How to Manage Social Anxiety

Illustration courtesy of Rachel Idzerda

How to Manage Social Anxiety

Social anxiety tells us two lies, says Boston-based clinical psychologist Ellen Hendriksen. The first is that the worst-case scenario is bound to happen: We will be rejected; people will point and laugh; we’ll be humiliated. The second is that we can’t deal with that worst-case scenario or the ups and downs of a socialized life that come with being human.

“I have a history of social anxiety, and I was actually nervous to disclose that in the book,” says Hendriksen, referring to How to Be Yourself: Quiet Your Inner Critic and Rise Above Social Anxiety. The book details her scientifically based, judgment-free approach to social anxiety. “I thought revealing a struggle would make people pull away as if it were contagious. But when you disclose something about yourself, more often than not, someone will disclose something very similar to you, and that creates a bond. If I had a nickel for everybody who came up to me and said, ‘I have social anxiety, too…’”

A Q&A with Ellen Hendriksen, PhD

What is social anxiety? How do you know whether you have it?

Social anxiety is self-consciousness on steroids. It is the perception that there are things deficient about us that—unless we work hard to hide or conceal them—will be revealed, resulting in our being judged or rejected.

We can all relate to the experience of looking in the mirror in the morning and seeing some kind of physical flaw that we feel self-conscious about. Maybe we have a big pimple, or maybe we’re having a bad hair day, or maybe we think we look weird in these pants. So we try to conceal that thing. We might put on some extra foundation, or wear a hat that day, or change our pants. But if we can’t do those things, if we go out into the world with our pimple or our bad hair or our weird pants, the resulting feeling is similar to social anxiety.

Social anxiety usually falls into one of four categories:

1. The external self. There’s a whole category of perceived physical flaws—we’re ugly, we’re fat, our skin is blemished.

2. The symptoms of anxiety themselves. We may believe that it will become obvious that our hands are shaking, or that we’re blushing, or that our voice is trembling.

3. The fear that our social skills will be judged inadequate. We’re boring, or we’re annoying, or we have nothing to say, or we keep going blank.

4. Our entire personality. The anxiety here is that it will become obvious that our entire personality is somehow defective or inadequate, that we’re stupid, or that no one wants to hang out with us, or that we’re incompetent.

Social anxiety can blossom as many different flowers, but they all come from the same perceived root that there is something that needs to be hidden. But these perceived flaws are not true at all. At most, there’s a grain of truth in a perceived flaw—like maybe we do blush, for example, but not to the extent that we think—plus it doesn’t cause the amount of attention or rejection we anticipate.

How is social anxiety distinct from generalized anxiety disorder?

If there were a Venn diagram of general anxiety disorder and social anxiety disorder, many people would fall in that overlap. General anxiety disorder is characterized by worries: There’s worry that feels uncontrollable and skips from topic to topic. We might start with, “Oh, I’ve got a headache this morning,” to, “Oh my god, maybe I have a brain tumor.” Then: “If I die, how would my family support itself?” And so on. It might skip from your job to your social life to your health to global warming.

Whereas social anxiety is centered on this fear of the reveal: The fear that something theoretically deficient about you will become obvious to everyone.

Is social anxiety a new thing?

I’ve seen a rise in social anxiety cases coming to our clinic, and it’s for a number of reasons. One is that the stigma of mental health challenges is slowly eroding, which is wonderful. People are more comfortable reaching out for help.

Social anxiety is also on the rise, however, because of technology. Everybody knows that social media is the highlight reel, that everybody posts the good things that are going on in their lives: the successes, the adorable babies, the pictures of themselves looking cute. We compare our entire lives, both good and bad, to the highlights we see online. What results is a sense that we need to be perfect, or that the bar is unreachably high. That can lead to social anxiety, because it’s driven by this idea that we’re somehow flawed, and if we reveal that, we’ll be judged for it.

Technology also allows us to avoid one another. It’s easier to text or leave comments on social media than it is to pick up the phone or speak face-to-face. But when we don’t practice having face-to-face conversations, we simply don’t gather as much experience under our belts. That inexperience drives uncertainty, which, in turn, drives anxiety.

However, when we gain experience out in the world, when we talk to lots of people, when we ask for directions, even, we learn that most people are nice and that the lies that anxiety tells us—one, that the worst-case scenario is bound to happen and two, that we can’t deal with challenges—are just that: lies. Feared outcomes happen much less often than we think, and even if they do occur, we can gather our resources and deal with them.

