Do birthday parties, after-work happy hours, or even just getting together with friends for dinner fill you with tension, anxiety, or even dread? Do you find yourself making excuses to get out of social obligations just to avoid “having to deal with people?” For people with social anxiety, social events or situations often feel like ordeals that must be endured. Social anxiety is a common issue—it affects over 15 million Americans and often begins in early adolescence. Social anxiety involves feelings of nervousness, worry, and fear that stem from social situations, and is often described as an extreme fear of being judged or criticized. This going beyond being shy; people with social anxiety may dread social gatherings or events, and spend excessive amounts of time imagining ways in which they may embarrass themselves or be judged by others . Then, if they do feel judged or embarrassed in a social setting, they often feel completely mortified, stewing over the moment for hours or even days after the fact.
Symptoms of Social Anxiety
The Mayo Clinic lists the emotional and behavioral symptoms of social anxiety as follows:
- Fear of situations in which you may be judged
- Worrying about embarrassing or humiliating yourself
- Concern that you’ll offend someone
- Intense fear of interacting or talking with strangers
- Fear that others will notice that you look anxious
- Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice
- Avoiding doing things or speaking to people out of fear of embarrassment
- Avoiding situations where you might be the center of attention
- Having anxiety in anticipation of a feared activity or event
- Spending time after a social situation analyzing your performance and identifying flaws in your interactions
- Expecting the worst possible consequences from a negative experience during a social situation
Social anxiety may be experienced in a few ways. The cognitive factors, behavior, and emotional processes described above are typically what people associate with of this type of anxiety. Many people also experience physical, somatic symptoms as well. Stomach aches, nausea, and perspiration are common, but in extreme cases, dizziness, light-headedness, shakiness, and a rapid heart rate can occur.
Therapy for Social Anxiety
While therapists look at social anxiety as having these key features, every client is different, and everyone experiences this anxiety to different degree and in different ways. As such, the first step in treatment for social anxiety involves exploring and understanding what this type of anxiety means for you, specifically. Your therapist will begin by helping you define which situations make you most anxious, and which ones are easiest to handle. Frequently, therapist and client work together to construct a hierarchy of situations that range from lower to higher anxiety (i.e., a birthday party with family might be easier, whereas a first date with a new romantic interest might provoke more anxiety). Developing this understanding helps shift toward the second phase of treatment, which is involves two simultaneous points of emphasis—external and internal processes.
Externally, the therapist may focus on the client’s relationships with others. Many clients who are preoccupied by a fear of judgment or criticism may present as “people pleasers,” and may be hyperattentive to meeting the needs of others, even at the expense of their own. They may find themselves fearing the repercussions of saying “no” to a request, or experience feelings of fear or panic when they let someone down. In these instances, the therapist and client may engage in assertiveness training, which might involve rehearsing with the therapist and/or homework assignments to practice being assertive at home or with friends. This is part of a larger healing process called exposure, in which the therapist and client work together to practice facing the challenges that come up when exposed to those situations that provoke anxiety. Typically clients begin by facing those lower on the low-to-high hierarchy developed before, and then as they become more successful and confident, they may begin to face more challenging tasks.
Cognitive Behavioral Therapy for Social Anxiety
Internally, the client and therapist explore the client’s internal dialogue about themselves. One major factor in the maintenance of social anxiety is the client’s automatic negative thoughts—and the beliefs that underlie those thoughts. For example, if we believe that we are likely to be judged harshly for a mistake, then our automatic, knee-jerk reaction to making a mistake is going to be intense embarrassment, which will only make our anxiety greater. Part of overcoming social anxiety involves exploring these thought processes in therapy, challenging them, and, in time, changing them to be more realistic. Often, our immediate, panicked reaction is based on our anxiety, and not reality—we may have underlying beliefs about ourselves that fuel these anxious reactions (i.e., “I’m a failure,” “People don’t like me,” or “I’m going to be rejected or dismissed”), rather than more realistic beliefs (i.e., “I’m generally a likable person,” or “I’m important to people in my life”). Often, the exploration of where we have learned these critical, negative beliefs about ourselves can be an important turning point in letting them go and learning to love ourselves again. Cognitive Behavioral Therapy (CBT) is a common method of treatment for social anxiety. All of the therapists at Bergen Counseling Center are trained in CBT techniques and have worked extensively with clients who experience social anxiety.
Despite its prevalence, many people struggling with the extreme symptoms that accompany this disorder wait years before seeking help, and it’s easy to understand why—fear of judgment or evaluation can be difficult to discuss with another person, as we frequently fear that even a therapist might think poorly of us! Fortunately, social anxiety is extremely treatable, and has a good prognosis for clients who seek help. If you’re considering options for social anxiety therapy in Chicago, then be proud of yourself for even ending up here and reading this page—that’s the first step! Consider reaching out to one of the therapists at Bergen Counseling Center to discuss the next step that’s right for you. Fill out the contact form on the sidebar and a trained therapist will reach out to you to discuss options that may work for you.