GoodTherapy | Facing Social Anxiety: Practical Tips for Everyday Challenges   Social anxiety disorder can be a formidable challenge, impacting various aspects of daily life. In Plano, where mental health is a priority, individuals facing social anxiety find solace in ineffective treatments such as Cognitive-Behavioral Therapy (CBT). This blog delves into practical tips to navigate everyday challenges associated with social anxiety, providing insights for those undergoing depressive disorders treatment in Plano and seeking CBT for social anxiety. 

Understanding Social Anxiety in Plano: A Common Struggle 

Social anxiety involves an overwhelming fear of social situations, often accompanied by intense self-consciousness and fear of judgment. In Plano, acknowledging the prevalence of social anxiety underscores the importance of providing practical guidance to help individuals confront and overcome these challenges. 

1. Gradual Exposure and Positive Reinforcement 

CBT emphasizes gradual exposure to feared social situations as a key strategy for managing social anxiety. In Plano, individuals can start small by exposing themselves to low-stakes social interactions and gradually progress to more challenging scenarios. Positive reinforcement, acknowledging even small successes, helps build confidence and reshape negative thought patterns. 

2.  Challenge Negative Thoughts with CBT Techniques 

Cognitive restructuring, a core component of CBT, is invaluable for addressing negative thoughts associated with social anxiety. Plano residents undergoing CBT for social anxiety learn to identify and challenge irrational beliefs about social interactions. This process fosters a more realistic and positive outlook, empowering individuals to navigate social situations with greater ease. 

3. Mindfulness and Relaxation Techniques 

In the bustling environment of Plano, incorporating mindfulness and relaxation techniques is crucial for managing social anxiety. Mindfulness practices help individuals stay present in the moment, reducing excessive worry about future social interactions. Techniques such as deep breathing or progressive muscle relaxation contribute to a sense of calmness and control. 

4.  Develop Social Skills through Practice 

Practical social skills are essential for navigating everyday challenges. Plano offers various opportunities for individuals to enhance their social skills, through social groups, workshops, or community events. Engaging in purposeful practice builds confidence and competence in social interactions, aligning with the principles of CBT. 

5.  Set Realistic Goals for Social Interactions 

Setting realistic and achievable goals for social interactions is pivotal in overcoming social anxiety. In Plano, individuals can work with their CBT therapists to establish specific goals, such as initiating a conversation, attending a social gathering, or expressing opinions in a group setting. Celebrating these accomplishments fosters a positive trajectory in overcoming social anxiety. 

6. Seek Support from Friends and Family 

A strong support system is invaluable in managing social anxiety. Plano residents undergoing treatment for depressive disorders and social anxiety can lean on friends and family for encouragement and understanding. Open communication about their challenges and victories strengthens the bonds of support, aligning with the holistic approach to mental health in Plano. 

Pioneering Mental Wellness: Faith Health Wellness, Your Trusted Partner in CBT for Social Anxiety 

At Faith Health Wellness, we’re committed to being your community’s leading healthcare provider, specializing in cutting-edge CBT treatment for social anxiety. As your trusted partner in psychiatric health, we strive to set and exceed the same high standards we’d want for our own family members. Choose Faith Health Wellness for compassionate care, innovative solutions, and a commitment to fostering lasting well-being. Your journey to mental health is our top priority. 

 

GoodTherapy | Masks Off, Anxiety Up: Dealing with No-Mask Anxiety

Masks Off, Anxiety Up: Dealing with No-Mask Anxiety

After over a year of covering their faces, Americans across the country were told they could breathe freely earlier this year as mask mandates were lifted. 

Unfortunately, the return to “normal” life hasn’t been smooth sailing for everyone. In fact, nearly half of Americans admit they have concerns about resuming in-person interactions, according to the American Psychological Association.  

It appears as though the mental health issues brought about by the pandemic aren’t going away anytime soon. 

Indeed, “no-mask anxiety” is real, and folks all over America are worried about life returning to the way it was before the pandemic. 

What Is No-Mask Anxiety? 

Like the name suggests, no-mask anxiety is a condition where people are scared about the prospect of taking off their masks in public.  

Those affected by no-mask anxiety feel uneasy when they themselves don’t wear a face covering, and they can also be uncomfortable around others who are not wearing masks. 

People of all ages can suffer from no-mask anxiety, including kids who are not yet vaccinated. 

Worried you might be suffering from no-mask anxiety? Don’t be. Doctors say it’s completely normal — and will likely be an increasingly common diagnosis as we move further into the post-pandemic world.  

The Why Behind No-Mask Anxiety  

On top of general uncertainty about the future, there are a few reasons why folks might develop no-mask anxiety: 

It’s become a habit.  

Imagine Henry, a 45-year-old father of two.  

For the first 44 years of his life, Henry never wore a mask. All of a sudden, in 2020, he wore a mask every day, each time he stepped out of his house.  

Since research says it takes an average of 66 days to develop a new habit, it comes as no surprise that Henry now feels more or less “naked” without a mask on. 

It feels like a security blanket. 

Throughout the pandemic, masks have served as our front line of protection against the virus. While vaccinations are helping the world safely move past the pandemic, many still feel comforted by wearing a mask and were planning on wearing them for the foreseeable future. 

Then, suddenly, the CDC updated its guidelines and said that folks who were fully vaccinated could return to pre-pandemic life. Expecting to wear a mask for some time and being told it was no longer required has been a difficult adjustment for many people. 

“The only time I don’t have mine up is when I’m at home or driving my car,” Jenny Krislov, a resident of Madison, Wisconsin, told Spectrum News 1. “It almost feels like my security blanket.”  

Krislov doesn’t only wear the mask to protect herself. She also wears it to protect her loved ones. 

Unmasking can exacerbate social anxiety. 

Those who have social anxiety live in fear that their peers will judge them for awkward or abnormal behavior in social settings. Simply put, people with social anxiety do everything they can to act “normal” and fit in with the crowd. 

As the pandemic began, these individuals might have been hesitant to put their masks on in the first place out of concern they’d get weird looks. However, ever since masks were mandated and the vast majority of people complied, they were happy to mask up.  

Now, as we transition to a post-pandemic world, social anxiety may be a bit higher than normal, according to David Moscovitch, a professor at the University of Waterloo. People who were nervous to be in public might have felt some comfort in being able to hide their faces. But in order to fit in now, they need to reveal their faces — which is causing some people to develop no-mask anxiety.  

“Many people who didn’t struggle with social anxiety before the pandemic may find themselves feeling more anxious than usual as we emerge out of the pandemic and into a more uncertain future — especially within social situations where our social skills are rusty and the new rules for social engagement are yet to be written,” Moscovitch wrote in a recent paper. 

Social anxiety got you shut down and isolated, hyper-vigilant and self-critical, or any other way that is blocking your path to a peaceful, full life? Don’t let anxiety define you. Reach out to a therapist near you today for help.

