Social anxiety disorder (SAD) is painful to live with. What most people would consider an everyday, ordinary social interaction can send you into a tailspin, trigger anxiety, self-doubt, and negative thought patterns. Fortunately, SAD is treatable. In this post, I sat down with Dr. Steve Orma, a cognitive behavioral therapy (CBT) clinical psychologist specializing in insomnia and anxiety.
What is social anxiety disorder?
Social anxiety disorder (SAD) (also called social phobia) is a psychological problem where a person experiences significant fear of social and/or performance situations, particularly when exposed to unfamiliar people or where there’s the potential of being judged by others. When in these situations (or when anticipating them), the person feels intense anxiety, sometimes enough to induce a panic attack. As a result, the person usually avoids these situations or tolerates them with great distress. The person is aware that their is excessive or unreasonable. The anxiety and distress cause impairment in the person’s normal routine, social life/relationships, school and/or career.
Everyone has felt anxious in social situations at one time or another (e.g., asking someone out on a date, speaking in front of a large group), but those with SAD feel such intense anxiety that it impedes their functioning in one or more areas of their lives. They might not attend college for fear of having to meet and interact with others, or they may never date because they are so fearful of being rejected. SAD can stop people from pursuing their goals and values, and cause them to live restricted, less fulfilling lives.
How prevalent is SAD?
SAD is the third most common psychological problem (after depression and alcohol dependence) and affects about 5-7% of the U.S. population annually. About 15 million Americans suffer from SAD. During a person’s lifetime, there is up to a 13% chance of developing SAD. It usually begins in childhood or adolescence, but can also develop in adulthood.
What causes SAD?
There are different theories about what causes SAD, including a person’s genetics, biology, environment, thinking, or a combination of these factors. However, there is no agreement among psychologists about these theories. It is clear, though, that one’s thinking and the beliefs one holds have a significant impact on the nature and intensity of SAD.
When in social or performance situations, people with SAD have thoughts such as, What if I screw up? What if I say something stupid? People will think I’m boring. It will be a disaster if they don’t like me. People with SAD fear that others will judge them negatively for what they say, do, or how they look. They become very self-conscious in social and/or performance situations, which can feel painfully uncomfortable.
Some with SAD have these thoughts and feel anxious in specific situations only (e.g., while giving a speech, when meeting new people), while others have these thoughts and feel anxious in most or all social situations. (It is important to note, you should never feel guilt or shame for having these anxious thoughts. Most of the thoughts are triggered automatically when you are in or anticipating situations you fear, and you may not even be aware you are having these thoughts.)
What is cognitive-behavioral therapy? Is it effective for treating SAD?
Fortunately, SAD can be effectively treated. One treatment that has been shown to be effective is cognitive-behavioral therapy (CBT). CBT is an active, collaborative, and skills-based therapy that focuses on teaching people to identify and change negative, inaccurate thoughts and beliefs they hold that are driving their anxiety and behavior.
The treatment includes having people go into social situations they previously avoided out of fear and anxiety. Exposure to feared social or performance situations helps people become desensitized to their anxiety and helps them to build self-confidence.
Treatment usually includes learning effective social and communication skills that are practiced in and outside of therapy. CBT is generally a short-term treatment that can be done individually or in groups.
This article previously appeared on Forbes.