7 tips for living with social anxiety
Living with social anxiety can be limiting and lonely. If you find that your fear gets in the way of you living your best life, read on to find out how to turn things around.
7 tips for living with social anxiety
By Joyce Chong
In the 2007 National Mental Health and Wellbeing survey that surveyed 16million Australians to gain a picture of the nation’s Mental Health we found that anxiety is the most common mental health disorder experienced by individuals. (see here for a brief summary)
Within anxiety, social anxiety is the second most common anxiety disorder experienced (behind posttraumatic stress disorder). Social anxiety is linked with poorer quality of life and workplace productivity [1] and also with the increased use of alcohol and cannabis.[2]
If you're one of the many who experience social anxiety or know of someone who does, read on for our 7 tips for living with social anxiety. We've also included a printable version at the bottom of the article.
1. Know the difference between shyness and social anxiety
It’s easy to fall into the trap of seeing social anxiety as just an extreme of shyness. Indeed, there is a higher rate of social anxiety amongst shy individuals compared to individuals who aren’t shy, however the majority of shy individuals do not have social anxiety.[3]
However, social anxiety differs from shyness in that there is a marked level of fear involved, there is avoidance of feared situations, there is a strong fear of negative evaluation, and the social anxiety has a negative impact on functioning in several areas of life (e.g. work performance or relationships).
For example, a student may feel shy in a tutorial room, but if that person is distressed at the prospect of having to speak in the tutorial, and the tutorials have a participation component that students must pass (that is, they risk failing the entire unit if they don’t contribute) then we are looking more at a picture of social anxiety.
Did you know that for some, the anxiety is present only in situations where performance is concerned? So, while they may do well in most aspects of socialising, there may be anxiety just when doing public speaking or talking to people in positions of authority (e.g. managers, lecturers).
2. Take action…now!
Social anxiety typically starts between late childhood and mid-adolescence, with sufferers waiting an average of 15-20 years before they seek treatment.[1]
Given the wide-ranging impact of these social fears, it is understandable that social anxiety is linked with poorer quality of life and wellbeing – how restrictive would it be if you were afraid to go for a job interview, ask someone for directions, ask a question of your teacher, or even looking people in the eye in a passing conversation in case they think negatively of you?
How long have you lived with social anxiety? How does it hold you back in your life? Take action now so that you don't have to continue to live this way.
3. Challenge your avoidance
Avoiding a scary situation may bring you immediate relief, but over time you may notice that more situations cause you anxiety, or that your anxiety gets more intense.
The reality is that striving to feel safe all of the time is unrealistic, and trying to achieve this means that the number of situations in which you feel comfortable starts to rapidly shrink.
Make changes by taking one small step at a time. For example, if you're afraid of making conversation with people, start off by making small talk about the weather with the check out operator at a new grocery store, then build up to making small talk with the receptionist at your doctor's surgery. It takes one small step to get the ball rolling.
4. Rethink your drink
Social anxiety is associated with an increased rate of alcohol dependence. [4] Alcohol is often used to cope with nerves before and during a social situation, but it's important to rethink your drink and take a good hard look at whether it's just another form of avoidance.
Why is using alcohol to cope with anxiety a bad thing when many of our social situations involve alcohol? Well, alcohol may make you feel less anxious in the short term, but in the longer term do you learn that you can cope without a drink? Sound familiar? Refer to Point 3 – yes, using alcohol sounds like a form of avoidance.
5. Check your thoughts
Are your thoughts and thinking styles making your anxiety worse? Tune in to your thoughts when you first notice anxiety building up in a social situation. Are you making an incorrect assumption? Are you jumping to conclusions, or catastrophising by focusing on the worst case scenario?
If you're giving a presentation, do you assume that one small mistake in your presentation means that you have made a fool of yourself? Will the worst case scenario of being laughed at by everyone really come true?
We’ve previously blogged about Checking your Thoughts in relation to social anxiety here in our post on social anxiety and Christmas functions so use that as a starting point. You can also find more information on thinking styles here.