Resilience and Growing Through Change: How to Conquer No-Mask Anxiety 

If you’re impacted by no-mask anxiety, you need to remember there’s nothing to be ashamed about. None of us have ever lived through a pandemic at the scale of COVID-19 before, so we will all need to adapt to varying degrees. 

If you’re looking to conquer your no-mask anxiety, here are a few tips to keep in mind:

1. Take your time.

Just because other people aren’t wearing masks doesn’t mean you have to take yours off, too. 

Doctors say there’s nothing wrong with taking your time to ease back into a more open world. 

“You can pick a safe place with safe people, and just gradually go from there,” Dr. Eric Berko of MetroHealth Medical Center told Cleveland’s Fox 8 News. “Keep a mask in your pocket. It’s OK if you feel uncomfortable, just put it on. There’s no harm or shame in any of that. Gradually get yourself out there, and I think you’ll start to feel better and better.”

2. Force yourself to be social.

As Robert Frost once wrote, the only way out is through. 

If you find yourself saying no to social gatherings or wanting to keep your face mask on in supermarkets and retail shops, try to force yourself to do the opposite. 

“Catch yourself when you’re choosing to avoid even when you aren’t being forced to do so by pandemic-related restrictions,” Moscovitch said. “Do your very best to summon the courage to push yourself to enter those situations and confront your anxiety.” 

3. Find resilience.

According to Brené Brown, people who are resilient in the face of trauma tend to practice three specific acts: 

If you’re struggling with no-mask anxiety — or any other effect of the pandemic — remember that you don’t have to wrestle the issue entirely on your own. 

Start your search for a therapist who can guide you through your struggle and help you live a more fulfilling life today. 

The silhouette of a person standing in a field of yellow mustard flowers.Social anxiety and avoidant personality disorder share some common features, but they are separate mental health conditions. Because the two conditions appear similar in many ways, it’s not uncommon for people to mistake one for the other.

Sometimes simply getting help is more important than having a specific diagnosis. But some people also find it beneficial to know what’s affecting them. In some cases, the best approach to treatment differs for separate mental health issues, so misdiagnosis can affect treatment and make it harder for a person to improve.

Social anxiety, or social phobia, is a specific type of anxiety characterized by a fear of social situations. People with social anxiety worry about embarrassing themselves in public or doing something that will cause others to judge them negatively. It’s fairly common for people to feel nervous about doing something embarrassing in public, but the feelings of fear and anxiety that occur with social phobia can become so distressing they cause difficulty at work, school, or other parts of daily life. About 75% of people with social anxiety are between the ages of 8 and 15 when diagnosed.

Avoidant personality disorder is a cluster C personality disorder. Personality disorders are a specific kind of mental health issue where patterns of thought and behavior affect daily life, and those with personality disorders often experience difficulty in professional and personal life because they have a hard time understanding other people and common situations.

Levana Slabodnick, LISW-S, a therapist in Columbus, Ohio, notices one difference between social anxiety and avoidant personality may lie in how a person views their own experience. She explains, “A fundamental difference between social anxiety disorder and avoidant personality disorder relates to how the sufferer perceives their own pain. Those with anxiety understand on a basic level that their anxiety is irrational and that the world doesn’t judge them as harshly as they judge themselves. Those with APD, on the other hand, lack this insight. They hold deep rooted feelings of insecurity and worthlessness that they believe to be factual.”

People with avoidant personality often feel socially awkward and inferior to others. They tend to be very sensitive to criticism and rejection and often avoid making friends or participating in social events unless they are sure of their welcome. Feelings of shame or self-loathing are more strongly associated with avoidant personality than social anxiety. This condition is not often diagnosed in children, though it often develops in childhood.

Avoidant Personality Disorder vs. Social Anxiety

Social anxiety and avoidant personality share an intense fear of being embarrassed or judged in social situations. People might describe a person with either condition as shy, timid, awkward, or fearful.

Fear associated with these conditions can present in many ways, such as:

Debate over whether avoidant personality is a more severe type of social anxiety exists among mental health experts. According to the fifth edition of the DSM, these issues are often diagnosed together and can overlap to the point where they might seem like different presentations of the same concern. But while an avoidant personality typically involves patterns of avoidance in most or all areas of life, social anxiety may only involve avoidance in a few specific situations. The DSM continues to categorize them separately.

Debate over whether avoidant personality is a more severe type of social anxiety exists among mental health experts.

The two issues continue to share similarities when it comes to risk factors. Genetic and environmental factors can contribute to the development of either condition. Avoidance can be a learned response. People might begin to avoid social situations after a negative experience, for example. Being shy as a child can also increase the likelihood that a person will go on to develop social anxiety or an avoidant personality, though being shy does not necessarily mean a person will develop either issue for certain.

Experiencing abuse, trauma, bullying, or other negative events in childhood can increase the risk for both social anxiety and avoidant personality. But neglect, particularly physical neglect, is a significant risk factor for avoidant personality. A 2015 study comparing the two conditions found that having disinterested caregivers, feeling rejected by caregivers, or not having enough affection in childhood was more common in people with avoidant personalities.

Certain risk factors do differ between the two conditions:

Should I Get Treatment for Social Anxiety or APD?

Therapy is generally recommended for both avoidant personality and social anxiety. Only a mental health professional can diagnose mental health issues. If you think you might have symptoms of either avoidant personality or social anxiety, making an appointment with a qualified therapist or counselor can be a good place to start.

Letting any potential counselors know your particular symptoms and describing your specific experience can help them decide whether they’re qualified to help you. Not every therapist has experience treating every mental health condition, but an ethical therapist will always let you know if they think another therapist might be more helpful.

Social anxiety is often treated with cognitive behavioral therapy (CBT). This therapy helps you identify thoughts that cause distress and affect you negatively. Once you identify them, you learn how to change them. You can do CBT alone, but some people find group therapy helpful.

Exposure-based CBT is a specific approach to CBT where you slowly expose yourself to feared situations. This approach often involves skills practice or role-playing techniques, both of which can help people get more comfortable interacting with others in the safe space of therapy.

According to a 2015 study, performing random acts of kindness for others led to a decrease in symptoms of social anxiety in study participants after 4 weeks.

While therapy can have great benefit, sometimes social anxiety doesn’t improve right away. If you are working with a counselor and still experience significant difficulty in your daily life, a psychiatrist may recommend medication, such as:

Anxiety medication can help relieve some symptoms of social anxiety, but it’s a good idea to continue with therapy at the same time, as therapy helps you learn how to cope with what you’re experiencing. This can have a more lasting effect on your symptoms.

Many people believe personality disorders are not treatable, but this isn’t the case. They can be difficult to treat, especially if you’ve had symptoms for a long time. But therapy can still be very helpful. People with avoidant personality often seek treatment when they experience loneliness and distress as a result of being unable to participate in social events.