What are some examples of how social anxiety might manifest in schools?

In the classroom, it can manifest as not raising your hand, not participating in discussions, or not being able to approach the teacher or professor to ask questions. It could be a dread of group projects or study sessions. It could be a tendency to show up right when class starts or maybe right afterward and leave as soon as it ends, so as not to have to make small talk with fellow students before or after.

But there’s a line between social anxiety as an everyday challenge versus a disorder. Social anxiety crosses the line into a disorder if it causes great distress or impairment. If you’re a little nervous before you walk into class or if you’re feeling a little anxious about showing up at office hours and asking what you worry is a stupid question but you still do it, that’s okay. You can still function. But if the distress is such that it makes you lose sleep or if you have GI problems for a week before you know you’re going to have to give a presentation or you consciously decide to forgo the 25 percent of your grade that is classroom participation, it crosses the line into impairment. Then it keeps you from living the life you want to live, and which can be called a disorder.

Does social anxiety ever work itself out? Or is it always something that needs to be worked at to be overcome?

It depends. Social anxiety is driven by avoidance. Avoidance might be overt: We might not show up at a party, tell our best friend we can’t participate at her wedding, or not tell anybody it’s our birthday at the office. Avoidance can also be covert: We could show up at a party but spend all our time scrolling through our phone. Or we could tell people it’s our birthday at work, but then make sure that we basically hide from everyone, all day, so they don’t make a big deal, etc.

Either way, through overt or covert avoidance, what results is a buildup of a dearth of experiences. We don’t realize that we were safe all along, or that our imagined worst-case scenarios don’t actually happen. If we keep avoiding as we move through life, then the anxiety will not resolve itself. It will be maintained by our own avoidance.

However, social anxiety does often get better as people age, because generally we can’t avoid everything. Life happens. We will often passively absorb experiences and realize they weren’t so bad. For example, maybe our boss makes us give a talk, and even though we dreaded it and secretly hoped it would be canceled, it goes fine, and we realize, “Oh, maybe I can do this.” All in all, it depends on how much we engage in avoidance and how much we are willing to try the things we’re afraid of despite our fears.

Now, actively working on social anxiety can turbocharge that growth and change. I advise people to select a few things, big and small, that they would like to work toward and actively try to not avoid those experiences but actively search them out. It feels awkward, but the key is to start small and work your way up. You can start as small as you like—you don’t have to cannonball into the deep end.

How can you help a friend with their social anxiety?

Unfortunately, what usually happens when somebody discloses social anxiety is that their friends tend to ask less of them. The friends tend to try to accommodate to make them feel comfortable. Which I get; which is lovely and heartwarming and I appreciate that they’re trying to make their friend feel better. But what happens is then they decide, “Oh, now I can’t invite this person to the party.” Or “Now we can’t go to new places.” Or “Oh, my cousin is coming to town, so my socially anxious friend probably wouldn’t want to meet her.” In protecting their friend, they end up enabling them.

What I tell friends to do, in contrast, is to be a champion. That means hearing their friend’s fears and working with them to see what they want to strive for. How do they want to stretch and grow? See if you can help them with that.

It’s important not to dismiss their fears, such as, “Don’t worry—you’ll be fine,” or “There’s nothing to be afraid of.” We don’t want to minimize their very real fears. Instead we can tell the truth and say, “You’re strong and you can do this.” Or “The scariest moment’s right before you go in. Let’s give it a shot.” Or “Last time you stuck with it, you felt better after just a few minutes. Let’s see if that happens again.”

In sum, let them be in the driver’s seat, but also ask how you can help.

What if you think your child might be developing social anxiety?

The advice is very similar. Introduce developmentally appropriate experiences for them to try. If they have trouble talking with new people, for example, gently invite them to ask the librarian a question. Search out safe people who will help them realize that the world is generally kind and that they can handle little challenges. That’s what builds confidence.

We don’t gain confidence in a vacuum. We don’t say, “I can do it,” and then just go out and do it. What happens is we go and engage with the world, and we see ourselves doing it. Through observing our own behavior, we start to believe that we can and that we are capable. That’s how true confidence is built.

How does social anxiety affect building relationships, both platonic and not?

