All of us have some degree of social anxiety; we face social anxiety in important interviews, public performances, public speaking, acting, singing or playing a musical instrument, playing under pressure etc.
A certain amount of adrenaline is known to enhance the performance but too adrenaline can cause social anxiety. The normal trend of the body to produce adrenaline and make us alert for social challenges is lost and the body starts producing excess chemicals that make the person anxious and produce the symptoms of social anxiety.
Symptoms of social anxiety disorder:A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or predisposed panic attack. The person recognizes that the fear is excessive or unreasonable. (In children, this feature may be absent.) The feared social or performance situations are avoided or else are endured with intense anxiety or distress. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning or social activities or relationships, or there is marked distress about having the phobia. In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people. Physical symptoms of social anxiety disorder:Confusion, Increased heartbeat, Sweating, Trembling, Shaking, Blushing, Increased muscle tension, Upset stomach, Diarrhea. |
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Social anxiety disorder is the most common anxiety disorder and the third most common mental disorder in the U.S., after depression and alcohol dependence. An estimated 19.2 million Americans have social anxiety disorder.
People with social anxiety often display hypersensitivity to criticism, difficulty being assertive, low self-esteem, and inadequate social skills. Avoidance of speaking in front of groups may lead to work or school difficulties. Most patients with social phobia fear public speaking, while less than half fear meeting new people.
Less common fears include fear of eating, drinking, or writing in public, or of using a public restroom.
Like most other phobias, social phobias are more common in women. They are more common in young people. Onset of social anxiety typically occurs between 11 and 19 years of age. Onset after age 25 is rare. Social phobia is a highly prevalent but often overlooked psychiatric disorder that can cause severe disability in functioning. Fortunately social phobia has shown good response to specific pharmacotherapy and psychotherapy.
Approximately one half of patients with social phobia have comorbid mental, drug or alcohol problems. The disorder increases a patient’s lifetime risk of depression approximately fourfold.
Treatment For Social Anxiety Disorder:
Cognitive behavioral therapy:
Cognitive behavioral therapy, with or without specific antidepressant therapy, is the evidence-based treatment of choice for most patients. Concurrent use of benzodiazepines can facilitate the treatment response of patients who need initial symptom relief
Cognitive and behavioural therapy is known to be effective in adults as shown by research studies and there is growing evidence of similar benefit in children and adolescents. Newer behavior therapies include the use of exposure therapy and strategies; they appear to be more effective in treating social anxiety.
The scheme of this therapy is as follows:
- Recognize the automatic or irrational thought processes
- Identify the underlying beliefs
- Challenge those irrational beliefs
- Replace those beliefs with suitable alternatives
Pharmacotherapy:
There is growing evidence that the condition is mediated by specific neurobiological factors and so drugs may be more logical than formerly supposed. The strongest evidence for efficacy was noted to be with selective serotonin reuptake inhibitors (SSRIs).
A review from 2005 entitled ‘Social anxiety disorder: current treatment recommendations’ suggested that venlafaxine XR (modified release) should be the first line.
The second line should be monoamine oxidase inhibitors (MAOIs) such as phenelzine and reversible inhibitors of monoamine oxidase, such as moclobemide.
Some benzodiazepines and antiepileptics like clonazepam and pregabalin may also be useful.
Self-help tips:
- Avoid worrying about and dwelling on or anticipating how you will act under these stressful situations
- Whenever you feel anxious your breathing becomes shallow, since you do not breathe properly under stress, pay close attention to how you breathe – practice inhaling and exhaling slowly through the nose rather than the mouth, in addition to breathing through the diaphragm instead of the upper chest. Take a slow, deep breath in and hold it for as long as possible and then slowly exhale.
- Cut back on caffeine intake: caffeine is known to act as a stimulant and it worsens anxiety.
- Get enough rest and sleep: Stress hormones in the body can trigger off a variety of anxiety reactions; therefore it is important that you get adequate rest.
- Watch your diet: Junk food, cola and high fat foods are known to increase anxiety levels.
- Avoid skipping meals or eating at irregular times
- Get regular exercise: Exercise is known to stimulate the production of feel good chemicals such as encephalins and endorphins.
Develop a routine for relaxation: This may be through avenues such as yoga , meditation or breathing exercise. These routines help in muscle relaxation and provide a sense of balance to the mind.- Practice visualization: Get into a relaxed state through deep breathing , imagine yourself in the situation that causes you anxiety allowing the scene to unfold in front of you in as much detail as possible with all the sight, smells and sounds associated with the place., practice relaxing in the situation, start relaxing the muscles in your toes, your ankles, your calves, knees, thighs and keep moving upwards until you have relaxed all the muscles. Practice this relaxation exercise as often as you can to reduce your social anxiety in real life scenarios.
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