Understanding social anxiety and the fear of talking to strangers

Talking to strangers (and understanding them) is hard enough but what if you have an intense fear of interacting with others? Everyone can experience shyness, or a sense of awkwardness when faced with unfamiliar situations or people. But for some, their nervousness affects their functioning. I spoke to counselling psychologist, Tania Boshoff, to learn more about social anxiety.

What is social anxiety?

“Social anxiety can be described as a marked feeling of nervousness and self-consciousness during social interactions due to the intense fear of being negatively judged or evaluated,” Tania explains. Being a little nervous before a job interview or a date is completely normal. But when this nervousness negatively affects your functioning, you might have social anxiety. “People struggling with a social anxiety disorder might not just feel nervous about a job interview, they might be so anxious that they don’t attend the interview or don’t even apply for the job,” Tania says.

Some individuals experience a generalised form of social anxiety in which they fear most social interactions while others only fear specific social situations such as being observed (e.g. eating, drinking, or using public toilets) or in which they need to perform (e.g. public speaking).

Signs and symptoms of social anxiety

“Social anxiety is often accompanied by intense physical, cognitive and behavioural symptoms,” Tania says. She provides a list of signs and symptoms to look out for below if you think you might be experiencing an abnormal amount of nervousness in social situations:

Psychological symptoms

• Fear of being judged, negatively evaluated, or rejected
• Feelings of awkwardness or being perceived as socially awkward
• Feelings of inferiority
• Self-consciousness during social or performance situations
• Fear that others would notice your discomfort
• Fear of doing something embarrassing
• Anticipatory anxiety

Physical symptoms

• Rapid/elevated heart rate
• Sweating
• Blushing
• Shaking/trembling
• Mind going blank
• Chest tightness
• Dizziness and light-headedness
• Awkward/stumbling speech
• Muscle tension
• Poor concentration
• Nausea
• Out-of-body sensation

Avoiding the problem

Many people who suffer from social anxiety will avoid feared social situations. “Avoidance behaviour allows socially anxious people to avoid certain situations, but they have a nasty downfall to them,” Tania explains. “They tend to negatively influence one’s routine and impairs functioning in several areas of one’s life including relationships, social engagements, job or school, finances, and health.” 

Avoidance behaviour can include:

• Avoiding eye contact
• Avoiding being the centre of attention
• Staying away from social situations altogether (e.g. visiting friends, family reunions, job interviews, dating, answering the phone, etc.)
• Leaving social situations, such as parties, prematurely
• Keeping quiet during social situations and avoiding expressing your opinion or initiating conversations due to fear of being dismissed.

Social anxiety during the lockdown

“The social distancing rule of COVID-19 may provide emotional relief to individuals who struggle with social anxiety as the rule of social distancing plays beautifully into their avoidance behaviour patterns,” Tania explains. But the lockdown only provides temporary relief for social anxiety symptoms. “Once socially anxious individuals need to return to ‘normal life’ after the lockdown their social anxiety would increase and they might feel worse than before as they have not been exposed to social interactions for an extended period,” Tania adds.

Individual’s experiencing social anxiety might want to consider online therapy during the lockdown. “It’s my personal preference of doing therapy with socially anxious individuals,” Tania says. Both online and more traditional face-to-face therapies are effective in treating social anxiety. “So, I would recommend any of these two methods, whatever method makes the socially anxious individual the least anxious,” Tania says. She, however, warns that online therapy can also become an avoidant behaviour. “If demographically possible, I encourage face-to-face sessions after several online sessions to allow the socially anxious individual to practise engaging in social interactions within a safe non-judgmental space,” Tania adds.

Treatment for social anxiety

There are two approaches to treating social anxiety: a pharmacological approach and a psychotherapy approach (Seedat, 2013). “There is no clear evidence suggesting that one approach is better than the other, but it can be recommended that the combination of these two approaches can increase the chances of successful treatment,” Tania explains. “The goal of treatment is to reduce the intensity of symptoms and to minimise the functional impairment social anxiety causes,” she adds.

Cognitive behaviour therapy (CBT) is a popular and evidence-based psychotherapy approach that has been proven effective in the treatment of social anxiety (Hofmann, 2012). A CBT approach to social anxiety makes use of gradual exposure to feared social situations (while giving you extra tools to use in social situations). “It also includes cognitive restructuring, which aims to identify, challenge and correct maladaptive beliefs about social situations and the social world,” Tania says. There are also several other interventions you can try to better manage your social anxiety symptoms:

• Practice your social skills – If going to a party seems overwhelming, start small. Say “thank you” to the person packing your groceries at the grocery store or offer a compliment to a colleague for a great presentation. It could also help to read books about how to win friends and influence people.
• Use relaxation techniques – Yoga improves your body’s ability to handle stress and can help you relax. Practising online by joining a free yoga class on YouTube is a great start. But once the lockdown is over you might want to consider joining a yoga class in your neighbourhood. This will give you another opportunity to practise your social skills in a calm environment.

• Be mindful – Meditation has been shown to help people manage feelings of anxiety. There are several smartphone applications such as Calm and Headspace that offer guided meditations.
• Challenge your negative thoughts – If you have a lot of negative thoughts about your social interactions, it could become a self-fulfilling prophecy. “Try to force yourself to think more rationally and realistically about social interactions,” Tania advises.
• Exercise –Exercise is important, not only for our physical health but also for our mental health.
• Eat a healthy balanced diet – Our Westernised diet adds extra calories to our plate without adding real nutrition. Animal studies have found that calorie-rich processed food can lead to higher levels of anxiety and depression. Ensure you choose brain-healthy foods to help keep a positive mood and a healthy mind.
• Get enough sleep – “Not too little and not too much,” Tania advises.
• Avoid using alcohol or other substances to manage your social anxiety – While alcohol and other substances can temporarily reduce symptoms of social anxiety, it is a short-term solution. Using alcohol to face a social situation can become a crutch, and you might soon find yourself avoiding social situations where drinking isn’t possible.

If you are experiencing social anxiety symptoms that impair your functioning, seek help from your doctor or a psychologist. Social anxiety is treatable and can be conquered. Share this article with someone who might need help treating their social anxiety symptoms.

References

Hofmann, S. G. (2012). Conquering social anxiety disorder. An Introduction to Modern CBT: Psychological Solutions to Mental Health Problems (pp. 79–92). United Kingdom: Wiley-Blackwell Publishers.

Seedat, S. (2013). PART 2 The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders Head of Publishing The South African Society of Psychiatrists (SASOP) Treatment Guidelines. South African Journal of Psychiatry, 19(3), 127–196.