6. Conduct an experiment
Sometimes we believe what we believe because we haven’t had evidence to the contrary. Let's say you keep your head down on the bus because you think that others on the bus will stare at you. By keeping your focus on your feet or phone, you won't see that they’re not staring at you. In other words, your belief is reinforced or, at the very least, not disputed.
Let’s mix things up a little. Let’s conduct an experiment by sitting at the back of the bus, and then watching what people actually do. Chances are, you’ll see that people are either looking at their phones, or looking out the window. The thing is, though, you won’t really know unless you do the experiment to test your belief.
7. Seek professional help
A lot can be done to help with social anxiety, so please take action before 15-20 years pass you by (see Point 2). Psychological treatments such as Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been shown to be effective in the treatment of social anxiety.[5] You can also speak with your GP to discuss medication options.
Thanks for reading. We hope that the tips on managing social anxiety are helpful.
Want more? Learn about Social Set, our 8-session Social Anxiety Course. Work one-on-one with a psychologist to develop a tailored approach to bounce back from social anxiety.
REFERENCES
[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edition, DSM-5). Washington: American Psychological Association.
[2] Buckner, J.D., Schmidt, N.B., Lang, A.R., Small, J.W., Schlauch, R.C., & Lewinsohn, P.M. (2008). Specificity of Social Anxiety Disorder as a risk factor for alcohol and cannabis dependence. Journal of Psychiatric Research, 42, 230-239.
[3] Heiser, N.A., Turner, S.M., & Beidel, D.C. (2003). Shyness: relationship to social phobia and other psychiatric disorders. Behaviour Research and Therapy, 41, 209-221.
[4] Schneier, F.R, Foose, T.E., Hasin, D.S., Heimberg, R.G., Liu, S.M., Grant, B.F., & Blanco, C. (2010). Social anxiety disorder and alcohol use disorder comorbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 40, 977-988.
[5] Craske, M.G., et al. (2014). Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. Journal of Consulting and Clinical Psychology, 82, 1034-1048.
What to do in case of a panic attack
What is a panic attack, and what can you do about it? Read on for our tips on how to manage it ‘in the moment’, and what to do after the panic attack has passed.
what is a panic attack?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; p. 214 [1] ), panic attacks refer to a sudden surge of intense anxiety and discomfort that peaks within minutes, and is defined by several symptoms including increased heart rate, trembling, shortness of breath, chest discomfort, tingling, nausea, feeling detached, and fear of losing control or of dying. Panic attacks are estimated to affect 40% of Australians at some point in their lives. [2]
Panic attacks can be unexpected (for example as in the case of Panic Disorder), or they can be quite specific to certain situations. For example, they may occur:
In social situations (e.g. public speaking, performing)
When faced with specific phobias (e.g. spiders, snakes, heights, flying)
Around injections/blood (e.g. visit to the dentist, immunisations)
Related to traumatic incidents (e.g. reminders of car accidents or traumatic surgery)
When thinking about your health (e.g. jumping to the ‘worst case scenario’ about a health symptom)
When you feel trapped (e.g. in enclosed spaces such as lifts, buses, trains)
After a panic attack, worrying may set in - What if it happens again? What if you can’t cope? What if there’s no one around when it happens? What if it happens and you can’t escape?
You may then start to avoid places you’re unfamiliar with, or where you’ve previously felt anxious. You may turn to carrying medication ‘just in case’ you need it, or only going places when a familiar person is with you. Over time you may find:
Your idea of what’s safe in this world shrinks, to the point where you’re very limited in where you will venture and what things you will take on
You develop a series of subtle avoidances (e.g. rather than escape altogether you may have ‘safety figures’ or ‘safety behaviours’).
Your mood suffers because of how much your fear holds you back, and its effect on your quality of life.
Given how distressing panic attacks can be, the impact on an individual’s quality of life can be devastating. They can also lead to repeated presentations to medical practitioners for the distressing physical symptoms.
WHAT causes PANIC ATTACKS?