Folks with social anxiety tend to keep their lives close to the vest. We tend not to disclose very much about ourselves. It feels like we’re talking too much or making it about us, and we don’t want to be the center of attention. But then what happens is that as we’re trying to build a relationship or make friends or deepen a romantic relationship, the other person doesn’t have very much to work with. The biggest advice I can give folks with social anxiety is to disclose more about what you think and do and feel. It will feel wrong at first. It will feel like you’re giving away too much information or that it’s somehow risky.

But building a relationship needs to be reciprocal. It’s important to reveal a little bit about yourself, which in turns sparks others to reveal something about themselves, and then you keep the cycle going. The biggest impediment of social anxiety is wanting to be not noticed, so we become invisible. You try to disappear to make yourself feel more comfortable, but then no one knows who you are.

What are things socially anxious people have in common (besides social anxiety)?

Social anxiety comes bundled with some really good traits. People with social anxiety often have really high standards, so they hold a good work ethic; they’re conscientious; they often can read others’ feelings. (Well, sometimes we overread them.)

But in general, we’re pretty empathetic; we’re helpful and altruistic; we’re often good listeners. We work hard to get along, because if you roll back caring too much about what people think of you, what you get is simply caring about people. In terms of living a happy life, the greatest thing you can do is connect with others by being kind and warm. People with social anxiety are extremely well-suited to do that.

Plus, it’s important to emphasize that as we work on our social anxiety, as we try to conquer our fear, those good traits don’t go away.

What are some tools that help?

There are three big ones:

1. When you go into a situation where you feel socially anxious, give yourself an assignment. Anxiety is driven by uncertainty, so by creating a mission for yourself, you take away some uncertainty. So for instance, if you’re going to an event, you could say, “Okay. I’m going to try to talk with two people besides the person I came with.” If you’re going to your company holiday party, think about it this way: “I want to chat with my boss, the people I supervise, and the office manager.” Having an agenda gives you structure and helps take away the anxiety.

2. Turn your attention inside out. When we’re in a socially anxious moment, our attention naturally turns inward, and we start to monitor our thoughts and what we’re saying: “Oh, did that sound stupid?” Or “Oh, she just glanced to the right. Is she bored? I wonder if I’m being boring.” The self-monitoring takes up all our bandwidth and leaves very little left over for actually attending to the moment, or being engaged in the conversation.

Essentially, the trick is to pay attention to anything except ourself and to turn our attention outward, either to our environment or, preferably, to the person we’re talking to. Listen very closely to them and look at them, and that will free up a lot of bandwidth and allow us to respond more naturally in the moment.

3. Don’t aim for perfection. We often think we have to present as competent and confident as possible, but when we focus too much on meeting our own high standards, we get anxious because our expectations are unrealistic. In fact, it’s counterproductive because when we present as perfect, we come across as intimidating or unapproachable, which is the exact opposite of what we’re trying to do if we’re trying to make connections with others. We put so much pressure on ourselves to be smart or funny or interesting or cool that it actually trips us up. If we can try to roll back those expectations and lower the bar, that eases up on the pressure we put on ourselves. Imperfections and even mistakes come across as humanizing and often make people like us more.

Remember that social life isn’t like a laser maze: If you make one mistake, alarms are not going to go off all around you. It’s okay to lose your train of thought or not drop perfect comments into conversation. Allow yourself the little blips and foibles that are just part of being human, and trust that it will endear you to others.

Is therapy helpful?

I’m extremely biased, but I think cognitive behavioral therapy is an excellent treatment. Any good therapy for social anxiety includes challenges, assigned either in session or at home, to try the very things that you’re afraid of: to chat with the grocery store clerk instead of being silent, to say hello to the coworker at work you always see but don’t know the name of, to go hang out at the playground with your kid after school pickup rather than going straight home. It’s important to find a therapist who will go beyond commiserating with you or looking for the origins of your social anxiety. Search out a therapist who will work with you to help you grow and stretch and move forward in your life. It takes courage to reach out, and finally feeling comfortable and confident in your own skin is absolutely worth it.

Ellen Hendriksen is a clinical psychologist who helps people calm their anxiety and be their authentic selves through her award-winning Savvy Psychologist podcast and also at Boston University’s Center for Anxiety and Related Disorders (CARD). Hendriksen earned her PhD at UCLA and completed her training at Harvard Medical School. She lives in the Boston area with her family.

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