Shyness & Social Anxiety

Meeting new people and developing friendships is an important part of college. Many people experience some degree of nervousness or awkwardness in relating with unfamiliar people such as professors, classmates, students in the dorm and other acquaintances. They may consider themselves to be "shy."  But we now know that many "shy" people actually have "Social Anxiety Disorder." Individuals who struggle with Social Anxiety Disorder experience a level of anxiety and fear about social situations that goes beyond minor or temporary feelings of discomfort. Social Anxiety Disorder (SAD) is characterized by intense self-consciousness and embarrassment in social settings. People with SAD have intense, overwhelming fears of being watched or judged by others. Physical symptoms of anxiety, such as blushing, perspiring, and shaking are common. These feelings and physical sensations often lead the person with SAD to become anxious for days or even weeks before social events. Social Anxiety Disorder is not equivalent to shyness. Unlike shyness, Social Anxiety Disorder is persistent, intense fear and anxiety that does not diminish in social situations and that greatly interferes with the ability to function academically, socially, and at work. People who struggle with SAD often avoid activities such as speaking in class, joining clubs or sports teams, attending parties, initiating romantic relationships, and approaching professors. Some SAD sufferers avoid eating in public, writing in front of others, or using a public restroom as they fear scrutiny and feeling ashamed in these situations. Prevalence rates for Social Anxiety Disorder range from 2-13%. The overwhelming anxiety associated with SAD often begins during the teenage years, and may follow shyness and fear as a child. SAD frequently co-occurs with other mental health disorders, including other types of anxiety disorders, depression and substance abuse. SAD often occurs in more than one family member, and probably is caused by a combination of life experience and heredity.

Counseling

Many people who struggle with Social Anxiety Disorder avoid seeking psychological treatment. The symptoms of the disorder lead SAD sufferers to fear many interpersonal situations, including counseling. This is unfortunate, as SAD can be effectively treated with therapy, or a combination of therapy and medication. Counseling for SAD typically involves examining and changing the negative and self-defeating thoughts that are part of the disorder. These thoughts are usually irrational, and treatment helps the client understand that his or her fears are exaggerated and unrealistic. For example, if a person has a great fear of speaking in class, the therapist will explore the client’s fears about what would happen (e.g. “I’m going to stammer and my voice will shake,” “People will think I’m stupid”). The therapist helps the client in substituting more positive, realistic beliefs (e.g. “People are concerned with the class, not with me.” “It is perfectly acceptable to not know all the answers.”). The therapist might also assist the client in using and practicing social skills, such as making appropriate eye contact, smiling, and asking questions to get to know others better. Another way counseling may help is in exploring social experiences earlier in life that may have contributed to the client viewing interactions with others as frightening or potentially humiliating. Many college students have had negative experiences during elementary, middle or high school years. When facing a new social situation, the individual with SAD may come to expect a repetition of negative, uncomfortable experiences with others. Therapy investigates the client’s assumptions about social interactions, such as the expectation that others will be judgmental or critical, or the excessive need for others’ approval. The client in treatment for SAD learns to develop different, more realistic expectations about social situations.

Medication

Research has shown that Selective Serotonin Reuptake Inhibitor (SSRI) medications, (e.g. Prozac, Zoloft, Paxil, Luvox) help to reduce symptoms of Social Anxiety Disorder. These drugs usually take from between 3 to 12 weeks to begin working. The SSRI medications are usually used for at least 6 to 12 months and withdrawn slowly. Short-acting anti-anxiety medications (e.g. Ativan) can also help with short-term relief from Social Anxiety Disorder symptoms, but are less desirable for long term use than the SSRI’s because of the risk of becoming “habituated” (needing to take more of the drug to achieve the same effect).

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