Research has shown people with avoidant personality may do better in therapy if they have the support of family members.

Any kind of talking therapy can be helpful for avoidant personality. CBT is commonly used to treat this condition, but other helpful approaches include family and group therapy. Research has shown people with avoidant personality may do better in therapy if they have the support of family members. Group therapy can help people learn how to develop relationship and communication skills in a safe space, and it’s often recommended for treating personality disorders.

There’s no specific medication used to treat avoidant personality. However, antidepressants and anti-anxiety medications may help relieve some severe symptoms.

Conclusion

Social anxiety and avoidant personality have some similarities, and some approaches to treatment may be similar. Regardless of which condition you have, therapy can help. It’s important to reach out for help if you’re struggling with social situations. When social anxiety or avoidant personality go untreated, complications like depression, isolation, and substance abuse can develop. Some people may experience significant loneliness and distress.

Talking to a therapist can help you get a diagnosis. But you’ll also begin to learn ways to cope with the feelings you experience and explore methods of overcoming these feelings. Therapy can help you become more used to the company of others. In time, you may find it easier to participate in social situations.

If you need help finding a counselor in your area, our therapist directory is a good place to start. Remember, you aren’t alone!

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 103-110.
  2. Anxiety disorders. (2017, December 15). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders
  3. Avoidant personality disorder. (2017, November 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9761-avoidant-personality-disorder
  4. Eikenaes, I., Egeland, J., Hummelen, B., & Wilberg, T. (2015, March 27). Avoidant personality disorder versus social phobia: The significance of childhood neglect. PLoS One, 10(5). doi: 10.1371/journal.pone.0122846
  5. Kvarnstorm, E. (2016, April 6). Avoidant personality disorder goes beyond social anxiety. Bridges to Recovery. Retrieved from https://www.bridgestorecovery.com/blog/avoidant-personality-disorder-goes-beyond-social-anxiety
  6. Lampe, L. (2016). Avoidant personality disorder as a social anxiety phenotype: Risk factors, associations and treatment. Current Opinion in Psychiatry, 29(1), 64-69. doi: 10.1097/YCO.0000000000000211
  7. Personality disorders. (2016, September 23). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
  8. Smith, K. (2018, November 19). Avoidant personality disorder. Retrieved from https://www.psycom.net/avoidant-personality-disorder
  9. Social anxiety disorder (social phobia). (2017, August 29). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
  10. Trew, J. L., & Alden, L. E. (2015, June 5). Kindness reduces avoidance goals in socially anxious people. Motivation and Emotion, 39(6), 892–907. Retrieved from https://link.springer.com/article/10.1007/s11031-015-9499-5

Couple talking while they take a walk in natureStuttering is a complex speech issue that affects about 1% of adults. People who stutter may become socially anxious, fear public speaking, or worry their stuttering will undermine their performance at work or school.

Research shows that stuttering is not a mental health diagnosis, and anxiety is not the root cause of stuttering. Anxiety can, however, make stuttering worse. This can create a vicious feedback loop in which a person fears stuttering, causing them to stutter more. In some cases, anxiety about stuttering may disrupt a person’s relationships and ability to communicate.

What Causes Stuttering?

The hallmark of stuttering is repeating certain sounds, syllables, or words. It exists on a continuum from mild to severe. In some people, stuttering is so mild that others might not notice it at all. For a minority of people who stutter, the condition can be so severe that it makes it extremely difficult to communicate at all.

Most people who stutter fall somewhere in the middle. They stumble over words and repeat certain syllables. They may feel anxious about speaking, and others may notice their speech is not typical. But they’re able to speak to others, and others are able to understand what they say.

Types of Stuttering

Researchers used to think that stuttering was a mental health problem caused by trauma or fear. While it’s possible for trauma to cause stuttering, it’s rare. Instead, providers divide stuttering into two distinct types:

Developmental stuttering

Developmental stuttering is the most common type of stuttering. Common among children ages 2-6 who are learning to speak, it usually goes away on its own. Five to 10 percent of children stutter at some point, and at least 75% outgrow it. For the remaining 25%, stuttering may continue to be a problem in adulthood.

Developmental stuttering is often much worse when a child is anxious. The speech of children who stutter may improve when they speak for longer periods. This means the first few sentences of a conversation may be slow and halting, but as a child become more relaxed, they may stutter less.

Developmental stuttering runs in families. This suggests a genetic link, and researchers have identified a few genes linked to stuttering. However, the specific causes of and triggers for developmental stuttering are still not fully understood.

Neurogenic stuttering

Neurogenic stuttering is much less common than developmental stuttering. It’s due to a problem with the brain caused by an injury, developmental issue, or disease. For example, some people develop a stutter following a stroke or a traumatic brain injury (TBI).

Although anxiety may make neurogenic stuttering worse, anxiety is more closely tied to developmental stuttering.

Negative experiences with others can fuel a person’s anxiety about stuttering, and this anxiety may make stuttering worse.

The Link Between Anxiety and Stuttering

For many people, verbal communication is an important way to connect with others. Stuttering makes this communication more difficult. This may trigger anxiety, especially abut social relationships. A 2009 study found stuttering increased the odds of being diagnosed with anxiety by six- to seven-fold and increased the likelihood of a diagnosis of social anxiety 16- to 34-fold. Another 2009 study found that 50% of adults who stutter have social anxiety.

Stuttering may change the way people relate to the person who stutters. Children who stutter sometimes experience bullying and isolation. Adults may struggle to feel heard at work or in high-pressure situations, such as speaking publicly at an academic conference. Negative experiences with others can fuel a person’s anxiety about stuttering, and this anxiety may make stuttering worse.

A person who stutters may also have false beliefs about stuttering, such as that stuttering necessarily means others won’t take them seriously or listen to them. This fear may affect major life decisions such as where to go to school and which jobs to seek. For example, a talented researcher might opt not to speak at a conference or accept a professorship because of their fears about public speaking.

Coping with Stuttering-Related Anxiety

People who experience anxiety related to stuttering may find relief in a number of strategies. Those include:

How Parents Can Help With Stuttering-Related Anxiety

Most people who stutter are children. Parents and other family members can do a lot to help. Try the following:

How Therapy Can Help with Anxiety Caused by Stuttering

Stuttering can be treatable. Many people see immense improvements in their speech after seeking help from a speech-language pathologist. A therapist can help with anxiety and other stuttering-related issues, allowing a person who stutters to focus on overcoming their speech difficulties.

A strong therapeutic relationship is the most important factor in therapy’s success. Research also shows specific techniques can help with stuttering-related anxiety. Exposure therapy may help people who have anxiety about stuttering in specific situations, such as on a date or while at a conference for work. Cognitive-behavioral therapy (CBT) can curb social anxiety by helping people identify, correct, and eventually prevent automatic self-defeating thoughts.

