Social Anxiety Treatment at The Skill Collective Subiaco Perth clinical psychologists and counsellors.png
 

WHAT IS SOCIAL ANXIETY?

Social anxiety is characterised by an excessive fear of negative judgement by others in situations including interactions, being observed, or performing (see also Performance Anxiety, a subtype of Social Anxiety). [1] Social anxiety affects around 8.4% of Australians at some point in their lifetime; it is also linked to other mental health conditions (around 70% have a comorbid mental health concern) [2][3][4].

Features of Social Anxiety (DSM-5) [1]:

  • The anxiety occurs in one or more situation where the exposure is to potential scrutiny by others, and the person fears they will act in a way - or show signs of anxiety - that will lead to others forming a negative opinion of them.

  • The social situations almost always trigger anxiety, and the anxiety tends to be out of proportion to the actual threat.

  • The fear/anxiety/avoidance leads to significant distress or affects your functioning (e.g. career advancement, your studies, your personal relationships).

In some instances panic attacks may co-occur with social anxiety.


THE IMPACT OF SOCIAL ANXIETY

Performance anxiety can occur in any setting where speaking or performing in public is involved. It could be performing at an end of year school concert, giving a speech at a friend’s birthday, being interviewed for a job, receiving an award in front of a group of colleagues, speaking at a work meeting, or even walking up the aisle where all eyes might be on you. Below are some of the more common types of performance anxiety that we work with here at The Skill Collective.

AT WORK, SCHOOL, OR UNIVERSITY

Social anxiety can have a real impact in the workplace or in your studies. A fear of negative evaluation can lead you to worry about how others see you, whether they think you’re competent, or even whether they can ‘see’ that you’re anxious. This can lead to you withdrawing from activities, even if there are negative outcomes attached, including:

  • Not speaking up in class even though there is a class participation mark.

  • Leaving events early so you don’t have to make small talk.

  • Not speaking up in meetings, or only emailing your manager because talking to her would be too confronting.

Another way of coping that we commonly see in our work is that of adopting a more perfectionistic coping style in an attempt to be less susceptible to criticism.

 

IN YOUR PERSONAL LIFE

As you can imagine, social anxiety can be highly debilitating for maintaining a personal life. Constant concerns about what others think of you can result in social isolation and withdrawal, or even using alcohol to cope. We often see the following:

  • Only attending an event if a close friend is there for social support/as a buffer.

  • ‘Hiding behind’ more sociable people during conversation, or speaking quickly when asked a question so it’s over with as quickly as possible.

  • Dating and forming close relationships can be a real challenge.

  • Using alcohol for a bit of ‘Dutch courage’.

The triggers for social anxiety can differ significantly. For some, talking to strangers is far easier than talking to acquaintances. For others, it’s feeling like there’s nowhere to hide if it’s just you and a closer friend and feeling more exposed and pressured to ‘carry a conversation’.

Making small talk is a concern we see affecting many people who experience anxiety in social situations. If this is something you’re faced with why not check out our Resource Library Tip Sheet on How to Make Small Talk when you’re Socially Anxious? (see below)

  

PERFORMING/PUBLIC SPEAKING

Social anxiety that occurs only in the context of performing in front of others is classified as Performance Anxiety, and can include anxiety when public speaking (public speaking anxiety), performing in an orchestra, sport performance, . Learn more about Performance Anxiety here, and you can also read more about Public Speaking Anxiety here.



SOCIAL ANXIETY SYMPTOMS

As with any type of anxiety, there are a typical categories of symptoms to look out for - cognitive, behavioural, and physical. Here’s how they may look in social anxiety:

COGNITIVE SYMPTOMS OF SOCIAL ANXIETY

At the core of performance anxiety is a fear of being judged negatively. This could relate to judgements of your performance, or even that your anxiety might be ‘on show’ for everyone to see. Related to this, you then become hypervigilant for signs of anxiety and failure or scrutiny, and worrying becomes a feature.

Unhelpful thinking styles and unhelpful interpretations can then come into play, and you focus on any small error that occurs and magnify it out of proportion. Catastrophising can also dial up your anxiety levels and lead to uncomfortable physical symptoms that can interfere with performance (e.g. fine motor control).

