“Nobody realizes that some people expend tremendous energy merely to be normal.” (Albert Camus, 1965).
What is Anxiety?
The
emotion of anxiety is a state of intense apprehension, uneasiness, and
uncertainty about the future (Open University of Sri Lanka, 2021). This complex emotion is a collection of somatic or
cognitive elements and the person’s body that has suffered from anxiety will
prepare itself to deal with an external threat. His hearing rate speeds up,
blood pressure is increased and muscles will receive more blood and oxygen. And the digestive system is also slow down to cope with lower level of serotonin.
Social anxiety disorder
(SAD)
SAD
(social phobia) is one of the anxiety orders that
the individual is fearful or anxious about or avoidant of social interactions
and situations that involve the possibility of being scrutinized (American
Psychiatric Association, 2022). A person with the SAD finds it extremely
difficult to meet or talk to unfamiliar people or eating and drinking in public as
they fear of getting observed, judged, humiliated or rejected by others. It will
interrupt their life and affect the daily routine, work, school or any other
activities.
Etiology of Social anxiety disorder
Illustration 01: https://www.verywellmind.com/social-anxiety-disorder-causes-3024749
SAD
has more physical and psychological effects like trembling and shaking compare
to normal shyness. Negative parenting style and parental lifetime depression
will be associated with more depressive symptoms among adolescents (Keijser et
al., 2020). When they do over control, criticize and show low affection, the
child’s self-image and the child’s impression of the world can be shaped as an
unpredictable place filled with ill-intentioned people.
Connecting
to past traumatic social experiences can develop stressful life events and
influence the development of social anxiety problems. Childhood experiences
like abuse, domestic violence, bullying, teasing, social withdrawal or
rejection from the community are responsible to generate SAD symptoms in
people.
According
to The American Psychiatric Association: "anxiety disorders run in
families (American Psychiatric Association, 2021). As an example, if one identical twin has a
SAD, the second twin is likely to have the same disorder as well. In addition
to that people with a biological parent who’s suffered from SAD have a 30% to
40% possibility of developing the same conditions themselves (Norrholm &
Ressler, 2009).
Part of the brain called amygdala is responsible for controlling the fear response which activates the body to respond to threats. But in SAD, the prefrontal cortex increases the activity of the amygdala instead of calming it down. (Sladky et al., 2013). People with SAD have fear of other people’s reactions as their brains have already understood social interaction is a threat and it is not easy to deal with.
Diagnosis of Social anxiety disorder
Diagnosing
the SAD is very important to find effective treatment as many people don’t realize
that they are suffering for SAD. However there is no medical test to check the
level of SAD. The mental health professional will examine the conditions that
are causing the disorder.
As
described in the Diagnostic and Statistical Manual of Mental Disorders (5th
Edition), the key features of SAD are:
· Continuous fear of social situations such as
meeting unfamiliar people, having conversations and being observed while eating
and perform in public.
· Experiencing social or public situations make
anxiety responses and avoided or suffered with extreme distress.
· People who suffered from SAD recognize that
their fear is excessive or unreasonable
· Person with SAD may feel panicked if other
people are looking at him, but would be perfectly comfortable alone in same
place.
· Social anxiety is continued, typically
lasting for 6 months or more.
· The anxiety is not due to the physiological
effects of a substance or a general medical condition and is not better
accounted for by another medical disorder.
Treatment methods for social anxiety disorder
SAD
is usually treated with psychotherapy, support groups, medication or
combination. Mental health care professionals will decide the best treatment
for the relevant persons.
Psychotherapy
for SAD usually involves a combination of behavioral and cognitive methods.
Cognitive behavior therapy (CBT) is a talk therapy that can help a person to
learn a different way of thinking, reacting and behaving to overcome anxious
and fear. Also help to learn and practice social skills. CBT can organize as
support groups as well. In support group person
can find people who all have SAD and can receive unbiased, honest feedback
about how they see about others. Then it’s very helpful to learn that about
judgment and rejection are not true or are biased and also able to learn how
others with SAD approach and overcome the fear of social situations. (National
Institute of Mental Health (USA), n.d.)
In
research from Jefferson (2001), he found that public speaking anxiety
could be overcome by using nonprofessional programs such as Toastmasters. By
repeatedly applying the principles of preparation, rehearsal and exposure, they
can often achieve a level of comfort in perform in public.
