Social Anxiety Treatment

Social anxiety treatment: Social anxiety is an anxiety disorder characterised by an intense and persistent fear of one or more social situations. Also known as social phobia, social anxiety disorder and a fear of embarrassment, it is one of the most common phobias in UK, affecting about 10% of the adult population. Social anxiety usually starts in childhood and adolescence, with the majority developing the condition by the time you reach your twenties. Very few people develop the condition later in adulthood.

Most people can recall a social anxiety triggering event or situation e.g. when being taunted at school or changing schools. Others believe that it has always been there, varying in intensity or gradually increasing depending on your level of social interaction and social anxiety.

As you reach your adulthood, you can outgrow your social anxiety, but the severity of social anxiety rarely eases without social anxiety treatment. The majority of those suffering with social anxiety will have other associated mental health disorders (co-morbidity)  like panic disorder, low self esteem, generalised anxiety, depression, PTSD, OCD, health anxiety and a level of substance dependency e.g. drinking alcohol, smoking cigarettes, using recreational drugs. By the time that someone seeks social anxiety treatment, many of these associated conditions will be salient.

Social anxiety treatment: Social anxiety as a phobia and a disorder

Simple phobias tend to affect how you respond to particular objects or situations e.g. fear of spiders or dentists. Social anxiety can be specific too, impacting on how you deal with one situation e.g. when you have a fear of public speaking yet have an enjoyable and active social life.

As a generalised condition, social anxiety more commonly disrupts several situations or triggers that can be classified into:

• Interaction: such as starting spontaneous conversations, speaking with strangers, making eye contact, dating, speaking (in class, meetings or in groups), talking with (aggressive) authority figures or extroverts, socialising in large social gatherings e.g. parties, attending concerts, sports events, night clubs, bars, etc., coping with being teased, being assertive, returning items to a shop, etc.
• Observation: being in view of others when performing new or unfamiliar everyday tasks, such as when working, eating and drinking in public, attending school, walking in public, shopping, exercising in gyms, physical examinations, security checks, entering a room in which other people are already seated, entering a bar/restaurant by yourself, etc.
• Performance: such as using public toilets, public speaking, speaking on the phone or by video call, giving an artistic performance, being interviewed, introducing yourself and speaking in class and meetings, completing practical tests or exams, etc. Many of these situations can be considered as a category of performance anxiety.

Further categories of specific and general social anxiety distinguish between those who fear social situations (e.g. public speaking, dating, exams, parties, etc.) and those who fear their anxious outcomes (e.g. fear of blushing, fear of sweating, fear of stammering, fear of saying something foolish, fear of doing something that will be criticised, etc.).

More significance can be given to the following criteria in these subtypes that distinguish social anxiety from social anxiety disorder. It includes the:

• Severity and persistence of your symptoms.
• The degree of anticipation and avoidance.
• How much that you rely on safety behaviour to alleviate your anxiety (e.g. smoking, drinking, comfort eating, etc.)
• The dysfunctional ability to think and communicate in the social situation.
• An overly critical self evaluation of your coping that can integrate low self esteem and low self confidence.

On the whole, generalised social anxiety intensely interferes with how you lead your life. On this basis, social anxiety is classified as a complex phobia, upsetting many formal and informal situations.

You can be affected by both a simple phobia and social phobia e.g. when you feel embarrassed about showing your arachnophobic panic attack to your peer group.

You can expect a social anxiety treatment programme for a specific issue to be more concise than for the generalised condition.

Social anxiety treatment: what causes social anxiety?

There are many underlying causes of social anxiety. It is best understood as an interaction between bio-psychosocial factors. They include:

Genetic factors – You can have specific genes that predispose you to suffer with social anxiety due to a defect in serotonin processing.

Environmental factors – You can “learn” to be socially anxious from authority figures (which may also infer a combined genetic link). A parent who is socially anxious is likely to condition you to perceive embarrassment as a source of danger and condition your beliefs and worries accordingly. They will protect you from social experiences rather than helping your confidence in those social situations. In some countries, cultural values may also play a role developing socially anxious fears.

Direct learning of traumas (e.g. when being teased or bullied) is likely to play a major role in acquiring a fear of embarrassment. However, you can also observe others suffering embarrassment and project these reactions onto yourself (indirect learning).

A social phobia trait called behavioural inhibition in which toddlers become severely upset when placed in new situations of unfamiliar people may also be an environmental and/or biological factor in the development of social phobia later in life.

Biology – Brain structure and the imbalance of neurotransmitters in the regions of the brain associated with fear are factors that can cause social anxiety. A research study involving PET scans of those with social phobia highlighted how these areas of the brain are affected when public speaking.