Even for people who continue stuttering, therapy can restore a sense of self-worth. Addressing the anxiety stuttering causes may prevent it from getting worse. Stuttering does not have to undermine a person’s quality of life or ability to succeed. It’s just one of many human differences. For many people who stutter, therapy offers a path out of shame and isolation and into confidence and better relationships. With the right support, people who stutter may no longer see their stuttering as a deficit or something to fear.

References:

  1. Büchel, C. & Sommer, M. (2004). What causes stuttering? PLoS Biology, 2(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC340949
  2. Craig, A. & Tran, Y. (2005, January 5). What is the relationship between stuttering and anxiety? Retrieved from https://www.stammering.org/speaking-out/articles/what-relationship-between-stuttering-and-anxiety
  3. Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., . . . Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 7(23), 928-934. doi: 10.1016/j.janxdis.2009.06.003
  4. Menzies, R. G., Onslow, M., Packman, A., & O’Brian, S. (2009). Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 3(34), 187-200. doi: 10.1016/j.jfludis.2009.09.002

Dear GoodTherapy.org,

I have really bad social anxiety. I don’t want to go anywhere or do anything anymore because I’m worried I will say something stupid and people won’t like me. I am not a good speaker, so I tend to say things that sound dumb. Then I spend the rest of the night thinking about what other people were thinking when I said it. I second-guess myself a lot.

It has gotten to the point that even when I am forced to be around people, I stay quiet most of the time. I overheard someone tell their friend that I am “unfriendly” and “aloof” because I don’t involve myself in conversations. It’s like my choices are (1) sound dumb or (2) seem unfriendly.

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I can’t make friends because of my social anxiety and I don’t feel like there is anything I can do about it. Does social anxiety get better or go away in time? Or am I stuck being a socially awkward misfit for the rest of my days? —Outcast

Dear Outcast,

The pain and frustration you are feeling comes through loud and clear. You feel like social interactions are no-win situations—you either remain quiet and risk being perceived as unfriendly or try to participate in conversations and risk being perceived as less intelligent than you are. I also imagine this can become somewhat self-perpetuating. As you become more and more self-conscious about your social interactions, it likely becomes harder for you to engage in a way that feels good.

You pose two questions: one, will your social anxiety diminish in time, and two, are you stuck dealing with social anxiety forever. I suggest tabling those questions in favor of a different question: What can you do to make yourself feel more confident and capable in social situations?

You pose two questions: one, will your social anxiety diminish in time, and two, are you stuck dealing with social anxiety forever. I suggest tabling those questions in favor of a different question: What can you do to make yourself feel more confident and capable in social situations?

Joining a therapy group could be helpful. I know it might sound frightening to willingly put yourself in a group of strangers on a regular basis when doing so is deeply anxiety-provoking, but a therapy group is quite different from a typical social situation. First, it is designed to help group members deal with the issues they face. Second, therapy groups are established with rules that are designed to ensure the safety of group members. A group affords you the safety and security of therapy along with the opportunity to explore social interactions and try on new behaviors. As you do so, inside and outside of the group, you’ll have the support of the group to celebrate your successes and to process the things that don’t go as well as you would have liked.

If starting out with a therapy group sounds like too much, that is okay. You might feel more comfortable partnering with an individual therapist first to explore your social anxiety and develop a deeper understanding of it. You could also work with a therapist to develop some tools for coping with the anxiety so joining a group doesn’t feel so daunting. You could even begin working on developing some social skills that you could begin practicing when you join the group.

There are also public speaking groups, such as Toastmasters, that are designed to teach people how to master public speaking. Even people who feel relatively confident in social situations can have tremendous anxiety when it comes to public speaking. Perhaps if you developed a sense of mastery in public speaking, smaller social situations wouldn’t feel so overwhelming.

However you choose to handle this, I encourage you to take a proactive approach. There is treatment available to help you learn to navigate social situations in a way that feels more comfortable and allows you to form deeper, more satisfying relationships. You deserve that!

Kind regards,

Sarah Noel, MS, LMHC

Girl covering her mouth with her hands, looking anxiousSocial anxiety causes feelings of panic or fear during interactions with people. It can occur only in certain situations or nearly all of the time. For adults, it often means avoiding other people, groups, or large crowds. But social anxiety can show up much earlier in life. In infants and toddlers, social anxiety will look much different that it does in adults.

Where Does Social Anxiety Come From?

It can be hard to pinpoint what causes social anxiety in infants and young children. One study found infants could learn socially anxious behavior from their mothers. A mother with social anxiety may display those behaviors to a child through interactions with strangers. The study indicated these nonverbal cues could teach the child that strangers are a source of anxiety.

Genetics also affect whether a child will have social anxiety. Genes help determine an infant’s disposition, or personality. Research shows certain genetic traits can increase risk for anxiety and situational phobias. Some of these traits may include inhibition and fear of being judged. Fear in low-threat situations could also help predict social anxiety.

Home life and environment can exacerbate risk factors. Trauma could trigger social anxiety at a young age. Addressing these issues with children early may pave the way for good mental health in the future. In addition, the severity of a child’s social anxiety can vary. Some children grow out of it as they develop, while others internalize the anxiety when they are older. [fat_widget_right]

Signs of Social Anxiety in Infants and Toddlers

Social anxiety may look similar to shyness, separation anxiety, or autism. There is no set age when symptoms start to appear. It is common to notice social anxiety in preschool or other social settings. However, parents may notice signs that could predict social anxiety in children from the time they are newborns.

Signs of social anxiety in infants may include:

These behaviors can be stressful for parents. Infants cannot communicate clearly what is causing them distress. Parents may worry their child is in pain or that they have done something wrong.

As infants grow into toddlers, their social anxiety may appear in other ways. It may be easier to understand what is causing a toddler stress. But knowing how to deal with a socially anxious toddler can still be challenging.

Signs of social anxiety in toddlers may include:

Parents of a socially anxious toddler may worry they are raising a “difficult” child. This causes some parents to punish their child for anxious behavior. Punishing a child for signs of social anxiety can have the opposite effect of what is intended. Toddlers who are punished for anxiety-rooted behavior may “close off” from parents. One study showed that harsh parenting may cause an already fearful toddler to become even more anxious. It also led to lowered neural processing ability in preschool.

A therapist can help address behavior issues that stem from social anxiety. They can show parents how to work with the behavior constructively.

How Are Separation Anxiety and Social Anxiety Related?

Reading books or watching movies that depict confident young children can give watching toddlers a hero to mimic.

Separation anxiety can be normal in young children. They may cry or become worried when a parent drops them off or leaves the room. But separation anxiety may be soothed in the short term. Some parents use entertaining distractions to help kids settle into social situations.

But for toddlers with social anxiety, distractions may not improve the situation. Social anxiety can cause children to worry about being around others as well as separation from parents.

