Social Anxiety Disorder - It’s More Than Being Nervous

“Social anxiety is the fear of being judged and evaluated negatively by other people, leading to feelings of inadequacy, inferiority, self-consciousness, embarrassment, humiliation, and depression.” (Richards, 2024).

Let’s face it, certain events feel overwhelming, even scary. Things like giving a speech, acting in a play, or meeting your fiancé’s entire family for the first time at a reunion are apt to cause some angst. Anxiety in social settings isn’t unusual; in fact, a little social anxiety can even be adaptive. It can help us be on our best behavior, see to it that we’re well prepared, and even help ensure that we’re accepted into a social group. For some folks, though, social anxiety is debilitating.

In today’s post, we’re talking about Social Anxiety Disorder. We’ll tell you what it is and share some tools for coping.

Defining Social Anxiety Disorder

According to the Anxiety and Depression Association of America, Social Anxiety Disorder is the 2nd most diagnosed anxiety disorder (after specific phobias) and impacts approximately 15 million American adults (AADA, 2024). Social Anxiety Disorder (previously called Social Phobia) is a clinical disorder defined by the American Psychiatric Association in the DSM 5 (American Psychiatric Association, 2013). The criteria for this diagnosis are:

• A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms: e.g. blushing, muscle twitching, excessive sweating, trembling, or shaking) that will be embarrassing and humiliating.
• Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack.
• The person recognizes that this fear is unreasonable or excessive.
• The feared situations are avoided or else are endured with intense anxiety and distress.
• The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or activities or relationships, or there is marked distress about hanging the phobia.
• The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.
• The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.

Individuals may struggle with social anxiety related to a specific event, or they may suffer from a more generalized form, which is more common. The following situations can cause extreme emotional distress for someone who has Social Anxiety Disorder:

• Meeting new people
• Being the focal point of attention
• Receiving criticism
• Being observed while doing an activity
• Being in social settings, especially with strangers
• Talking with authority figures or other perceived “important people”
• Interpersonal relationships
• Being called on to speak in a class or meeting

Coping with Social Anxiety Disorder

Social Anxiety Disorder is treatable. Medication and therapy can be helpful, and there are also coping skills that can be practiced and developed to help cope with social anxiety. Breathing exercises, mindfulness practices, physical exercise, and combatting thought distortions are all useful techniques for coping with social anxiety. While these skills and activities can help ease anxiety in the moment, it’s a good idea to practice them regularly, even (perhaps especially) when anxiety isn’t active. It’s also important to remember that you don’t have to manage your anxiety alone. Reach out for help if you need it!

Breathing Exercises

There are several breathing practices that have been associated with decreased negative affect, decreased state anxiety, and improved mood. These include basic deep breathing (belly breathing), box breathing, cyclic hyperventilation with retention, and cyclic sighing among others. Cyclic sighing has received positive attention in the past year or so following a research study carried out by Balban, et al., (2023). Researchers compared 3 breath practices (box breathing, cyclic hyperventilation with retention, and cyclic sighing) and mindfulness meditation. Their results indicated that while all 4 practices were associated with decreased negative affect, decreased state anxiety, and improved mood, the breath practices were more effective. Further, cyclic sighing showed the largest increase in positive affect (think: improved mood). You can find instructions for different breath techniques with an easy internet search of “breathing techniques for anxiety”. To get you started, here’s how to practice cyclic sighing:

• Lie down or sit comfortably.
• Begin by noticing your breath for a minute or so.
• After an exhalation, inhale through your nose to a comfortable level of fullness (about 90% or 95% full).
• Pause your breath.
• Breathe in again, filling up completely.
• Exhale slowly through your mouth.
• Repeat for 5 minutes ending on an exhalation.
• Breathe normally for a minute or so and then go about your day.