Other risk factors can include having other mental health disorders, a lifestyle change involving new or excessive social demands e.g. when moving to a new school or new job with obligations to speak in public. Additionally, having physical or medical conditions that increase feelings of self consciousness and can draw attention from others e.g. a disfigurement, stammer or tremors caused by Parkinson’s disease can increase your risk of developing a social phobia.

Social anxiety treatment involving therapy is more likely to help you address the environmental factors that have caused or reinforced your fear of embarrassment.

Living with social anxiety

Often dismissed as shyness, social anxiety is a more severe condition. In common with all phobias, you can experience high anxiety and panic attacks during the social situation that you fear. Your panic reaction may be disproportionate to the actual danger that confronts you, but knowing this information rarely offers any consolation to the way that you cope.

Your fear of embarrassment can associate with many other personality traits including introversion, insecurity, conflict handling, self criticism, assertiveness, low self esteem and low self confidence. You may also fear upsetting other people and ruminate on feelings of guilt, shame, self blame, over-responsibility, regret, etc.

Sometimes termed as emotional and behavioural symptoms, living with a fear of embarrassment can include:

You live in fear

• You fear situations in which you may feel embarrassed, judged, criticised, humiliated, rejected, intimidated or given excessive attention (usually negative attention is most embarrassing, but positive attention can also trigger embarrassment too).
• You fear that you will do or say something foolish to embarrass or humiliate yourself. This can include not knowing what to say to people.
• You have a fear of communicating with people who you’ve never met before (strangers).
• Desperate to hide your anxiety symptoms e.g. blushing, shaking, distorted voice, sweating, etc., you fear that others will notice them and judge you as weak or incapable.
• You fear offending others, troubling them with your problems or upsetting people, so you rarely talk about other people’s behaviour and how their behaviour affects your feelings.
• When meeting people for the first time, you fear that others will judge how you present yourself. You spend too much attention on your appearance, clothes, make-up, hair, etc.
• Despite social anxiety being a common condition, you are convinced that you are the only one who suffers with it.

Your behaviour is dominated by avoidance

• You avoid social situations, speaking to people or doing activities in which you might draw attention due to yourself.
• You avoid situations in which you might be (or be perceived as being) in the centre of attention. This can include being seated in discrete locations out of people’s view.
• Even though you enjoy being with people that you trust, you may avoid a larger gatherings, preferring to self isolate.
• You may lie about your avoidance behaviour to preserve your self-image rather than admit that you suffer with social anxiety.
• In conversation, you avoid eye contact to reduce feelings of embarrassment. Where you stare instead can be another source of embarrassment.
• Your social anxiety may combine with your introversion, intensifying your avoidance of larger group gatherings.
• Whilst avoiding social situations, you may also experience feelings of loneliness when you are unable to communicate with people who understand you.
• In order to manage your social phobia, you may avoid specific social situations that associate with another phobia e.g. when you also have a fear of flying, fear of confined spaces, fear of open spaces, fear of heights, etc.
• You may limit your career choices and promotional prospects by avoiding jobs that involve a high degree of social observation, interaction and performance.
• You may have higher levels of absence in social situations that you feel obligated to attend e.g. school, college, work, work meetings, work socials, etc.

You conform to other people’s expectations and behaviour

• To avoid standing out from your peer group, you may imitate the majority’s codes of behaviour e.g. wear similar styled or branded clothing, smoke cigarettes, drink alcohol etc.
• Convinced that you are being scrutinised by your audience, you may change your everyday functions to fit the group’s expectations e.g. walking, eating, speaking, etc. as others in the group would do.
• You believe that conformity will prevent you from being ejected from the social group.

You suffer with anticipatory anxiety

• You worry for days or weeks prior to a social event, affecting your how you lead your lifestyle e.g. comfort eating, smoking, drinking alcohol, losing sleep etc.
• Your anticipation keeps you locked in procrastination, inhibiting you from developing skills or rationally dealing with social situations e.g. proactively developing your presentation that would relieve some of your anxiety.

You suffer with anxiety and panic attacks in social situations

• Various physical symptoms can include erratic breathing, fast heart rate, blushing, sweating, trembling, frequent urination, upset stomach, loss of concentration, memory loss, muscle tension, vertigo, etc.
• Your social anxiety may also affect your ability to speak, being closely related to selective mutism.

You struggle to deal with authority and over-confidence

• Following bullying and/or abuse, you feel nervous when in the presence of authority, aggression, and over-confidence.
• To prevent feelings of intimidation, you avoid conflict by being unassertive.
• You struggle to accept criticism (and praise) from authority figures.

You ruminate over your fears

• You dwell on what you did and didn’t say or do after the social event, often reinforcing your fears that you have offended someone or said something embarrassing.
• You can dwell on embarrassment from your past for years after the event.
• You are convinced that your imperfect performance, traits or abilities will lead to your rejection from a relationship, the social group or organisation.
• You imagine the worst possible consequences from a negative social experience (catastrophic thinking), despite praise from your peers or audience.
• You are convinced that your anxiety is a sign of weakness.
• You are very sensitive to embarrassment and can experience it vicariouslye. when others suffer embarrassment you feel it too.