Several factors come to mind when consider what causes panic attacks: [3] [4]
Family history. Twin and family studies of Panic Disorder revealed that genes make a significant contribution to the emergence of panic disorder.
Your health. Some medical conditions may yield symptoms that mimic panic symptoms, including thyroid diseases, cardiac diseases, and respiratory disorders. The use of stimulants such as caffeine and nicotine can also contribute to your experience of a panic attack.
The degree of stress experienced. Sometimes a panic attack may be brought on by a clear and ‘significant’ trigger, for example, having to give a speech in front of 100+ people. At other times, it may be harder to find a clear trigger, but upon reflection you may be able to see that you’ve experienced heightened levels of anxiety in preceding weeks.
Your thoughts. Panic attacks arise when you perceive there to be a threat. How you think has the capacity to ‘ramp up’ your anxiety.
WHAT CAN BE DONE TO HELP WITH PANIC ATTACKS?
When it comes to helping with your panic attacks let's approach it from two angles.
While we can look at what to do to calm down the immediate panic symptoms so that you're better able to cope with the distress, we strongly encourage that you also seek assistance to address the anxiety in the longer term.
We've outlined these two approaches and you can also grab the printable tip sheet below (and also get access to our Resource Library of tip sheets).
WHAT TO DO WHEN YOU'RE IN THE MIDDLE OF A PANIC ATTACK
Slow down your breathing as this will help to decrease your anxiety. Start by holding your breath while counting to ten, then breathe in over four seconds and out over another four seconds. Breathe from your diaphragm rather than your chest, and continue for 5 to 10 minutes, repeating if necessary.
Check your thoughts in case they’re escalating your panic symptoms. Catastrophising about the worst case scenario can increase your panic symptoms. Instead, look to test if the thoughts are true (e.g. Is it the case that no one will help if I have a panic attack in public? Have I ever heard of someone passing out from a panic attack?). Alternatively, you can try to take a mindfulness approach by letting the thoughts come and go without getting caught up in them.
Keep in mind that the panic attack will eventually subside. It may not feel pleasant in the meantime, but it will pass. Think of it as ‘surfing’ the wave of anxiety.
WHAT TO DO A LITTLE LATER FOLLOWING A PANIC ATTACK
After the panic attack it’s helpful to take action to help manage your panic attacks in the longer term. Steps that you can take include:
Ruling out any underlying medical conditions in consultation with your health professional. Some medical conditions (e.g. respiratory conditions, cardiac diseases, thyroid diseases) may contribute to the experience of panic symptoms.
Making lifestyle changes to keep your overall stress levels down, including:
Decreasing strain on your body by limiting the use of stimulants that may produce panic-like symptoms (e.g. excessive caffeine consumption may lead to heart palpitations).
Engaging in aerobic exercise on a regular basis.
Look to improve manageable sources of stress by developing skills including stress management, time management, and developing efficient processes to streamline your life and decrease your daily hassles.
Seeking assistance from a mental health professional such as a psychologist to learn skills to help you manage the anxiety. Psychological treatment options shown to be effective include:
Cognitive Behaviour Therapy which includes exposure therapy in the forms of graded exposure and also interoceptive exposure (which is exposure to those uncomfortable panic symptoms). This is the treatment that has the strongest evidence-base for Panic Disorder. [5]
Acceptance and Commitment Therapy.
Mindfulness (either on its own, or as part of Mindfulness-based Cognitive Therapy or ACT).
Our psychologists who help with panic
REFERENCES
[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Association.
[2] https://au.reachout.com/articles/what-are-panic-attacks
[3] Lam-Po-Tang, J. (2011). Panic disorder and agoraphobia. Australian Doctor, 28 October 2011, 29-36.
[4] Hettema, J.M., Neale, M.C., & Kendler, K.S. (2001). A review and meta-analysis of the genetic epidemiology of anxiety disorders. American Journal of Psychiatry, 158, 1568-1578.