Mindfulness Practices

Intentionally slowing down and bringing the mind into focus is a useful tool for managing social anxiety. Breath awareness meditations and body scans as well as mindful movement practices like yoga and tai chi can all contribute to staying present, slowing the breath, regulating emotions, and moving away from judgmental, often anxiety-inducing thoughts. Mindfulness can be engaged in social settings too. Rather than focusing on internal sensations, like the breath, the focus is aimed outward; curiously attending to the situation at hand, the person, and the conversation. Using mindfulness this way can help shift awareness away from self-critical thoughts and distressing internal sensations associated with anxiety (Cohen, 2016). Here’s an easy breath-awareness style mindfulness practice you can try:

• Sit comfortably with your hands in your lap.
• Become aware of your breathing without trying to control it.
• Now pay attention specifically to your exhalation.
• Count 4 exhalations in a row and start again at 1. Repeat this for 3 or more minutes. (Counting on your fingers can be both useful and comforting).
• Get up and go about your day.

Physical Exercise

While all exercise can be beneficial, aerobic exercise may be the most helpful for coping with social anxiety. Bike rides, dance classes, and brisk walks around the block can help shake off anxious energy. Exercise shifts your attention, decreases muscle tension, and changes brain chemistry (Ratey, 2019). You can read more about the positive impact physical exercise has on the brain by checking out the book, Spark: The Revolutionary New Science of Exercise and the Brain by John Ratey, M.D..

Combatting Thought Distortions

In order to cope with social anxiety, it’s helpful to learn how to fight thought distortions – automatic, negative thoughts. Some common thought distortions that can feed social anxiety are:

• All or Nothing Thinking – the tendency to see things as black and white; shades of gray don’t exist. Here’s an easy example: I’m either perfect, or I’m terrible.
• Mind Reading – the tendency to assume you know what others are thinking or feeling based on insufficient information. An example might be: An audience member yawned during my performance, so I must be a terrible actor.
• Catastrophizing – anticipating the worst-case scenario. An example is: I’m underdressed for this office event; my boss is definitely going to fire me.
• Overgeneralization – applying one negative experience to all related scenarios. For example: My friend told me that I’d forgotten her birthday. I screw up all the important things in our friendship.
• Should statements – holding oneself to inflexible rules and unrealistic expectations. Here’s an example: I should’ve been able to stand up and confidently present my thesis without sweating; I’ve got no business trying to get a Masters Degree.
• Fortune Telling – predicting a negative outcome without evidence. An example could be: I’m going to blow this interview, I know it!

The first step to combating these thought patterns is awareness (mindfulness practices can help with this!). Make a list of the thought distortions that you THINK you use, and then make a point to watch for them. As you notice them, start writing them down. A good way to do this is to make 2 columns. In the left-hand column, write down the thought you had and label it with the appropriate thought distortion. In the right-hand column, create a sentence that (1) is the opposite of your thought distortion, (2) is a more realistic assessment, or (3) leaves the door open for another alternative. Here’s an example of each and what your columns could look like:

• I’ve had too much caffeine. I’m going to blow this job interview! (Catastrophizing)
  I’ve had a lot of caffeine. I’m awake and alive and I’m going to crush this job interview! (opposite)
• I should have aced that test; it’s my favorite topic! (Should statements)
  I did pretty well on that test. It’s my favorite topic. (realistic assessment)
• That lady in the back isn’t participating in the discussion I’m leading. She hates me. (Mind reading)
  That lady in the back isn’t participating in the discussion I’m leading. Maybe she has something else on her mind. (opening the door for another alternative)

Getting professional help

It’s important to remember that while the skills listed above can be helpful, they may not always be enough. If you find that your social anxiety is causing you extreme distress, and you are unable to find relief in healthy ways, reach out for help. Primary care providers, Employment Assistance Programs, and even teachers can help you find the right care. You can also reach out to us here at Luna by calling 1-888-488-LUNA. We provide integrative mental health care for a variety of mental health concerns.

Let’s sum up…

Everybody gets nervous now and then especially in social situations. Humans are social animals! Still some people suffer unnecessary, sometimes debilitating distress. Social Anxiety Disorder is a serious mental health issue. There are a number of skills and practices that can help manage the symptoms of Social Anxiety Disorder. Professional help is also available, and reaching out sooner rather than later is a good idea. There’s no reason to struggle alone.