Social anxiety can stem from separation anxiety, or both may occur together. Toddlers with social anxiety may seem afraid to participate in group activities or play with peers. If they also have separation anxiety, it may be difficult to calm them after a parent leaves. This can make preschool or daycare a stressful event.

Tips for Parents of Socially Anxious Infants and Toddlers

If an infant shows signs of social anxiety, it can help to model calm, self-soothing behavior. Modeling healthy reactions in social settings can help teach young children these behaviors. In addition, giving toddlers a chance to practice before new situations may help them feel more confident. For example, a parent might invite them to practice show-and-tell before the big day. Reading books or watching movies that depict confident young children can give watching toddlers a hero to mimic.

Instead of feeding into fearful behaviors, it can be more helpful when parents give enthusiastic praise when toddlers try something new. Explaining a child’s anxiety to any caregivers, teachers, and other parents will help them understand their behavior. This can help inform how they act around the child. Caregivers can help by fostering positive interactions. This can reinforce the idea that others do not have to be a source of anxiety.

Medication and Socially Anxious Infants and Toddlers

It is considered best practice to not give medication to children under the age of 5, except in extreme cases. Social anxiety does not typically warrant medication at this age. Young children are sensitive to the effects of medication. Medicating too early may cause unwanted side effects. If the anxiety persists when the child is older, consult a professional about the next step for treatment.

How Therapy Can Help Infants and Toddlers with Social Anxiety

It may be too soon to tell if an infant or toddler has social anxiety. A therapist can help parents or caregivers address behaviors that indicate a child’s discomfort in social settings. Some therapists specialize in mental health issues in young children. They may give an assessment that more clearly reveals where the child is struggling.

Seeing a family therapist together can be helpful for parents. It can give them guidance for any difficulties they have in helping their child. Seeing parents talk calmly with a therapist can help children with social anxiety understand the social setting is safe for them. A therapist may also be able to identify root causes of a child’s social anxiety.

Children grow and change over time. Understanding that it is always okay to ask for help is a lesson they are likely to take with them through the rest of their life.

References:

  1. A guide for community child serving agencies on psychotropic medications for children and adolescents. (2012). American Academy of Child & Adolescent Psychiatry. Retrived from https://www.aacap.org/App_Themes/AACAP/docs/press/guide_for_community_child_serving_agencies_on_psychotropic_medications_for_children_and_adolescents_2012.pdf
  2. Brooker, R. J., & Buss, K. A. (2014). Harsh parenting and fearfulness in toddlerhood interact to predict amplitudes of preschool error-related negativity. Developmental Cognitive Neuroscience, 9, 148-159. doi: 10.1016/j.dcn.2014.03.001
  3. Buss, K. A. (2011). Which fearful toddlers should we worry about? Context, fear regulation, and anxiety risk. Developmental Pscyhololgy, 3(47), 804-819. Doi: https://doi.org/10.1037/a0023227
  4. Cuncic, A. (2018, February 16). How to cope as a parent of a preschooler with social anxiety. Retrieved from https://www.verywellmind.com/preschool-child-with-social-anxiety-3024286
  5. de Rosnay, M., Cooper, P. J., Tsigaras, N., & Murray, L., (2006). Transmission of social anxiety from mother to infant: An experimental study using a social referencing paradigm. Behaviour Research and Therapy, 8(44), 1165-1175. Doi: https://doi.org/10.1016/j.brat.2005.09.003
  6. Kendler, K. S., Prescott, C. A., & Meyers, J. (2003, January 9). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Arch Gen Psychiatry, 9(60), 929-931. doi: 10.1001/archpsyc.60.9.929
  7. Rogers, C. E., Sylvester, C. M., Mintz, C., Kenley, J. K., Shimony, J. S., Barch, D. M., & Smyser, C. D. (2017). Journal of the American Academy of Child & Adolescent Psychiatry, 2(56), 157-166. doi: https://doi.org/10.1016/j.jaac.2016.11.005
  8. Schwartz, C. E., Wright, C. I., Shin, L. M., Kagan, J., & Rauch, S. L. (2003, June 20). Inhibited and uninhibited infants “grown up”: Adult amygdalar response to novelty. Science, 5627(300), 1952-1953. doi: https://doi.org/10.1126/science.1083703
  9. Social anxiety: Risk factors. (n.d.). Retrieved from https://childmind.org/guide/social-anxiety-disorder/social-anxiety-disorder-risk-factors
  10. Versfeld, P. (n.d.). The highly sensitive child and behavioral inhibition. Retrieved from https://skillsforaction.com/highly-sensitive-child

Two couples drinking coffee and chattingIt is quite common to fall in love with someone who possesses qualities that balance out your own. The phrase “opposites attract” describes exactly that. There are many ways in which being in a relationship with someone different is helpful. Messy people can be motivated by their cleaner counterparts, and the chronically late are often kept on schedule by their timely partners. What happens, though, when the difference between partners goes beyond a personality quirk and becomes a significant mental health concern?

Social anxiety is a condition defined by an intense aversion to social situations due to fear of being judged or rejected. People with social anxiety have difficulty controlling their worry about how others perceive them and, as a result, often avoid social situations. When social situations are unavoidable, they experience high levels of stress and anxiety, even panic attacks. Sometimes people who have social anxiety are viewed, inaccurately, as unfriendly or antisocial because of their difficulty socializing.

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Depending on the severity of the social anxiety, the symptoms can take a toll on a relationship. Conflicts can arise from the various areas of life that the anxiety is affecting. Feelings of resentment arise when parties and events for couples are missed. Partners find themselves arguing about spending time with family, especially over holidays when more family members tend to congregate. Annoyance builds when work functions for couples are missed. Work events such as these are opportunities for networking and potential advancement, but may be a nightmare to the anxious partner.

Conflicts stem not only from the need to engage with friends, family, and coworkers, but also from the need to engage with each other. Performers and sports players feel unsupported when their partner is unable to show for their events; the crowds and potential for socializing might be too overwhelming. Social anxiety can force one partner to be responsible for most or all social situations, especially when the couple has kids.

As with all mental health issues, social anxiety has the potential to disrupt and negatively impact even the strongest marriages. It is possible to work together to avoid letting social anxiety ruin a relationship. Here are four ways to avoid letting social anxiety strain your relationship:

1. Communicate and Validate

Being honest about what the anxiety feels like, its triggers, and how it impacts the ability to function in social situations is crucial to gaining support.

Communication is one of the most important ways to maintain a healthy relationship. In marriages where social anxiety is present, it is even more so. Being honest about what the anxiety feels like, its triggers, and how it impacts the ability to function in social situations is crucial to gaining support. When anxiety symptoms are kept secret or hidden, they often manifest as irritability, anger, and irrational thinking. When this is the case, it is typically not clear what is causing these symptoms and leading to arguments and misunderstanding. Having the ability to say, “I am feeling very anxious about meeting your coworkers” is much more likely to gain support from a partner. In addition, talking about your feelings can lead to a reduction in symptoms. This communication also creates opportunities for both partners to express understanding of the other’s feelings and provide much-needed validation of their experiences.