[5] Australian Psychological Society (2018). Evidence-based psychological interventions in the treatment of mental disorders: A review of the literature (4th ed.). https://www.psychology.org.au/getmedia/23c6a11b-2600-4e19-9a1d-6ff9c2f26fae/Evidence-based-psych-interventions.pdf
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Confessions of a mindfulness sceptic...
Mindfulness...it's everywhere we look, and it permeates every aspect of our lives. But is mindfulness the miracle cure it's touted to be?
confessions of a mindfulness sceptic
Mindfulness. Previously reserved solely for eastern philosophy and hardcore yoga addicts, in 2016 mindfulness has well and truly entered the mainstream.
Walk past a self-help section at a bookstore, browse a blog on wellness and healthy living, chat with the mums at the playground and no doubt before long you will find yourself confronted with someone extolling the virtues of mindfulness.
Mindfulness is taught at our schools and workplaces, it’s encouraged as a way to de-stress, get sleep, reduce anxiety and probably lose 5kg in the process. A modern panacea for pretty much anything that ails you. But is mindfulness a miracle cure or snake oil?
THE CASE FOR SCEPTICISM WHEN IT COMES TO MINDFULNESS
Now as a psychologist, this writer should be all about mindfulness. This is a golden age for mindfulness, a win for mental health! Shouldn’t I be itching to settle in to twice daily, hour-long mindfulness meditation sessions?
Maybe I should. But I’m not. Confession time – I’m just not a fan. So let me lay it all out on the table. Here are the reasons why I’m a mindfulness sceptic.
1. MINDFULNESS IS boring.
Come on, be honest now. It’s sitting there doing nothing. Deliberately doing nothing. Sure, you’re being mindful of everything that’s happening in the moment, but if you’re just sitting there, that adds up to not much. Even trying a 20 minute guided mindfulness exercise, I have to admit to boredom creeping in.
2. MINDFULNESS HAS NO CLEAR RESULT.
This is especially hard for those of us who are just a tiny bit perfectionistic and results-oriented. What if I were doing it to train my thoughts to never be negative? Well, that would be a result; that would be something worth putting in the hard yards for.
But one of the key elements of mindfulness is that you are not trying to change anything, but simply to observe. Practising true acceptance of everything you notice in the moment means that if you’re looking for a nice measurable change as a result, you’re not doing it for the right reasons.
3. MY THOUGHTS DON’T TURN OFF DURING MINDFULNESS.
Some people have the misconception that mindfulness is about learning how not to think. And it’s true, people who practice mindfulness meditations regularly do report a slowing of the mind, or a reduction in the running-like-a-freight-train type thoughts. But there’s no turning your thoughts off completely.
Trying to clear an unclearable mind? Now that sounds like a recipe for frustration.
4. I FEEL AWFUL AND IN PAIN A LOT OF THE TIME. WHY WOULD I DRAW ATTENTION TO IT WITH MINDFULNESS?
Here’s another tricky one. Mindfulness calls on you to “tune into” or be mindful of every part of your experience. Pay attention to your emotions, whether they are happiness, sadness or panic. Be present with your thoughts, whether they are saying “I am content in all situations” or “I am a worthless human being”. Bringing you closer to your experience in the moment can bring you back in touch with yourself. But it can also bring you closer to your pain.
5. I’m too lazy to be consistent ENOUGH WITH MINDFULNESS to see the benefits
Most proponents of mindfulness meditation advocate that you need to start at around two sessions a day, for 20 minutes each. And you must stick with this for around 3 months to see the benefits.
Now, is 20 minutes really all that much time? No, I guess not, but every day? For weeks on end? While I’m thinking of all the more productive things I could be doing? I’m afraid I just don’t have the staying power.
I’d say I have a pretty strong case for throwing the towel in. But in an effort to give mindfulness just one more chance, I thought I should look into the research to see just what it is about mindfulness that works. Here’s what I found:
THE BENEFITS OF MINDFULNESS: WHAT RESEARCH TELLS US
Mindfulness has been found to:
Improve concentration and mental clarity
Increase self control
Improve working memory
Increase tolerance to painful emotions
Increase kindness, acceptance and compassion towards others and self [1]
They all sound like good things, but how can we be sure it was actually practicing mindfulness that led to these changes?
