By Irina Fiksman, M.D

Social Anxiety Disorder is the most common anxiety disorder and the third most common emotional disorder after depression and alcoholism. It affects 5%-13% of the general population. There are 5.3 million people in this country suffering from social anxiety.

Left untreated, it causes untold life-long suffering. Persons with Social Anxiety Disorder are more likely to suffer from Major Depression, Substance Abuse and other Anxiety Disorders, to be single, disabled, unemployed, or underemployed.

Sufferers of Social Anxiety are extremely vulnerable to rejection and criticism, real or imaginary.

In fact, being rejected, embarrassed or looking stupid are among their worst fears. They feel insecure, out of place, and lost for words in social situations. Interacting with or being introduced to other people makes them blush, tremble, perspire and often go into full fledged panic attacks. They have trouble meeting other people’s eyes.

Some people have social phobia only in one or two situations, for instance, performing in public or talking to an important person. Others feel anxious in many situations. They dread being the center of attention, attending parties, meetings, classes or other social events. They may have trouble using public bathrooms, eating in restaurants, talking on the telephone or signing their name in front of people.

Persons with social anxiety disorder often realize that their fears are excessive and irrational but are unable to change them. These fears lead to avoidance of the feared situations, social withdrawal and further deterioration of their social skills.

Social Anxiety Disorder is caused by interplay of genetic and environmental factors, and it tends to run in families. People with social anxiety disorder are exquisitely sensitive to social cues, such as, for example, another person's glance or look in their direction or, in particular, faces looking directly toward them. These simple types of provocations elicit an exaggerated response of the amygdala - the part of the brain responsible for the fight-or-flight response, and a failure of frontal regions to give a logical or appropriate assessment of what the realistic harm is. Consequently, the person with social anxiety experiences a fight-or-flight response feeling like he or she needs to flee the situation or completely freezes in it.
Social phobia usually begins in the early teens, although some people claim to have had it all their lives. It usually takes a long time, however, between the onset of symptoms and the appropriate diagnosis and treatment - partly due to sufferers’ own shame, anxiety, and humiliation preventing them from seeking help.

Treatment

Once diagnosed, social anxiety is highly treatable, but treatment does take time and effort.
Treatment begins with learning to understand the symptoms of this condition.
The two basic approaches to the treatment of SAD - cognitive-behavioral therapy (CBT) and medication - may be used concurrently and compliment each other rather well. Antidepressant and anti-anxiety medications can relieve more severe symptoms and enable the person move ahead in the CBT of social anxiety.

Therapy for Social Anxiety may include both individual and group therapy. Group therapy decreases one’s sense of isolation and allows learning and practicing new social techniques in a supportive and safe environment.

CBT techniques used in the treatment of social phobia include:

• Cognitive restructuring changes one’s ideas about the anxiety provoking situation and helps develop more realistic ways of perceiving it. It allows to challenge and change fearful thinking that overestimates social threat, underestimates one’s ability to manage social demands and catastrophizes the consequences of social miscues.
• Thought-stopping
  
• Systematic desensitization focused on the physical sensations of anxiety
  
• Relaxation Techniques, such as controlled breathing, muscle relaxation, meditation, positive imagery, and other means of relaxation
  
• Social skills training: verbal and nonverbal communication, assertiveness skills, appropriate eye contact, the importance of smiling, being a good listener, mastering the art of initiating and maintaining conversation.
  
• Gradual exposure to and reentry into feared social situations
  

Self-help tips and lifestyle changes to overcome social anxiety:

• Make eye contact and return greetings from others, or say hello first.
• Smile frequently.
  
• Be generous with compliments.
  
• Listen carefully to the other person.
  
• Show an interest in others. Ask about their homes, children and grandchildren, hobbies or travels.
  
• Be prepared to refocus your attention if it drifts back to you; excessive self-focus takes you attention away from others, causes you to miss important information, and makes others think that you are uninterested in them.
  
• Practice overcoming anxiety by getting involved in smaller, more manageable social experiences.
  
• Broaden your circles of friends. Use personal interests to develop social contacts.
  
• Volunteer for something you might enjoy doing, such as walking dogs in a shelter, or stuffing envelopes at church – anything that will give you some activity to focus on while you are also engaging with a small number of like-minded people.
  
• Accept invitations, have a plan for every weekend.
  
• Take chances by inviting potential friends on outings and reconnecting with old friends.
  
• Remember that you are judging others for their level of comfort by “looking at their outsides from your inside” – they may be uncomfortable, too, but doing a good acting job.
  
• Try breaking some of your tension by naming it out loud – “I sure am nervous about speaking” can diffuse some of your anxiety and put others at ease (even professional speakers often start with a joke to help themselves and the audience relax).
  
• Use interactions with strangers as opportunities to practice your social skills:
  
• Ask a retail clerk to help you find an item.
  
• Get directions from a stranger.
  
• Mistakes and rejection happen to all of us, and nobody is successful all the time.