in those who suffer from this disorder. 4
How is Social Anxiety treated? People with social anxiety know that their anxiety is irrational and does not make sense. However, thoughts and feelings of anxiety persist and show no signs of going away without appropriate treatment. Most individuals with a social anxiety can achieve a more fulfilling lifestyle and become more comfortable in social situations. Treatments should begin with a comprehensive evaluation. It is vital to take a good look at anything that could be a contributing factor to the problem. Then a treatment plan should be developed that is tailored to the particular needs of the individual. Often, treatment includes a well-balanced combination of several approaches. Cognitive Behaviour Therapy (CBT) is a type of therapy for social anxiety to help people modify the way they think, feel and behave in social situations. Though everyone s therapy is unique, there are several common components of CBT. All participants are educated about the nature of social phobias and maladaptive beliefs and expectations about social situations are gradually identified, challenged and altered. Treatment may also include behavioural experiments or exposures, which are designed to help people confront feared situations in a stepby-step manner. Clients are taught anxiety-management skills to assist them in this process. Some individuals with social anxiety may experience additional anxiety due to the lack of a certain skill, such as public speaking skills or assertiveness skills. This treatment may also focus on improving these skills and is known as social skills training. Medications are useful for many people with social anxiety disorder. In general, a number of antidepressants which have anti-anxiety effects - have been found to be very beneficial. These include escitalopram (Celexa), fluvoxamine (Luvox), paroxetine (Paxil), Sertraline (Zoloft) and Venlafaxine (Effexor). For those individuals who experience certain physical symptoms often related to performance anxiety (i.e. trembling hands, increased heart rate), beta blockers such as Propranolol (inderal) or atenolol are sometimes prescribed. The decision to take medication should, of course, be discussed with your physician. 5
Tips for Families and Friends People who social anxiety disorder often feel isolated and alone. They may feel ashamed of their problem and attempt to hide it. If they have mustered up the courage to tell a family member of friend about their difficulties, they may have been met with well-meaning but unhelpful remarks such as, Everyone is nervous getting up in front of a group of people. or, So what if people look at you? Maybe they re just admiring your new outfit (nice hair, etc.). It can be difficult for others to understand the overwhelming anxiety that people with a social phobia experience. If you suspect someone you care about has social anxiety disorder, encourage him or her seek an evaluation by a professional. They may also be suffering from another problem such as panic disorder or depression. Learning about social anxiety disorder, its symptoms and the other conditions that can go along with it is one step towards helping your friend / family member. If the individual s difficulties are interfering with your life, and the person is not willing to seek help, you can contact a professional yourself to learn how best to deal with the situation. 6
Reading resources 1. Triumph Over Shyness, Murray B. Stein, M.D. and John R. Walker, Ph.D McGraw-Hill, (2002) 2. Dying of Embarrassment: Help for Social Anxiety and Phobia. Barbara G. Markway, Cheryl N. Carmin, C. Alec Pollard and Teresa Flynn. New Harbinger, (1992) 3. Painfully Shy: How o Overcome Social Anxiety and Reclaim Your Life. Barbara G. Markway and Greegory P. Markway. New York, (2001) 4. The Hidden Face of Shyness: Understanding and Overcoming Social Anxiety. Franklin Schneier and Lawrence Welkowitz. New York, (1996) 5. The Shyness and Social Anxiety Workbook: Proven Techniques for Overcoming Your Fears. Martin M Antony and Richard P. Swinson. New Harbinger, (2000). 7
Internet websites: 1. www.anxietycanada.ca ADAC (Anxiety Disorders Association of Canada) website 2. www.psych.org American Psychiatric Association 3. www.adaa.org American Disorders Association of America 4. FFFNAD@aol.com Freedom from Fear 5. www.nimh.nih.gov/anxiety National Institute of Mental Health 6. www.cpa.ca Canadian Psychological Association 7. www.shyness.com The Shyness Institute 8. www.veryshy.com University of California San Diego Anxiety and Traumatic Stress Disorders Program 8
NOTES: 9
ANXIETY AND MOOD PROGRAM A PARTNERSHIP OF SASKATOON HEALTH REGION MENTAL HEALTH & ADDICTION SERVICES AND THE DEPARTMENT OF PSYCHIATRY UNIVERSITY OF SASKATCHEWAN (306) 655-7950 April 2009