Am I Socially Anxious or Just Shy?

Have you ever felt the following:

• Uneasy about going into a party where there will be some people you’ve never met because they might see you eat or dance
• Sweaty palms and a racing heartbeat at the thought of having to give a speech in front of an audience
• Worried that a group of new classmates will judge you for your voice
• Nauseous at the thought of having to talk to your supervisor for your yearly performance review
• Having headaches or stomachaches that seem to come from nowhere the day of an event
• Uncomfortable sharing details of your life with an acquaintance out of a fear they might use it against you
• Isolated because you’ve just stopped going out If so, you might have experienced social anxiety.

Social anxiety is experiencing fear and anxiety around others, particularly anxiety about being judged. Social anxiety disorder is also known as “social phobia” and is more than just shyness. When stress about social situations interrupts our relationships, job, health, or other major areas of our lives, it can be diagnosed as Social Anxiety Disorder. The essential piece of Social Anxiety Disorder is a high fear of “Negative Social Evaluation”, which is the perception that we will be judged negatively in social situations. Often these are fears that people will think we are stupid, uncool, embarrassing, fake, or gross. Some social anxiety is focused on performance, and comes out in situations like speeches, interviews, job presentations, exercising in public, or playing sports or music in front of an audience. Other times, social anxiety can feel more personal and related to fears that other people will judge and dislike us no matter what we do.

What separates social anxiety from shyness or introversion is not whether we might like or dislike being around people, it’s the threshold for how unbearable we perceive those negative interactions to be. If someone consistently expects to be judged by others in social situations AND finds that they can’t stand the thought of being judged, then they most likely experience social anxiety. Meanwhile, shyness is feeling reserved or mildly uncomfortable in social situations and introversion is a personality trait that means a person finds being alone to be most comfortable and rejuvenating than socializing with others.

If Social Anxiety Disorder continues or worsens, it can lead to social withdrawal in some people, which is when a person intentionally avoids social contact and activities they once enjoyed. Social withdrawal is not exclusive to those with social anxiety disorder. It can also occur during difficult periods of life like grief, trauma, depression, or changes to physical health symptoms.

Where Does It Come From?

Like many mental health conditions, Social Anxiety Disorder has both genetic and environmental factors that contribute (nature vs. nurture). It may seem obvious, but people who would describe themselves as shy, introverted, and who tend to worry are more likely to receive a diagnosis of Social Anxiety Disorder. The same goes for people who have parents, siblings, or other close relatives who have been diagnosed with it too. Many people find that there is a specific event or period in their life that made them socially anxious. Bullying in adolescence and experiencing a particularly embarrassing event are common triggers for the development of social anxiety. In the US, about 7% of people have or have had a diagnosis of Social Anxiety disorder, and of those about 75% experienced it between the ages of 8 and 15. Women are about twice as commonly diagnosed with it as men.

Coping Doesn’t Solve the Problem

Most people who live with social anxiety change their behavior or their thoughts as part of dealing with the intense anxiety, fear, or shame they feel. Avoiding social gatherings altogether, making excuses, or limiting time in social situations are common coping strategies that prevent or limit the distress a person might feel, but they can have big drawbacks like missing out on shared experiences, important friendships, and required work duties. Drinking alcohol to numb uncomfortable emotions at gatherings where it is present is also a common approach. However, drinking every time you’re out with people can increase fear and embarrassment, not to mention the health and financial costs of alcohol.

Lots of people cope with social anxiety by doing all sorts of things; speaking softly, avoiding eye contact, procrastinating arriving on time, checking their appearance over and over to make sure they don’t look out of place, never using public restrooms, changing their body posture to avoid visibly trembling, fixating on their phone or a tv, seeking reassurance, caving to the peer pressure of others, and even talking excessively to avoid thinking about what the other person might be thinking about them! Even while doing one or more of these things, the underlying fear about being judged still remains. Interacting with other people is a fact of life, and juggling coping skills to go to the grocery store or a friend’s house for dinner can be exhausting. So what can we do about social anxiety?

The Therapy Approach

The gold standard therapeutic way to treat Social Anxiety Disorder is called Exposure and Response Prevention (ERP). My colleague Alyssa has an excellent blog post about ERP for more depth, but I’ll give a brief overview. The goal of ERP is to gradually confront anxiety in a series of exposures (from least distressing to most distressing) to the stressors without relying on avoidance, distraction, or reassurance. ERP Therapists refer to any of those behaviors, thoughts, or rituals meant to avoid, distract, or reassure ourselves about our anxiety as “safety behaviors.”

Most ERP begins with making a thorough list of situations or scenarios that create anxiety and ranking those on a scale from 1-10 by how distressing they seem. For someone with social anxiety, this might look like; (1) Imagining saying hello to a coworker, (5) Going to party at a friend’s house and meeting one new person, and (10) Giving a speech to a crowd of 100 people. Then, you and your therapist will collaborate on the list of safety behaviors you might use to distract or avoid feeling anxious and plan how to handle those situations without relying on the safety behaviors. Effective and ethical ERP work is a collaborative process between the therapist and the client about choosing which exposures to do when the client is ready. 

Exposures fall into a few different categories: 

• Interoceptive Exposures – body exercises meant to simulate a feeling of anxiety (shallow breathing to stimulate hyperventilation, spinning to stimulate dizziness, running in place to elevate heart rate) 
• Imaginal Exposures – imagining that you are making a stressful phone call or social interaction 
• Virtual Reality Exposures – Not as often used as imaginal exposures, but these involve the use of VR headsets and immersive software to simulate social situations, heights, airplanes, and other common fears 
• Real Life or “In Vivo” exposures – Going out and engaging in situations that rank higher on SUDs scale. These are done after Imaginal exposures. 

Over time, the goal of ERP therapy is to create habituation, which is learning to see the situation that once resulted in fear and anxiety as no longer threatening. Sometimes, progress with ERP looks like doing a new exposure each week, and other times people need to repeat exposures multiple times until they feel ready to move on to something higher on their personal scale. ERP is a type of therapy that many people find helps them build confidence and gives them a variety of tools for handling life’s stressors. 

Next Steps

If you or someone you know has been struggling with social anxiety or withdrawing from social situations, please reach out. At Serengeti Wellness, I treat social anxiety, generalized anxiety disorder, and many other diagnoses and life stressors. If you would like to book a session with me as your therapist, please visit the Serengeti Wellness online booking site. I look forward to working with you!