2. Compromise

When communication and validation occur, it is easier to compromise and find a solution to meet the needs of both partners. Perhaps your partner realizes you don’t need to come to their work function after all or agrees you need to attend only one holiday party with the in-laws, not three. There are ways for both parties to feel heard and supported when compromise occurs.

3. Plan

When social occasions are unavoidable, or you compromise and attend your partner’s event, you can mentally prepare yourself to make the experience less painful. Use your phone as your lifeline! Make a list on your phone of five ways to calm your body when the symptoms begin so they don’t escalate. Make another list with possible topics to talk about in case your anxiety shuts down your conversation skills. Identify where you can go for “time-outs” throughout the event to recharge. You can also come up with an emergency exit plan if all else fails. Hopefully you won’t need it, and just knowing you have one may be enough to prevent you from using it.

4. Get Help

Finding a therapist who specializes in working with anxiety is invaluable. By learning to identify and cope with your triggers as an individual, you are making an investment in yourself as well as an effort for your partner.

Person wearing red scarf and black coat sits on back of bench and looks out at lakeIn August of 2014, in the middle of the night, a phone call came: My son was unresponsive and was being transferred to the hospital. I remember the 30-minute drive to the hospital, trying to get to my son, took forever. I knew nothing but what his friend had hysterically tried to explain over the phone.

When I arrived at the hospital, and they took me to his room, he seemed so small, surrounded by a machine and tubes. The doctors were unsure whether he would make it. At that point, he was only alive because the machine was breathing for him. They didn’t know how much he had taken, only that it was some combination of a deadly mix. His friend repeated over and over, “He was trying to stop the voices. I tried to stop him.”

Thankfully he made it through. After three days in the hospital, he was sent to a “stabilization unit” to receive treatment. Three days later, they released him to his father to took him back to Seattle to get the help he needed. But that help never came. Instead he stayed in a small apartment with his stepmom, smoking weed and snorting coke with shots of vodka. After two weeks, she put him on a plane back home because she didn’t want to be bothered.

I immediately made an appointment with a psychiatrist, who diagnosed him with bipolar 1 disorder and social anxiety. He told the doctor he heard voices and used drugs to quiet them. I asked if the doctor thought this could be addiction as well but was told no.

I struggled to keep him on his medications and encouraged him to find gainful employment in order to be able to care for himself, but he said he felt “better” and stopped taking the meds. After two more inpatient stays that lasted 2-3 days, he was released with a new group of medications that were very expensive. My struggle to keep him on these meds never stopped.

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One night I heard a noise and instinctively went into his room, where I found him hanging in his closet by a belt. I cut him down to find he was still breathing. I had got to him in time, but he was combative. I had to hold him down until help arrived. This led to another inpatient stay, one that lasted 11 days. There was no follow-up care provided, though he was prescribed several more medications that would continue to empty my checking account.

Life Changes

My relationship with my mate ended abruptly because they thought I should do things differently. But frankly, I knew nothing of what I should do. I had no clue of how to fix this situation or keep it from compromising my life. I went on, because I had to, but my lonely path became even lonelier. I was afraid to leave my house other than to go to work. I was afraid to pursue a relationship. I had deemed life with myself as a solo player to be my only option because I had no idea what to do. All I wanted to do was save my son.

Over the next two years, my son would make numerous visits to stabilization units. These always resulted in the same outcome: a month or so of him being stable, then he would go off his medications. I begged for help, from the doctors, from his psychiatrist, from anyone who might be able to help my son.

But no one was able to help.

I spent those two years waking to every sound, feeling like a prisoner in my own home. I worried he would harm me if I didn’t give him money. I was robbed multiple times, and although I called the police and told them the crime was committed by my son, nothing ever came of it. He continued to steal from me, and he would not leave. If he did, he came back when I was gone to steal whatever else he could find, but still, the police did nothing.

My health was affected significantly. I was exhausted, experienced trouble with my bowels, and lost weight and sleep while I tried to maintain my career. I missed work through my efforts to help my son and lost relationships as I struggled to cope with the challenges my son was facing.

I had no one to help me through this dark, lonely world. I watched in fear, with a tortured soul, as my son self -destructed before me. I locked myself in my bedroom, after hiding sharp objects so he couldn’t get to them. My attempts to kick him out failed because he was on my lease and I was too embarrassed to approach my landlord to have him removed. The police would not help me, and professionals shamed me for wanting to walk away, telling me he needed family support. I was losing myself, taking medication to help me stay even.

Trying to Move Forward

The final straw came when a drug dealer showed up at my door threatening to kill my son and his family if he didn’t pay up. I chose to move an hour away, still close enough to commute to work, but far enough away to feel safe from this nightmare. Leaving my son homeless was all I could do at that point, in order to save myself. I pushed on trying to find myself again, though I was full of guilt.

He moved in with his sister, who was experiencing addiction to painkillers after years of kidney disease. Soon enough another call came. She had called the police, knowing he had an outstanding warrant, and he went to jail the night before Thanksgiving. I felt relieved knowing he was safe there, but pained nonetheless. I stand alone trying to fight, not just for him but for myself. I ask myself, what kind of mother turns her back on her children?

He got out of jail right before Christmas with a promise to go to Narcotics Anonymous and a sober living house, but I knew it would never happen. Then another call came. My sweet boy, who would give anyone the shirt off his back, who loved his Momma and said he wanted to get better, couldn’t keep a job and was in and out of his sister’s house. What’s more, he had decided he had no choice but to do drugs. He robbed a convenience store and was charged with robbery in the first degree, a felony offense.

My heart broke at the news. Guilt filled me, and I couldn’t breathe. I didn’t think he would survive prison. He wasn’t “tough,” he was a skinny boy who would hurt no one. He would die there, or at least his spirit would .

The judge ordered rehab at a place about an hour away. A place that, if I wanted street drugs I could walk in and get whatever I wanted from the residents, who were supposed to be in a rehab program. The people running the place could care less if these residents succeeded. They didn’t offer meetings to attend, just a pool table and a TV. After 30 days, residents could go to a doctor to get medications, but before that, they were on their own. So, my son, who received no medications for his bipolar or anxiety, surrounded by people trading their psych meds for caps and other things, relapsed. He ended up back in jail after testing positive for Seroquel, and was given another 30 days, after which he would return to rehab.

Continuing the Fight

Meanwhile my health is poor, and my relationships with others are compromised because I can’t cope. I went to see a psychiatrist to try to develop better coping methods, so I could help my son without compromising myself. She told me he was grown and told me I needed to cut him off. She went on to try to dissect my brain, but I received no support on how to cope with and support an adult child with addiction and mental health conditions.