Well, several studies have been conducted on people who are new to mindfulness. In these studies individuals identified what they would like to work on, such as symptoms of distress, depression or concentration. Then they are divided into two groups, with one group given mindfulness training while the other group isn’t, to test the impact that mindfulness had on the areas they would like to work on.
One such study found that mindfulness training led to fewer negative emotions, fewer depressive symptoms and less stewing over unhelpful thoughts. Those who received mindfulness training also demonstrated longer concentration span, and significantly better memory capacity.[2]
But just one study doesn’t prove much right? Well, maybe not but there have been plenty more. A recent meta-analysis (which means a study of lots of different studies) gathered together evidence from 39 different studies all testing the benefits of mindfulness that all found support for mindfulness as a way to reduce anxiety and depression. [3]
So that does sound kind of great and things seem to be swinging in favour of mindfulness. But what about all the work it takes to do mindfulness? Who has the time and dedication for that? Well, maybe it doesn’t have to be as much work as it seems. Remember the first study I told you about? Those participants only practiced mindfulness for 10 days to get those benefits.
And here’s something even more encouraging. In another study – where half of the participants received mindfulness training and the other half didn’t – all participants then watched three movie clips. One clip was a happy one, one was a distressing one, and one was a mix of both. Those who underwent mindfulness training showed more positive emotions after watching the happy clip, and fewer negative emotions after watching the mixed clip. [4]
So maybe there is some truth in mindfulness bringing your attention to your pain when you are feeling bad. But if it also means that you can feel happier during the happy times, and less sad during the sad, then maybe it’s worth it. And the best bit is yet to come. The “mindfulness training” that the people in this study did? Just one session lasting 10 minutes.
Now that’s something even a mindfulness sceptic can achieve! And that’s the thing about mindfulness. Different people have packaged it up in different ways. A lot of people who have jumped on the mindfulness bandwagon have embraced the “twice a day for at least 20 minutes” kind of regime. And if they can stick to that, that’s great.
But mindfulness isn’t just for those dedicated few. At its core, mindfulness is about paying attention. Being completely in the present as each moment unfolds, rather than having your head stuck in the past or worrying about the future. And you could do that for 30 minutes or for just 30 seconds. You could do it in a tranquil rainforest, at a party, in traffic or when surrounded by screaming toddlers. Just because your life is busy and hectic, doesn’t mean mindfulness isn’t an option for you. And as the studies have shown, maybe even a little bit of mindfulness can still be a good thing.
So now that the results are in, am I going to turn into a mindfulness fanatic, who can’t get my without my hour long meditation? Probably not. But taking time to non-judgementally tune into my thoughts, feeling and physical sensations as a quick touchstone during the day? Remembering that it’s only the present moment you have to live in, and that each moment will pass? Even a sceptic can achieve that. Now that’s something to be mindful of.
Annie
REFERENCES
[1] Davis, D.M., & Hayes, J.A. (2011). What are the benefits of mindfulness? A practice review of psychotherapy related research. Psychotherapy, 48, 198-208.
[2] Chambers, R., & Allen, N.B. (2008). The impact of intensive mindfulness training on attentional control, cognitive style and affect. Cognitive Therapy and Research 32, 303-322
[3] Hoffman, S.G., Sawyer A.T., & Oh, D. (2010). The effect of mindfulness based therapy on anxiety and depression: A metaanalytic review. Journal of Consulting and Clinical Psychology 78, 169 – 183.
[4] Erisman, S.M., & Roemer L. (2010). A preliminary investigation of the effects of experimentally induced mindfulness on emotional responding to film clips. Emotion 10, 72–82.
Living with social anxiety can be limiting and lonely. If you find that your fear gets in the way of you living your best life, read on to find out how to turn things around.