Social Anxiety Disorder

Management and resources

At home

Although people with SAD usually require professional treatment, there are some simple behavior changes individuals can try to provide some relief. These include practicing acceptance, starting Small, planning for interactions, reframing, monitoring substances, and attending a social skills group.

Practicing acceptance

Living with social anxiety can feel crippling at times, and people who live with it might find themselves questioning how it is possible that social interactions seem so easy for others. It’s common to fall into the trap of wondering “why me” and of judging oneself for not having the confidence or courage to “get out there.” However, some individuals find that simply allowing themselves to experience the anxiety that comes with SAD without judgment can improve their symptoms over time. That acceptance, and the understanding that this condition is somewhat out of one's immediate control, can feel freeing.

Starting small

This involves building social skills on a small level. Sometimes, this can mean learning new ways to start a conversation. Individuals with SAD may practice asking others questions: starting an interaction with “Hi, how was your day?” is more likely to engage than a simple “Hi.” Others may find it useful to resolve to give one compliment (that they really mean) to someone each day. In relationship building, it can be helpful to remember to use others’ names when speaking to them. One may choose to commit to attending just one social gathering (of any size) per week, and commit to practicing these skills while they're there. The key is to start small with one skill at a time, and to practice it daily.

Planning for interactions

When thinking about upcoming social interactions, people with SAD may find it helpful to imagine themselves there, and remind themselves of a few helpful ideas:

First, every social interaction is an opportunity to hone the skill. In fact, avoiding social interactions can be counterproductive for one's treatment.
It is common for individuals with SAD to have the experience of being told to “speak up” or to increase their volume. To address this, they can practice remembering that their voice seems louder to themselves than it does to others: When in a group, planning to speak a little louder than what feels comfortable can be helpful.
Telling oneself to “embrace the awkward.” While others may experience an individual with SAD as shy or even awkward, this can be an endearing quality if they can learn to accept and even appreciate it with the thinking, "You are who you are." Acting “smooth & refined” can be helpful in social situations, but it is not necessary, and being a bit “different” can be intriguing to others.
Socializing can take a lot of energy for those with SAD, so planning accordingly is critical: Getting plenty of rest before social gatherings, and spending the hour ahead of time with whatever gives them the most energy is best. It can also be helpful to plan to have alone time right after the gathering to recharge.
It can be helpful for those with SAD to keep in mind that others are thinking more about themselves than they are thinking about them. And, people most enjoy talking about themselves. This can be difficult to believe given the intensity of one's feelings, and one's own focus on them.

However, trying to pay attention to others and what they talk about can help. Or, better yet: getting someone talking about something that interests them, like a hobby or a passion. Their focus is entirely on the object of conversation and how they might be coming off. Most people are unlikely to notice or care about another person's demeanor or actions when they are socializing.

Reframing

A common strategy used by cognitive behavioral therapists is the process of reframing one's thoughts. Many people with SAD have thoughts about themselves that might not always be true or if they are true, are usually harsher, less compassionate and make us feel more anxious. After all, we are our worst critics.

For example, rather than thinking “I am a shy person,” one can try reframing as “I often become quiet at social gatherings.” Or, rather than “I am anxious about attending this gathering,” re-assessing as “I am feeling excited.” This reframing, over time, can start to make a difference in how a person view's themselves and the world around them, and gives them more confidence in these

Monitoring substances

When feeling socially anxious at a gathering, it can be tempting to want to reduce one's anxiety with alcohol or another substance. People who struggle with SAD may turn toward substances and use them as a social lubricant. They may start to believe that they need to drink a glass of wine or beer to survive a night of socializing. Over time this belief can lead to becoming dependent on a substance, which may cause additional problems.

It's helpful for those with SAD to notice their usage of substances at gatherings and try to limit them, or go the night without that glass of wine. As one progresses in treatment and learns new coping skills, most people with SAD find they no longer need substances to be social and if they have that beer at dinner, it is because they genuinely wanted one. If one believes they might be addicted to substances, it is important to discuss those symptoms with their doctor.

Attending a social skills support group

Many individuals have been able to conquer their fears by attending social skills or social support groups that help people practice the art of conversation such as small talk, asking questions, and sharing information. Often the people there are peers and like them, also anxious and afraid to be there. In this supportive and friendly environment, individuals can practice socializing without the fear of being the only one in the room who feels anxious.

Toast Masters is an international organization that helps people with public speaking. This type of forum, or virtual or local, in person support groups can also be helfpul.