I stand alone trying to fight, not just for him but for myself. I ask myself, what kind of mother turns her back on her children? Meanwhile, I continue to struggle with a daughter who is addicted to painkillers and is going to lose a battle with kidney disease. I tried to separate myself but my concerns for my grandchildren keep me from cutting the ties—she has two small children and a third on the way. I lie awake at night, fearing the call telling me she has passed on. All I know to do is to cut her off and pray for the best, but the thought of doing so paralyzes me with fear for my grandchildren.

My inability to cope consumes me. It affects my ability to live freely, to have a relationship without it being compromised. I do a lot of self-blaming. I ask myself, how did two of my three children end up battling addiction and mental health concerns? I was an attentive parent. They saw me work, attend college, and take care of them. How does this happen? How do I avoid not being consumed with sadness? How do I reduce the effects of my guilt and keep from self-destructing myself?  How can I have a normal life, when my soul is so tortured?

This is a lonely place to be. I have no resources and no support. No other parent is involved, and my only family is an older sister who has young children.

Today, I am facing the destruction of another relationship. I blame myself and can’t cope, and these feelings turn to self-bashing, withdrawing into isolation, and another loss. It can consume me, although I have made huge steps in the last few months. But these aren’t enough to save me from more losses, more sadness, and more darkness that may be what ultimately takes my life. I am afraid the stress will kill me. I have been sick for months and have lost nearly 50 pounds. But I don’t know what else to do.

What can you do, when you have tried everything? I have sought out counseling only to be slapped in the face with, “Cut the ties. They are adults.” From other sources, I hear family support is the key to success for those experiencing addiction and mental illness.

So, what to do? Though I have no help or support, I know I am not alone in this place. I chose to share my story to both try and seek help, and to help others who feel as I do know that they are not alone in their pain, either.

Rear view of three friends raising sparklers to the sky at early evening“I was looking forward to the party and I liked everyone there, but afterward I felt so down. I couldn’t stop worrying about what I’d said that sounded stupid, or if I hurt someone’s feelings. But I can’t possibly have social anxiety. I love socializing! I have plenty of friends.”

I’ve heard a version of that story many times—people in therapy experiencing what they call shyness, self-criticism, or loneliness in social situations. When I suggest this might fit the category of social anxiety, they’re shocked. They picture a person who huddles in the corner at a party or tries to be invisible in work meetings, never speaking above a whisper. The reality is social anxiety could affect anyone around you, from the bubbly girl in your class who is secretly praying she won’t be called on by the teacher, to the take-charge guy in the office who goes home exhausted from the strain of interacting with others all day.

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It’s true one model of social anxiety is the extreme: a loner who fears any contact with other people. This person might be diagnosed with “social anxiety disorder,” a clinical term which involves a high degree of distress, significant interference with daily functioning, and often panic attacks. It’s more common to have a less severe version of the condition, which wouldn’t be labeled a disorder—it’s just a major, sometimes daily, challenge.

Social anxiety can show up in many ways, such as not wanting to be the center of attention or dreading walking into a room of strangers. The unifying factor for everyone who struggles with it is a persistent fear they are being judged critically. It’s a sense any interaction could be fraught with danger, where we run the risk of messing up and being seen in a negative light. In this way, it can turn occasions that ought to be pleasant—like parties, weddings, or holidays—into torturous ordeals.

Below are some common misconceptions about social anxiety, along with more detailed information about the ways this condition can present itself.

1. Everyone with social anxiety is an introvert.

Believe it or not, you can be confident or personable and have social anxiety. You can know you’re basically a likable person and still worry everything you say is wrong. This is because social anxiety isn’t about your overall view of yourself but rather the conviction you are being judged and are bound to fail.

It can be surprising to discover someone who is outgoing and successful also frets over how they come across. The condition is distressing whether it’s obvious (hiding in the back of the room at a wedding) or subtle (telling a story to a group, but grinding your nails into your palms under the table). Sometimes struggling in secret is harder because people don’t believe you have the condition or discount how much you’re suffering, or don’t know they need to offer you more support.

2. If you have social anxiety, you can’t be good at public speaking.

Many socially anxious people are quite good at giving lectures or heading up meetings. In fact, many actors, who make their living speaking in front of others, struggle with social anxiety. This is because giving a speech or reading a script is a learnable, practicable skill, and one that offers fewer opportunities to mess up than impromptu socializing does. Many worriers plan far in advance and rehearse multiple times, so that a presentation becomes more like a memorization activity, or a performance, than a nightmare scenario.

Public speaking has the additional benefit of allowing the speaker to feel in control of the room. Since the belief is everyone is always watching and judging, it can feel relieving to enter a situation where that element is assumed and can to some extent be prepared for.

3. If you have social anxiety, you feel it most of the time.

The condition can affect you only in certain settings, or only some of the time. Some of the people I work with in therapy feel confused when they attend two social events but struggle through only one of them. “Why can I deal sometimes but not all the time?” they wonder. Luckily, we can examine the difficult times to explore what makes them worse.

Usually, what seems baffling at first soon yields important truths. Each of us has elements that make us more anxious based on past experiences (such as the time we fell during a school dance), messages we’ve heard (a parent reminding us we’d put on weight), or societal norms (a fear nice girls are never loud and boisterous). When we can uncover our personal triggers, they become easier to soothe.

Like any other anxiety, this one can itself become the source of angst. Sometimes people aren’t really anxious about the social event—they’re more anxious they might feel anxiety, and the fear of what might happen overcomes them.

4. Social anxiety affects you only during social interactions.

Some people worry incessantly before a gathering, but once it starts, they’re in the moment and feel less concerned. Others don’t dread the office holiday party and enjoy it while it lasts, but the next morning face self-recrimination. Social anxiety doesn’t have a timeline, though it typically affects the same person in the same way during each occurrence. In other words, once a pre-worrier, always a pre-worrier. It’s not uncommon to be engrossed in a conversation and truly enjoying it, only later to recall the conversation as tormented or littered with your blunders.

Like any other anxiety, this one can itself become the source of angst. Sometimes people aren’t really anxious about the social event—they’re more anxious they might feel anxiety, and the fear of what might happen overcomes them. In these cases, it’s important to remember all the times the anxiety doesn’t exist and reinforce the idea it isn’t in control.

5. If you have social anxiety, you don’t feel it with people you’re close to.

It’s a little like the Phillip Lopate satiric poem, which begins: “We who are your closest friends feel the time has come to tell you that every Thursday we have been meeting as a group to devise ways to keep you in perpetual uncertainty frustration discontent and torture …” The condition convinces people that others could be misinterpreting them, teasing them, secretly thinking negatively, leaving them out, rejecting them, or talking behind their back. This is sometimes only with strangers, but it can seep into any relationship.

