Overcoming Social Anxiety

{Claremont, California}

To continue my series on conquering our fears (see Part 1 here), Part 2 consists of one of the more common phobias: Social Phobia.  I struggled with social anxiety since childhood (as I discussed in a previous post) and often felt uncomfortable in any situation that involved interacting with people. It wasn’t until six years ago during my psychiatry residency training that I finally gained control of my symptoms.  Some of the common thoughts that would race through my mind:

– “Are people judging my appearance?”

– “What should I say so that I don’t sound stupid?”

– “Hurry up and say something so that people don’t think I’m shy and quiet”

– “What I said was so stupid, they must think I’m an idiot”

– “What excuse can I give to avoid going to the event?”

My social anxiety dominated a huge part of my daily life.

If you also struggle with social anxiety, the following are some steps you can take to work towards overcoming your fear:

1.  Avoid Avoidance

One of my supervisors always emphasized “avoiding avoidance” in application to overcoming all forms of anxiety, and the statement definitely applies to social situations.  The more you avoid, the more you reinforce your anxiety symptoms. Sure, it might be far less anxiety-provoking in the moment to stay at home, but how will you cope with anxiety-provoking situations in the long run?  Social anxiety impacts all facets of daily life, from something as common as participating in a regular conversation or going to the grocery store to giving a talk at work.

An example of avoiding avoidance: one of my patients rarely left her home during the day (and would run errands only at night to avoid the crowds) due to social phobia, except to attend her appointments with me.  Therefore, in order to encourage avoiding avoidance during the day, I made sure she scheduled weekly, daytime appointments with me in order to challenge her fears of running into people during the day.

2.   Climb the social anxiety “ladder”

If you don’t have too much difficulty with shyness and feel motivated enough to expose yourself to a series of social situations, then create a list of approximately 10 situations and rank them in terms of level of anxiety (1 = lowest anxiety situation, 10 = highest anxiety situation).  Start with #1 and work your way up.  And be sure not to skip because you run the risk of getting too overwhelmed and exacerbating your anxiety, which could lead to increased discouragement, self-doubt, and feelings of failure.

For example, my hierarchy would look something like this:

1 = speak to the cashier at the grocery store

2 = go to the bank after work when it’s busy

3 = attend a new exercise class at the gym

(I’m skipping #4 – 9 for the sake of brevity)

10 = Give a talk/lecture to a large group of people (#10 should be a goal to work towards)

3.  Get a self-help manual, workbook, or internet-based self help program for social anxiety

Cognitive behavioral therapy (CBT) is one treatment modality shown to be effective for social anxiety disorder.  One study found that an internet-based self-help program helped university students with social phobia and public-speaking fears.  CBT examines the engrained, negative patterns of thinking (for example, “everyone at the party is judging me” or “anything I say is going to sound stupid”) in order to modify and challenge these irrational thoughts/beliefs.  CBTrequires commitment, a lot of homework, and practice of the techniques in order to be successful.  After all, the origins of such distorted ways of thinking have likely been engrained since childhood.

The following is a list of recommended resources (if you are currently seeing a therapist, please be sure to run the resources by them before using):

The Shyness & Social Anxiety Workbook

In The Spotlight, Overcome Your Fear of Public Speaking & Performing (for public speaking anxiety)

Overcoming Social Anxiety: Step By Step (Audio/Video Series)

3.  Work on self-acceptance and feeling comfortable with being less than perfect

This is something I definitely struggle with, especially since much of our social anxiety centers around our fears of being judged and wanting to maintain a “close to perfect” image, yet at the sacrifice of openly being ourselves.  How many times have you been at a meeting or lecture and are hesitant to ask a question or verbalize an opinion, but then someone else speaks up and says the exact same thought before you (this has happened to me numerous times)?  Or maybe you have a fear of doing something embarrassing in front of a group of people?  Recognize that your opinion is just as valuable as others and that as a human, something clumsy or embarrassing is bound to happen from time to time (even celebrities have major televised fail moments).

4.  Seek help from a competent mental health professional

Seeking support from a professional who specializes in anxiety disorders is always an excellent option especially if your social anxiety is preventing you from enjoying and/or moving forward in life.

So, how did I overcome my social anxiety?  Well, I went into a field that forced me to learn more about myself, started seeing a psychotherapist, participated in group therapy with my co-residents (a requirement in my residency program, which I believe should be mandated in all programs), exposed myself to situations that challenged and forced me to learn to cope with being in uncomfortable group and public settings (becoming chief resident was among the more challenging roles, yet provided the most growth), among other things.  Not to say you have to do ALL these exact same steps to conquer your fear, but that’s the process I underwent in order to feel confident and comfortable being myself in social settings.  And yet I STILL have to put in work on a regular basis to prevent my anxiety from getting the best of me (one of the reasons I’m in a weekly psychotherapy group).  I took a one year break from therapy after graduating from residency and noticed that my ability to work through my anxiety didn’t come as easily, which motivated me to restart group psychotherapy last year.

Medications can help alleviate your symptoms, but fully gaining control and overcoming the anxiety for the long term requires work, so you have to be willing to expose yourself to uncomfortable situations, willing to keep learning, and willing to face and challenge your fears on a regular basis.

If you also struggle with social anxiety, would love to know which techniques you find most helpful to cope with social situations.

 

Photo by Marlon Santos