Don’t be too shy

“Social anxiety disorder can be seen as an extreme form of shyness that impacts social and occupational functioning.“

A few weeks ago a social media post cited an article that suggested Omanis have a higher level of social anxiety disorder than people from other countries. As I read that I recalled the number of times a patient had come to my private clinic complaining of being anxious in particular social situations, the main ones were attending meetings, giving a presentation and attending a social gathering. Most of the people who came for consultations were successful young men and women who have stable jobs and often get good appraisals at the end of the year yet they feel extremely uncomfortable when they have to participate in public speaking due to their fear of being judged or scrutinised by others. Most of them understand that their fears are irrational or unreasonable, yet feel powerless to overcome them.

Social anxiety is sometimes considered an extreme form of shyness yet shyness tends to be temporary and does not disrupt one’s life whereas social anxiety is persistent and can affect the person’s ability at work and social interactions outside his or her family. In its severe forms, social anxiety can make the person avoid shopping in big malls, eating in restaurants or using the phone in public. A person with social anxiety experience different physical symptoms such as dizziness , increased heart rate, sweating, nausea and blushing which sometimes makes it difficult to speak, they also experience psychological symptoms in the form of intense worrying that can occur days before a social gathering and constant fear of embarrassment that makes them try to avoid the situation by refusing to attend the meeting or call in sick. In severe cases a person may resort to using alcohol to ease their nerves which makes them at risk of developing drinking problems.

So what causes people to develop social anxiety? According to scientific studies, the exact cause is not yet known but there are interactions between genetic factors, early childhood experiences that make some people more at risk. Some studies link experiencing bullying, emotional abuse and family conflict to developing social anxiety disorder.

So how can one deal with social anxiety? The first step is getting a diagnosis from a qualified doctor or psychologist who will be asking you questions to confirm the diagnosis then suggest the type of treatment depending on the severity of your symptoms and the presence of other mental health problems such as depression or generalised anxiety. While some patients would benefit from psychological interventions others would need medication to treat symptoms. In my practice I start by explaining the nature of social anxiety symptoms in simple terms and help the person identify their triggers, be it public speaking or attending social gathering. I also ask the person to identify how their symptoms affected their lives and what safety behaviour they use; for example attending a gathering with a friend or being prepared well before giving a presentation. For those with fear of public speaking I often suggest rehearsing well or recording oneself while rehearsing, then getting feedback from a close friend or colleague. The most common used type of psychotherapy is called cognitive behavioural therapy and it focuses on helping the person understand the link between their thoughts, emotions and the physical symptoms and learning how to control anxiety through relaxation and breathing and how to replace negative thoughts with positive ones. The other types of therapy is called exposure therapy which focuses on helping the person gradually face social situations instead of avoiding them.

Social anxiety is not classified as serious mental illness. The symptoms cause distress to the patient and may stop him or her reach their potentials. If you or anyone you know has social anxiety then don’t shy away from seeking help.