Medications can give considerable relief from symptoms. Anti-anxiety medications are given for short period of time. Antidepressants are mainly used to treat depression, but are also helpful for the symptoms of social anxiety disorder. According to National Institute of Mental Health in USA, beta-blockers are medicines can prevent some of the physical symptoms of anxiety such as an increased heart rate, sweating or trembling. Beta-blockers are commonly used for “performance anxiety” type of social anxiety.
Psychological strategies and interventions to reduce the symptoms and
behavioral problems of Social Anxiety Disorder
Psychological interventions for the treatment of SAD
are the best strategies we can find so far. According to National Institute for
Health and Care Excellence (Great Britain) and National Institute for Health
and Care Excellence (Great Britain), the development of a range of cognitive
and cognitive behavioural interventions, are substantial evidence for the treatment
of social anxiety disorder. These therapies can provide either individually or
in groups. Other psychological interventions and strategies can also be used to
treat SAD.
Cognitive
behavioural therapy (CBT)
CBT for SAD, people learn how to react to thoughts and
feelings. And they learn to engage in different behaviors which help to
decrease fear. CBT helps people to practice social skills. This is an active
treatment which use of skills training and behavioral assignments.
Cognitive
therapy (CT)
CT is a modified version of
CBT that focuses on the adverse beliefs that individuals with SAD have about
themselves and social interactions. Individually treated. However, there is a
need for the therapist to be able to use groups to participate as role plays.
Interpersonal
psychotherapy (IPT)
Developed to treat depression.
IPT structured approach that reports interpersonal issues. Its main assumption
is that mental health problems and interpersonal problems are interrelated. IPT
helps people to understand how these problems are functioning in daily life,
how those are leading them to become anxious and how develop SAD. IPT help to
develop individuals’ perceptions and expectations of relationships and aims to
improve communication and interpersonal skills.
Psychodynamic
psychotherapy
This short term therapeutic
approach helps individuals by exploring and working through specific
interpersonal conflicts.
Applied relaxation
Relaxation training which use
relax in everyday social situations.
Social
skills training
This
treatment involves systematic training in non-verbal social skills such as eye
contact and friendly posture and verbal social skills such as conversation,
giving feedback to others, ask questions. These are repeatedly practiced
through role-plays in therapy sessions.
References
American Psychiatric
Association (2021). What
Are Anxiety Disorders? Psychiatry Org.
https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
American Psychiatric Association.
(2022). Diagnostic and Statistical Manual of Mental Disorders, Text Revision
Dsm-5-tr (5th ed.). Amer Psychiatric Pub Inc.
Gilmartin, B. (n.d.). Social
anxiety disorder [Illustration]. Very Well Mind.
https://www.verywellmind.com/social-anxiety-disorder-causes-3024749
Jefferson, J. W. (2001). Social Anxiety
Disorder: More Than Just a Little Shyness. The Primary Care Companion to The
Journal of Clinical Psychiatry, 03(01), 4–9.
https://doi.org/10.4088/pcc.v03n0102
Keijser, R., Olofsdotter, S., Nilsson,
K. W., & ÅSlund, C. (2020). The influence of parenting styles and parental
depression on adolescent depressive symptoms: A cross-sectional and
longitudinal approach. Mental Health & Prevention, 20,
200193. https://doi.org/10.1016/j.mhp.2020.200193
National Institute for Health and Care
Excellence (Great Britain) & National Institute for Health and Care
Excellence (Great Britain). (2013). Social anxiety disorder [E-book].
National Institute for Health and Care Excellence (NICE). Available from:
https://www.ncbi.nlm.nih.gov/books/NBK327654/
National Institute of Mental Health.
(n.d.). Social Anxiety Disorder: More Than Just Shyness. National
Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness
Norrholm, S., & Ressler, K.
(2009). Genetics of anxiety and trauma-related disorders. Neuroscience, 164(1),
272–287. https://doi.org/10.1016/j.neuroscience.2009.06.036
Open University of Sri Lanka. (2021). Abnormal Psychology (Block 1). Faculty
of Psychology and counseling, Department of Health Science.
Sladky, R., Höflich, A., Küblböck, M.,
Kraus, C., Baldinger, P., Moser, E., Lanzenberger, R., & Windischberger, C.
(2013). Disrupted Effective Connectivity Between the Amygdala and Orbitofrontal
Cortex in Social Anxiety Disorder During Emotion Discrimination Revealed by
Dynamic Causal Modeling for fMRI. Cerebral Cortex, 25(4),
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