One in four people in the UK will experience a mental health problem in any given year. In a recent review of social anxiety, it was highlighted that it is not clear how many people suffer social anxiety in the UK, but research in the US indicated 12% of people will suffer social anxiety at some point in their lives with most people developing symptoms in adolescence.
We have been wondering whether the number of people suffering from social anxiety might be increasing given changes in how we socialise over the past 15 years such as the increase of social media. While there is no research looking directly at this, the UK census data suggest there is an increase for anxiety and depression more broadly.
How might social media and social anxiety be related?
Social media can help people learn to communicate, socialise and connect with a variety of different people with shared interests across the world, hence providing a way of communicating for people who are too anxious to socialise face to face.
However, there are also concerns that spending a lot of time on social media may increase anxiety because people may be exposed to cyber bullying. Bullying or being humiliated by peers has often been identified as a trigger for the development of social anxiety, so greater exposure to bullying on the internet could put people at increased risk. Even without bullying, it could increase anxiety to see so many people in your peer group socialising, achieving, having fun, being successful as this can lead us to compare ourselves unfavourably and be more likely to develop or maintain some of the cycles involved in social anxiety.
What is social anxiety?
Social anxiety is a fear of interaction with other people, that brings on self-consciousness, feelings of being negatively judged that can lead to feelings of inadequacy and embarrassment, and sometimes avoidance or depression.
Social anxiety is a very common mental health problem, and a lot of people experience social anxiety to some degree in some situations. However, social anxiety can make us feel very alone and disconnected from others, it can have a really negative impact on how we feel about ourselves, others and how we live our lives.
When you have social anxiety, it might be limited to certain situations, such as giving presentations, interviews, dating, eating, or it might be more generalised to all situations where you are around people.
If you suffer with social anxiety, when you are around people, you may find yourself becoming very self-focused and expecting to be humiliated, rejected or criticised. Some common thoughts you might experience leading up to a social event are
– People will think I am stupid
– I will probably fall over and embarrass myself
– Everyone will look at me
– No one will want to talk to me
– They will see I am anxious
These anticipatory thoughts lead you to feel anxious, self-conscious, even terrified and your body reacts with the fight or flight response, which means you might start sweating, shaking, breathing faster, as you pay attention to these bodily sensations you can then start to feel more anxious. Some people might find they become very anxious about the symptoms of anxiety e.g. worrying that they might pass out, go crazy or have a panic attack, these kinds of thoughts might indicate suffering from a panic disorder.
In response to these bodily symptoms you might worry more, over prepare for a variety of possible scenarios in your mind, and even avoid going to social events altogether, which in turn reinforces your anxiety as valid. If you go to the event, you might find yourself overly focused on your physical symptoms and internal experience and find it hard to engage with people, you might be planning your escape, or drinking alcohol to try to cope with the strong emotions you are feeling.
Fortunately, there is a good evidence base that social anxiety can be effectively treated using cognitive-behavioural therapy (CBT) and mindfulness. It can be hard work to work through your anxiety in therapy, as this process requires you to make changes and practice, practice, practice, but for most people it is possible to overcome social anxiety.
So, how does therapy work, and what can you expect to be doing during therapy?
Together we will identify the patterns of unhelpful thinking that lead you to feeling anxious in social situations and how you behave when you feel this way. Once we have a clear understanding of what triggers social anxiety for you and how it is being maintained in your life, we will start working on reframing these ways of thinking and changing your behaviour.
You will be encouraged to monitor your thoughts for homework and start turning the tables on them, particularly the absolute, all or nothing statements we tell ourselves. For example, I will never be able to give a presentation. These thoughts are really important to pick up on as the brain believes what we tell it, so if we are telling ourselves we will NEVER be able to do something, then we won’t. The aim in CBT is to step back from habitual ways of thinking about yourself, other people and the world and really question them e.g. is it really true that people will think I am stupid? What evidence do I have for this? We will work to develop a more balanced, rational way of thinking that you will practice using as a replacement e.g. I feel anxious about giving a presentation but I will be able to do it given time to prepare myself. With time and practice the brain will start to believe what you are saying and you will start to feel differently about approaching a presentation.
The other important component of therapy is behavioural change. With any anxiety it is important to expose yourself to the thing you fear. With social anxiety you might, quite rightly say, that you have been exposing yourself to this fear for years and it has only got worse, not better… but why is that? It is very difficult for people with social anxiety to avoid the thing they fear, much more difficult than say, fear of flying. People who fear flying can quite easily avoid their fear by not getting on a plane, but they could also more subtly avoid their fear by taking a Valium, which is a different kind of avoidance that we might call a safety behaviour.
Exposure in social anxiety is not just about putting yourself in social situations, but doing it while practising new ways of thinking about yourself and new ways of behaving around other people. For example, by making an effort to focus on other people and the setting you are in, rather than becoming self-focused. That is how you can see significant changes, not through exposure alone. We often start with imaginal exposure in the therapy room, for example, we might imagine approaching the feared situation of giving a presentation and notice the feelings increase, then practice talking to yourself in a soothing way until the feeling reduces to a manageable level, before we start the imaginal exposure again.
Once we understand your specific fears, we can also set up exercises to test your beliefs e.g. if you fear eating in public because you think you look disgusting and people will find you repulsive, we might set up a video camera and watch the footage together to test out this fear.
In this sense CBT is a creative and sometime playful therapy where we can be very active in testing out your specific fears and turning the tables on your beliefs about yourself.
What happens if it doesn’t work?
For most people CBT can make a significant difference in how they feel in social situations and over time as they practice approaching situations differently, practising their new way of thinking and behaving, they will start to feel more and more comfortable and confident in themselves and their abilities. What we say to ourselves day in and day out shapes how we feel about ourselves and others. Adopting a new way of thinking might feel unnatural at first and will require a lot of practice but over time becomes internalised and automatic.
In a minority of people, this approach might not be enough. This is because some people have underlying beliefs about themselves that were laid down very early on in life and provide a barrier to making changes using Cognitive Behavioural Therapy (CBT). If we come up against barriers with people in therapy, we aim to work out together what the barrier is, for example, a deep feeling of shame and defectiveness linked to early childhood experiences of humiliation. These kinds of barriers are not something to worry about if they arise, but it may mean that we need to dig a little deeper to work on healing what we might call your ‘schemas’ to help you make further changes in your life. An effective approach for this is schema therapy.
What else can help with social anxiety?
If you are not in a position to try therapy right now, a lot of people find that other strategies can also be helpful in making progress with social anxiety.
I would recommend opening up to trusted friends and family about the difficulties you are having, so you can feel less isolated with your feelings.
There are a number of good online resources to help you start developing a mindfulness practice, for example, the headspace app, which can help with becoming more present focused and developing a different relationship with our thoughts and feelings. As we become more mindful of our thoughts, we have more opportunity to notice the thoughts that are not serving us and to detach from them, or reframe them.
Making changes to your eating, sleeping and exercise habits can also help. A lot of people find that drinking coffee or caffeinated drinks can increase their base level of anxiety whereas practising yoga or engaging in some kind of physical activity can facilitate a sense of calmness and well-being.
Do get in touch if you would like to develop a personalised understanding and treatment plan for your social anxiety. Please try to hold in mind that social anxiety is not a personal failing or sign of weakness, although the kinds of thoughts people have when they suffer with social anxiety will be trying to convince you otherwise!