An important feature of cognitive symptoms of performance anxiety is the tendency for the brain to feel ‘fuzzy’, which has a significant impact when you consider that thinking clearly is an important part of performance (e.g. remembering what to say and do, recalling strategies for playing against the opponent, knowing which notes to play or lyrics to sing).

PHYSICAL SYMPTOMS OF SOCIAL ANXIETY

When we feel anxious our body goes through a series of physical changes designed to keep us safe - be it through fighting, running away, or freezing. It’s common in situations of performance anxiety to experience symptoms such as butterflies in the stomach, nausea, racing heart, tightness in your chest, and sweating. Some of these symptoms can be very distressing (and even lead to panic) - at its extreme fine motor control may be affected and, in turn, performance may be compromised.

BEHAVIOURAL SYMPTOMS OF SOCIAL ANXIETY

Avoidance is a core feature of anxiety, and when it comes to performance anxiety the avoidance may be overt (e.g. not participating in competitions, concerts, or not putting your hand up in class). The difficulty is that prolonged avoidance can come at a cost to you - for example, when you opt out of apply for a promotion because it involves a public speaking component, or you decide to give up playing an instrument you love because of the fear of others judging you. There may also be subtler forms of avoidance, an example of which may include taking beta blockers or using alcohol.

Perfectionism can also be a coping style (kind of like a ‘fight’ response, rather than a ‘flight’ response) associated with social anxiety where you do your utmost to present in a way so that you' won’t be judged poorly.


TREATMENT FOR SOCIAL ANXIETY

There are excellent evidence-based treatments for social anxiety, and these work - however, it’s important to get started sooner, rather than later - on average people wait 12 years before seeking treatment. Consider the following:

  • COGNITIVE BEHAVIOUR THERAPY (CBT). Cognitive Behaviour Therapy is a highly effective treatment for social anxiety. It teaches you how to re-appraise self-talk to shift the fear of negative evaluation. Exposure therapy is used as part of CBT to increase distress tolerance and to approach situations that your anxiety holds you back from.

  • ACCEPTANCE AND COMMITMENT THERAPY (ACT). A variation of CBT (part of the ‘new wave’ of CBT treatments), ACT teaches acceptance, mindfulness, and detaching from thoughts and discomfort that are part of social anxiety. Exposure therapy is also used as part of ACT to decrease experiential avoidance. Together these help an individual move towards living a values-based life.

  • PSYCHOPHARMACOLOGY. At times social anxiety may be so significant that medication may be indicated so that individuals are better able to engage in the ‘talking therapy’ and undertake exposure exercises. If this is the case, speak to your GP about medication options.

If you’re ready to work on Social Anxiety, why not Contact Us for a tailored approach?


If you’re keen to learn more about tips to help you manage social anxiety you can grab our Tip Sheet on How to Make Small Talk when you’re Socially Anxious.

Mens mental health man box anxiety depression counsellor psychologist per

Grab our tip sheet on How to Make Small Talk when you're Socially Anxious and you'll also get access to our Resource Library filled with even more tips on wellbeing, mental health, and performance. You'll also receive occasional updates of new resources at The Skill Collective. You can unsubscribe at any time by clicking the unsubscribe link in the footer of any newsletter email you receive from us, or by contacting us. For more information please read our Privacy Policy and Terms + Conditions.



REFERENCES

[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Publishing.

[2] Furmark, T., Tillfors, M., Everz, P., Marteinsdottir, I., Gefvert, O., & Fredrikson, M. (1999). Social phobia in the general population: Prevalence and sociodemographic profile. Social Psychiatry and Psychiatric Epidemiology, 34, 416-424.

[3] Crome, E., Grove, R., Baillie, A.J., Sunderland, M., Teesson, M., & Slade, T. (2015). DSM-IV and DSM-5 social anxiety disorder in the Australian community. Australian & New Zealand Journal of Psychiatry, 49, 227-235.

[4] McEvoy, P.M., Grove,R., & Slad, T. (2011). Epidemiology of anxiety disorders in the Australian general population: Findings of the 2007 National Survey ofMental Health and Wellbeing. Australian & New Zealand Journal of Psychiatry, 45, 957-967.