At work

The pandemic might have initially seemed a saving grace to those with SAD: stuck in quarantine, fewer work gatherings and more opportunity to work from the comfort of their home. However, this is not the case for everyone, and people are increasingly being asked to return to the office. When individuals with SAD have a job where being physically “at work” is required, or if working from home, it can be helpful for them to keep a few tips in mind:

Zoom fatigue and anxiety can be as real as socializing in person. Studies have shown that meeting participation when our cameras are on can be draining on the senses. This is especially true for those who have a tendency for scanning the room for social cues, or for whom being on camera presents anxiety. For this reason, it can be helpful to turn off the camera when possible. If this isn’t possible, one can adjust their display settings so that they can not see their own face, and so that they can focus on only the individual speaking (one at a time versus “gallery” display).
Preparing for meetings by jotting down bullet points ahead of time that they want to say or ask
Giving onesself grace: for some with SAD, simply keeping in mind that they might need to take a break every so often is helpful; Or, reminding themselves that everyone makes mistakes. An individual's productivity requires them to feel energized, and taking breaks and moments of self-forgiveness are necessary.
One should never feel that they must tell anyone at school about having SAD, but at the same time it is not necessary to be a secret. The amount an individual shares is a personal choice, though some people find it useful to share that they are having a rough patch with a professor or TA. Teachers often understand that individuals experiencing SAD might need a modification in their coursework for a period of time.

At school

School can be challenging with or without social anxiety. Due to the pandemic, many people have noticed a reduction and/or increase in their social anxiety when it comes to school. Universities and colleges went virtual and many had their first virtual online learning experiences, leaving people who are socially anxious with less in-person social interaction and the anxiety of virtual social connection.

Seeing people in the halls, going to large class rooms, and walking around campuses are all daily occurrences in the life of a college student and can be hard for those with social anxiety. Those with SAD might practice not avoiding these situations by making eye contact with fellow students or saying hi to the person sitting by them in class. Avoiding these anxiety-filled social interactions only make social anxiety worse in the long term and the less we avoid, the better one will feel and feel less inhibited academically by their anxiety.

If engaging in virtual learning, Zoom fatigue and anxiety can be as real as socializing in person. Studies have shown that meeting and lecture participation when our cameras are on can be draining on the senses. This is especially true for those who have a tendency for scanning the room for social cues, or for whom being on camera presents anxiety. For this reason, it can be helpful to turn off one's camera when possible. If this isn’t possible, it can help to adjust one's display settings so that they can not see their own face, and so that they can focus only on the professor or fellow student speaking (one at a time versus “gallery” display).

Preparing for academic presentations by jotting down notes with their talking points in case one forgets or social anxiety heightens during presentations is often helpful.

Whether engaging in virtual, in-person, commuting or on campus education, focusing on building a community of people can be helpful. The more practice a person gets in meeting new people and maintaining their current relationships, the easier it will be to be social.

It can be helpful to introduce oneself to a roommate, resident assistant, academic advisor, or teaching assistant. Individuals with SAD can join a group on campus that speaks to them. These relationships and communities are not only important, but essential. If there is a time when one needs their support, they will have already met these people and their social anxiety may not stop them from getting the academic or social support they are needing.

Those SAD may identify spaces in their lives that they can have time to themselves. On a busy campus or home, it can be hard to get alone time. Some people with social anxiety find that alone time after socialization helpful and restorative.

In relationships

Anxiety can have an impact on relationships in many ways. If one's partner or friend does not have anxiety, it can be difficult for them to understand what the other is going through. They may expect the individual to be able to “just relax,” or “have faith” that things will work out, which can add to one's worry.

Even so, opening up about one's experience can help bridge the gap in understanding -- although, sharing these challenges is not always easy. Individuals may feel like they are burdening others with their thoughts or anxieties, but this may not be the case. Sometimes being open during these struggles can fortify relationships.

For some people, having social anxiety, and also taking antidepressants can impact their sex lives. An individual may experience low libido, erectile dysfunction, etc... but there is hope: The first step to addressing this issue is for a person to acknowledge it, but sharing this type of sensitive information with a partner or provider is not always easy.

A couple steps one might try include

Trying a new routine with one’s partner such as exercising before sex, or incorporating new types of stimulation into the routine.
It is possible that when depression improves, libido will also improve: Research has shown that depression can cause these effects with or without taking an antidepressant.
A provider may adjust an individual’s dose of medication to find a level which balances effectiveness with libido.
Some of the commonly known medications for erectile dysfunction (Viagra, Cialis, etc..) can be helpful to antidepressant induced sexual dysfunction in men.
If the examples above do not work in a particular instance, a different type of medication that has fewer sexual side effects might be the next step.

During moments of intense worry, it can become impossible for those with SAD to think about anyone or anything else besides the object of anxiety, and this can be difficult for one's partner. It is important for both parties in the relationship to focus on treatment, and to remember that this self-focus is temporary. In most cases, the right combination of therapy and medication can bring a person back to being the partner they once were.

Anxiety in the family

Anxiety has a genetic component, and it can look different within the family. In children, anxiety can manifest as fear, and develop into full blown GAD after hitting puberty. Parents who have struggled with their own anxiety can be vigilant of their children. Getting early treatment for them can eliminate years of their potential suffering. And, getting treatment for the parent will ensure that their worries aren’t projected onto children.

According to experts, there are some familial factors that are protective against the development of SAD. For example, frequent positive contacts with family members such as grandparents may decrease the risk for SAD. In addition, the support of one’s peers also lowers the likelihood that a person will experience the symptoms of SAD.