“I enter a party and feel all eyes on me. My pulse quickens, my face burns and my stomach churns. Everybody must be judging me — the way I look, walk, talk and eat. Over time, I start avoiding more and more social situations because I can’t bear the anxiety. This isolation is soul-crushing.”
This is the kind of story I frequently hear from my socially anxious patients. As a psychologist, I have noticed that social anxiety has become one of the most often cited reasons people seek therapy in my practice, especially since the rise of social media and all the virtual ways we interact with each other as well as the pandemic. Anxiety is gradually increasing, and social anxiety disorder — previously termed social phobia — is the second-most prevalent anxiety disorder (after specific phobias), affecting about 1 in 10 adults and teens.
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Social anxiety disorder involves substantial anxiety in social or performance situations and is accompanied by a strong fear of being rejected as well as appearing or acting in a way that leads to embarrassment and humiliation. When social anxiety significantly interferes with an individual’s work, establishing or maintaining relationships, leisure or other functioning (for example, using public transportation, traveling, playing sports), we diagnose it as a disorder. Social anxiety disorder usually starts in childhood or adolescence and persists throughout a lifetime.
Caring about others’ views of us and feeling discomfort in some social situations are perfectly normal — a result of our evolutionary past, when rejection by one’s tribe was life-threatening for early humans. And some people are just more shy by nature while others are the life of the party. Whereas shyness represents a milder form of social anxiety, it should not be mistaken for a mental disorder.
If you suffer from social anxiety, you can learn to lessen or overcome it by understanding it and using certain helpful strategies.
Perceived rejection turns into self-reproach
My work with socially anxious patients often leads us to an undercurrent of harsh self-judgment and seeing themselves as socially awkward, inadequate and inferior to others. They often take any judgment as a sign of rejection, and in turn, take rejection personally — a reflection of something wrong with them. To make matters worse, they tend to see others reacting disapprovingly even when that is not the case. For example, socially anxious people perceive even subtle negativity in others’ faces as threatening, and they mistakenly interpret positive social interactions in a negative way.
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Social anxiety also has been linked to setting unrealistic social goals and having perfectionistic standards for interactions — each social encounter serving as additional “proof” of one’s inadequacy. Furthermore, socially anxious individuals overestimate any negative consequences of social encounters, often ruminating and obsessing over what they shouldn’t or should have said or done for hours or even days. When you feel so bad about yourself, you are more likely to construct your life around preventing further rejection, thus perpetuating social anxiety.
Self-criticism is most successfully countered with self-compassion. This website provides a good compilation of evidence-based strategies for increasing it.
A more unorthodox approach that I sometimes suggest to my patients is to ask others what they think of you. A socially anxious person might be surprised to discover that they come across better than they imagine.
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Finally, a deeper exploration — with a competent therapist, for example — might be required to uncover causes of any pervasive and immutable feelings of worthlessness or unlovability.
The price of emotional avoidance
Studies show that socially anxious people fear that their anxiety is visible and thus try to suppress it. More generally, they tend to avoid, distract from and minimize their negative feelings. And they are reluctant to pursue meaningful goals, for fear of inviting difficult emotions. Unfortunately, this comes at a cost: They end up shutting themselves off from positive emotions such as joy, excitement, awe and contentment.
To increase positive emotions and a sense of meaning in life, people with social anxiety could practice mindful meditation and learn to avoid labeling feelings as negative or positive, opening themselves up to all internal experiences.
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Other helpful strategies include reducing alcohol or similar substances used to numb emotions; tracking and sharing what they are grateful for; and clarifying what matters the most to them and committing to pursuing it, however gradually.
Self-perpetuating cycles
Several vicious cycles maintain or worsen social anxiety. Socially anxious people often avoid or escape social situations, making their anxiety graver in the long run. Life can become very small and limited, often leading to profound loneliness, depression or substance abuse — which in turn exacerbate anxiety.
Many socially anxious individuals stay glued to their phones at a gathering, refrain from speaking at a business meeting, wear inconspicuous clothing, only talk to their partner at a party, wait for an empty train car or use extra makeup to cover up any redness. These “safety behaviors” prevent them from learning that social situations or outward signs of anxiety are not as scary as they imagine them.
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Furthermore, socially anxious people sometimes make things worse for themselves by engaging in behaviors that turn off or alienate others. For example, they hyperfocus on how they are appearing to others rather than showing interest in others. And they are quick to anger, or fail to be kind after a poor social interaction. I have observed that social anxiety is so frustrating and exhausting that many of my patients have little energy left to be forgiving and empathetic.
Gradually approaching anxiety-provoking social situations, while reducing safety behaviors, is the main way to reduce social anxiety. When done methodically with a therapist, this approach is called exposure therapy, a form of cognitive behavioral therapy (CBT). After learning how to tolerate anxious feelings and thoughts, a patient usually progresses from vividly imagining participating in social situations to doing it in real life.
I also find it useful to work with my socially anxious patients on improving awareness, recognition and naming of various emotions that show up in addition to anxiety. This emotional literacy helps them notice when frustration or anger arises, allowing them to act in a less-detrimental way toward others. Finally, I often recommend my socially anxious patients to go to a party, look around to see who seems uncomfortable, and talk to them to help them feel better. This strategy not only shifts the focus away from self, but also engages curiosity, generosity and compassion — all antidotes to social anxiety.
Jelena Kecmanovic, PhD, is a clinical psychologist and professor in the D.C. area. She focuses on anxiety and the adverse effects of modern life on well-being.
We welcome your comments on this column at OnYourMind@washpost.com.