Social Anxiety: How Much is Too Much?

Social Anxiety Help

Larry Cohen, LICSW

Social Anxiety:
How Much is Too Much?


Guest Columnist: Cynthia Johansson
Women’s Monthly

Does the thought of giving a speech, meeting new people at a dinner party, or asking for a first date with someone you find attractive make you really nervous?

In fact, these types of situations top the list of common social fears, primarily because they evoke a sense of being evaluated by others.

“People with social anxiety regularly avoid these activities to avoid discomfort,” says local therapist Larry Cohen, “or they might force themselves to do things but can’t relax enough to enjoy themselves.”

Being able to distinguish the so-called “normal” social fears from other types of social anxiety is often the key to knowing when and how to pursue appropriate therapy.

One obvious indicator is the degree to which social fears affect your life, says Cohen, who offers 20-week social anxiety therapy groups for lesbians and gays. Group members typically say their anxiety interferes with such things as forming satisfying personal relationships or behaving comfortably and assertively at work

Socially anxious people “have and underlying belief that they are being judged by others,” Cohen says, and tend to be perfectionists who rate themselves negatively according to an “all or nothing” standard. This creates a vicious, self-defeating cycle of increased anxiety and avoidance

For all forms of social anxiety, treatment centers on cognitive/behavioral therapy. This type of therapy involves replacing the negative internal self-talk which arises during anxious situations with healthy, affirmative statements, Cohen says.

“The idea is to eliminate the self-defeating thoughts and actually feel better in your gut,” adds Cohen.

Group members practice role-playing difficult situations within the group, and later commit to weekly “homework” exercises outside the group designed to gradually increase their exposure to feared situations.

Public speaking, entertaining an audience, taking tests, eating in restaurants, and dating are typically dreaded by social phobics according to therapist Judy DeNardo of the Anxiety and Stress Disorders Institute of Maryland.

Most, if not all, of the social phobics DeNardo works with have avoided some or all of these situations for years, suffer from anticipatory anxiety (worrying hours, days or weeks before the dreaded situation), and experience episodes of intense fear called panic attacks.

During a panic attack a person often feels like he or she might die or go crazy, says DeNardo. The physical symptoms, which include rapid heart rate and palpitations, trembling, blushing, sweating, and gastrointestinal distress, result from excess adrenaline produced when the brain signals danger and triggers the body’s fight-or- flight response.

Effectively treating social phobia requires a combination of group cognitive therapy, stress management techniques and sometimes medication, says DeNardo.

“If a person is so plagued by symptoms and bogged down by excessive anxiety that learning is impossible, medication can be necessary,” says DeNardo.

Recent National Institutes of Mental Health research points toward the role of biochemistry, heredity and other biological factors in social phobia, a fact which may explain the corrective effect of medications such as antidepressants, which serve to diminish overall anxiety levels and block the panic response, DeNardo says.

“But treatment has to be individually tailored,” DeNardo added, noting that some people benefit from different types of antidepressants and/or tranquilizers while others prefer not to take medications and make significant progress with a combination of cognitive therapy, stress management techniques and gradual re-exposure to situations that elicit the phobia.

For more information about social anxiety and social phobia, contact the Anxiety Disorders Association at (301) 231-9350. They provide treatment referrals, and they maintain a current list of local self- help groups.

Cynthia Johansson is a freelance journalist with a special interest in behavioral sciences.

Reproduced with permission from Women’s Monthly, October 1994.

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If you have any questions or comments, please email Larry Cohen, LICSW, with offices in Washington, DC.

Social Anxiety Help is a founding regional clinic of the National Social Anxiety Center (NSAC):