You use safety behaviours to alleviate your social anxiety

• To help ease (medicate) your social anxiety, you may rely on smoking cigarettes, drinking alcohol, comfort eating, develop unwanted habits, use other recreational drugs etc.
• You disguise your anxiety from others displaying a false sense of enjoyment of the occasion, but inwardly you have barely survived the social experience.
• You may use social media as a substitute for live social interaction often depriving yourself of sleep.

You lack assertiveness

• You struggle to communicate the value of your needs. This may also be related to your low self esteem and low self confidence
• Already critical of your own abilities, you take other’s criticism as facts rather than as their opinions.
• Instead of viewing rejection as a momentary lapse in your abilities, you take rejection shamefully.
• Whilst you prefer praise to criticism, being praised can draw attention from others, triggering feelings of embarrassment.
• You have a high level of self criticism and can be distrustful of other’s praise.
• You may fear commitment since you will struggle to communicate your future need to leave and would then feel guilty that you have upset them.
• You fear commitment since a future rejection would confirm fears that you are not good enough.

As indicated above, living with social anxiety can affect your life in many ways. In reference to others it can alter how you perceive yourself, creating negative self-labels and self-doubts on your ability to make social choices.

It can also alter how you view others. As a projection of your fears, you believe that strangers are a danger to your well-being, and you may generally view people as distrustful and judgemental. This is likely to create a self fulfilling prophecy as others are likely to read your behaviour as being aloof and antagonistic.

In addition to this, convinced by your own beliefs, social anxiety can affect how you view the world, responding by wanting to feel safer from your perceived (social) threats. It’s common to be more house-bound (agoraphobic), limit your social network, and avoid careers that involve high sociability and social performance situations.

Connected to your socially anxious belief system, is how you imagine and reflect on your time-line of experience. You dwell on your past as definitions or convincers of your social anxiety. These emotionally-charged embarrassing experiences continue to haunt you as (depressive) fixed judgements that you can’t change.

How you relate to your past can affect how you similarly view your future. With social anxiety, you believe that your future will be determined by how you perceived your past. In other words, you are stuck with social anxiety forever and there’s nothing that you can do about it.

These thinking patterns are likely to create your physical symptoms of anxiety in the moment. When you are experiencing anxiety symptoms, it will overwhelm how you cope with the present. It can be ambitious to attempt a presentation whilst experiencing high anxiety. It usually overwhelms your ability to focus purely and clearly on your presentation content.

When you bring social anxiety into how you cope with what’s happening in the social world around you and within you, you will consider social confidence developmental opportunities as potential catastrophes to deepen your social anxiety. Opportunities will be defined as threats and when you don’t participate in a social event you will reinforce (without evidence to the contrary) that people are talking about you and judging you.

Common social anxiety treatments

The main options for social anxiety treatment include:

Cognitive behavioural therapy – A therapist will use CBT, a type of psychotherapy to help you to challenge negative thought patterns and behaviours related to your social anxiety. This is sometimes completed in a group and with your family.

Medication – Antidepressant medication (SSRI’s) are commonly prescribed by your doctor to treat the persistent symptoms of anxiety.

Guided self help – Improvements to your social anxiety can be made using workbooks that can help challenge your negative thought patterns and behaviour.

A combination of the above may be used to treat social anxiety.

Hypnotherapy as a social anxiety treatment

There has not been much research that has specifically validated hypnotherapy as an effective social anxiety treatment. There has been a small case study that has demonstrated the effectiveness of hypnotic visualisation rehearsals to overcome social anxiety and again in literature reviews of hypnosis to overcome performance–related social anxiety.

However, as an anxiety-related condition, social anxiety has common associations with general anxiety and phobias. These anxiety-related conditions all share anxious thoughts, beliefs, emotions, behaviours, avoidance patterns, panic attacks, etc. The same medication is used to increase serotonin levels in the brain across these anxiety-related conditions. Similarly, therapists will adopt a behavioural hierarchy of controlled exposure from other anxiety situations and modify them so that the social anxiety treatment is specific to the patient’s social anxiety situation.

There is more research (literature reviews and meta-analyses) to demonstrate how hypnotherapy can be used to treat anxiety as an individual treatment, with CBT, and in the treatment of phobias. Similarly, hypnotherapy can adopt the same principles of controlled exposure when the skilled hypnotherapist is analysing the client’s social anxiety background and can then apply them into a hypnotherapeutic treatment model.

How can hypnotherapy treat your social anxiety?