For some people, it’s the closest friendships and romances that cause them to feel the most vulnerable and exposed. Some partners get frustrated they aren’t being trusted to be kind and understanding. But social anxiety isn’t usually a result of real rejection; it’s a perceived threat of eventual rejection.

Treating Social Anxiety

Because social anxiety is so individualized, and runs the spectrum from severely impairing to hidden but distressing, there is no one-size-fits-all treatment. The best course of action to soothe these difficult emotions is to get a deeper understanding of where and when they may have started, what triggers them, and possible tools to calm them.

Perhaps more than any other issue, social anxiety is helped by therapy, whether one-on-one or in a group setting. This is because so much of the condition is based in shame or the feeling one is basically lacking. Having the support of another person who can give objective feedback is invaluable. To learn to be vulnerable and real with one safe person, or a group who really gets it, is one of the best ways to attack social anxiety and replace it with what the anxious person so dearly needs: a realistic and secure sense of self.

Dear GoodTherapy.org,

I’m reaching out partly at the insistence of a few friends, who all seem to be worried about me and my antisocial habits. I guess the problem, as they see it, is I don’t go out and party like a “normal” person. You’d definitely call me an introvert. I’m friendly enough sometimes, but I’m also the roommate who slinks back to my room instead of engaging in prolonged interaction with my housemates. I prefer writing to board games, and Netflix to house parties. I spend a ton of time online and mostly interact with online friends. I do have a few close friends I’ve kept (or who’ve kept me) after college and various jobs I’ve had, and I enjoy their company. We occasionally do activities together like hiking or movie nights, but I can’t really handle large groups or loud noise. And those events only happen a couple times a month … or I only join in that often.

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So the rest of the time, I get told I should have more of a life, should go out more, should be more social. The problem is, I’m a bit worried too. I don’t want to force myself to make small talk with people, but it seems like that’s how you’re supposed to get ahead in life, in a career, or in both. I worry that I lucked out with the friends I do have, and won’t be able to make more.

I’m not unhappy as it is, but I’m tired of feeling guilty for declining social events and doing things that feel better to me. Are humans supposed to be more social? How much does my mental health depend on social interaction and events? And do I need therapy for social anxiety? —Going Solo

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Dear Solo,

Thank you for writing. Thank goodness, also, for the introverts of the world; can you imagine a world full of nothing but extroverts? Sounds like a reality TV show on steroids.

Your letter is interesting in that it seems as though others in your life find your social preferences problematic, while you for the most part sound okay with them. Who are these others who “insist” you reach out? And why are they insisting you come out and play? Do their “protests” seem one-sided/out of self-interest? Or is there a part of you that wants to be more socially engaged but is hesitant? It is hard to tell if they are being empathically supportive or a pain in the … well, neck.

I take it you are not long out of college, as it is mostly twenty-somethings who place such an emphasis on partying, as these friends seem to. Not having sufficient “party habits” is not something to worry about. In a way, the “party” is about dealing with the anxiety of transitioning into the big, bad world of adulthood; sooner or later, the party is over. I work with people for whom the party never ends, and they end up struggling to get clean and sober as a result. Perhaps your choices will look prescient and mature in a few short years.

At the same time, it sounds as if this is has stirred some internal conflict, or you wouldn’t have written. I would also add that you do sound socially active to a degree and not “shut in.” The ability to maintain close friendships is an admirable skill.

Do your social preferences affect your work presently? It strikes me that you are able to socially engage, meaning you could do so if a profession required it, but you prefer not to as it is as not as enjoyable—or, perhaps, safe?

I must confess, however, I detect a strain of … something … in your letter—sadness, perhaps, or confusion, or some/none of the above. I can’t tell if it’s due to others’ apparent view of your choices or something else, such as a strain of isolation.

Which leads me to this question: Is there something emotionally undesirable or unsafe or un-fun about joining others live and in person, as opposed to online? I say this as you mention “a ton” of online activity.

Some might genuinely not know how to answer that. Here’s a constructive way to process not-so-comfortable feelings, which many of us would rather avoid. You can try this alone, with a supportive friend, or even with a counselor: Next time you get told to “get out more and join the party,” pay attention to what you’re feeling inside. Do you feel guilt? Shame? Anger? Anxiety? Some/none of the above? It may help to identify body sensations—if they are tense or knotty, and so on. Try to identify these feelings as best you can.

Assuming “social anxiety” is a diagnosis—and I personally have a lot of ambivalence about such labels and diagnoses, since they often hurt more than help—I would say everyone experiences some degree of it. So try not to get hung up on such labels; if there is anxiety there, it exists on a spectrum and, based on your letter, does not appear to be “severe” or acute. You sound like you’re doing fine on the whole, and the issue is more subtle than extreme.

Next, try to recall earlier times you felt such emotions and within what context they arose. Did this happen in college? High school? Earlier?

Another question I would ask: Were you ever asked to join in group or family events, in the past, toward which you were not particularly enthused, even dreading? Were you made to feel guilty or bad for having these feelings?

Again, you mention you spend “a ton” of time online. This is not the forum to debate the pros and cons of online socializing, but since you mention it, I wonder what it is that feels more enticing or safe or preferable about online versus in-person activity. As a therapist and Gen Xer, my perspective is biased in that I have come to value face-to-face interaction over online socializing, for the most part. While there are friends whose distance makes this impossible, at the end of the day, online exchanges feel somewhat empty to me, not as enriching or colorful as being together in the same space. This is not the case with everyone, however.

One could write a book about the phenomenon of online socializing (and some already have); my basic theme here is to reflect on what is going on in your own psychological experiencing, and begin to understand your truth, to see where you feel comfortable as things are, and where you might—if you choose—want to explore further or try new things. We all have what psychologists call our “growing edge.” It is not a bad thing to nudge ourselves out of our comfort zones, at least a little, with some regularity.

Finally, assuming “social anxiety” is a diagnosis—and I personally have a lot of ambivalence about such labels and diagnoses, since they often hurt more than help—I would say everyone experiences some degree of it. So try not to get hung up on such labels; if there is anxiety there, it exists on a spectrum and, based on your letter, does not appear to be “severe” or acute. You sound like you’re doing fine on the whole, and the issue is more subtle than extreme.

There might, however, be some twinge of concern about your experience with other people and what it brings up, and so a discussion with a counselor could help, if only to satiate your curiosity and uncover whatever this possible conflict is about. Though from what I can tell, it sounds as though your fears are more future-based and concerned with “what if” than anything tangible now, besides the possible disapproval of others. But others’ disapproval may be inevitable for those who want to march to the beat of their own drum. Unless that itself is the issue that gnaws at you.

In the meantime, it sounds like you have a core of reliable friends, and in the long run that’s really all you need. I would be curious to hear more about a possible note of sadness or quiet discontent in your letter, if that is indeed what I’m detecting.

Thanks again for writing!

Kind regards,

Darren

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.