Hypnotherapy can help you challenge your social anxiety beliefs

There are many types of hypnotherapy. Each hypnotherapy technique can be used to target different pathways of your social anxiety. Cognitive behavioural hypnotherapy techniques acknowledge that your thoughts, feelings, physical sensations and behaviour are linked. In hypnosis these negative thoughts in can be identified, changed and replaced with more objective and realistic thoughts that have become automated in the maintenance of your social anxiety. In a hypnotic state you can access these cognitive changes in a more accessible way.

Hypnotherapy can target your anxiety symptoms

Some social anxiety clients are overwhelmed by anxiety symptoms e.g. breathlessness, voice distortion, blushing, sweating etc. affecting how you function in the social situation. Anxiously, you can absorb your attention into your anxiety symptoms and fear that others are seeing and judging your symptoms. Hypnotic suggestions can be used to lower your symptomatic physical reactions and combine them with affirmations to have more control over these symptoms.

Hypnotherapy can help you control your panic response

Panic attacks are intense fearful physical reactions without any apparent danger or cause. When you have panic attacks, you have lost conscious control over your body. A study has demonstrated how individualised hypnotherapy techniques can help in the treatment of panic attacks. Your hypnotherapy treatment will help connect you with this thought-emotion-physical reaction pathway. Suggestions can be incorporated into common relaxation techniques e.g. breathing techniques to boost the alleviation of your panic symptoms.

Hypnotherapy can treat your anticipatory anxiety

Your past experiences will heighten your alertness to future threats. You are likely to build up anticipatory anxiety to “prepare” you for the danger of embarrassment. Losing sleep days or weeks prior the event, the anxious alertness can be a betrayal of something that rarely happens. Hypnotherapy can help to disconnect your anticipation and explore proactive ways to prepare a moderated alertness.

Hypnotherapy can boost your social performance anxiety

If you can perform well in practise but then go to pieces when performing in front of a live audience, then hypnotherapy can use several techniques to help you to build confidence in your ability. There is evidence that hypnotherapy techniques can build self confidence in student’s fear of public speaking ability. Social performance anxiety can affect many more situations like exams, sexual performance anxiety (erectile dysfunction, premature ejaculation), sports performance etc.

Hypnotherapy can improve your mental rehearsal

Positive mental rehearsal is a powerful tool that can project you towards the achievement of your goal. There is evidence that athletes use mental rehearsal to improve sports performance and help them access their performance zone. Mental rehearsal prepares the brain to access how you want to function in the absence of being in the real world. Hypnotherapy can focus your mind into the imagined situation enhancing your ability to visualise your positive experience.

Hypnotherapy can develop your self-hypnosis

There are many benefits of the application of self hypnosis, more notably in the management of anxiety. Your hypnotherapy treatment will help you to learn self hypnosis so that you can use these techniques independently in the various situations that are exacerbating your anxiety.

Hypnotherapy can assist your controlled exposure

Controlled exposure (also known as systematic desensitisation) is considered to be an effective treatment for many anxiety-related disorders. Hypnotherapy can serve as a positive mental rehearsal or “virtual reality” for the controlled exposure to social situations. This can help you to feel ready to put this rehearsal into practise and confront the situation that triggers your fear. Depending on how much you want to “future pace” your controlled exposure, you can prime the situation in hypnosis as if it has already been completed successfully.

Hypnotherapy can reframe the “cause” of your social anxiety

Regression is a technique that enables you to observe the various beliefs and values that shaped your handling of a past experience. It can also add insight into what you learned from the experience. Sometimes the learning (in the case of a phobia) can be exaggerated and unhelpful for future reactions. The regression technique is in contrast to solution focused hypnotherapy which prefers to leave the past behind, but has been shown to be effective in a multi-modal hypnotherapy treatment. Regression can help reframe the trauma of the “cause” and add insight into “why” some habitual patterns of negative coping persist.

Hypnotherapy can treat associated fear and phobias

You may bring to your treatment social anxiety as a core issue or a symptom connected to other anxieties, fears and phobias. In any case, your goals and the issues that you present will be discussed in the treatment session. This will enable your treatment to be individualised to your needs.

Social anxiety treatment: conclusion

Some researchers argue that humans are inherently social. Social interaction is considered to be important for mental health and can be a useful strategy to manage stress. For those with social anxiety however, the situations that others thrive on can, in the short term at least, be damaging to your emotional health.

It’s acceptable to want your own space “with yourself” and be “asocial”, particularly if you don’t suffer with loneliness. Having your own space can also be a useful time to relax and recharge. However if you are afraid to interact with others and have an overwhelming fear embarrassment, hypnotherapy can be a beneficial social anxiety treatment to build your self-confidence and social confidence.

Social anxiety treatment accessibility

Face to face consultations are available at the Cardiff hypnotherapy practice. If you are unable to travel to the practice, you can also access social anxiety treatment online.

For more information on social anxiety treatment, contact Richard J D’Souza Hypnotherapy Cardiff