All Aspects of Social Anxiety and Social Anxiety Disorder

Are you shy? Do you hesitate because people will listen and watch you in a social environment? Most people may experience some level of anxiety, especially in social situations where they meet new people, and this is considered normal. Social anxiety or social anxiety disorder, which is defined as a psychological problem, is the anxiety of being judged and evaluated negatively about one’s behaviors and physical symptoms in social environments where other people can examine them. This problem is much more serious than shyness. To understand this better, focus for a minute and try to visualize a situation like this:

After a long hesitation, you came to an invitation with many people you don’t know. You walk in and you think that all eyes are suddenly on you. Your heartbeat quickens and your face turns red. You see people staring at you and talking among themselves. Negative things they might say about you, your walk, your outfit, your blushing begin to ring in your ears. Your heartbeat gets faster and you start sweating as if your blush wasn’t enough. Your anxiety increases so much that you try to take slow steps to avoid falling. You think that your anxiety is noticed by everyone. You throw yourself into the most secluded corner of the room and try to pretend to be interested in something by turning your back on people. You pray inside yourself that no one will come and talk to you, and you try not to make eye contact with anyone. After spending an hour like this, you pack up at a suitable opportunity and leave. When you return home, you think about how bad the night had gone by picturing people watching you flushed and sweaty. Since you have lived with this anxiety for a long time, your distress is increasing and you think that you will never be able to attend such invitations again. 

People with social anxiety disorder fear or worry about behaving in a way that will humiliate, embarrass, or even humiliate them in social situations, as in the example above. However, they are also worried about showing physical symptoms such as sweating, blushing, trembling, slip of the tongue, which may cause criticism. They worry that people will describe them as weird, stupid, wacky, boring, dirty, scary, weak, or unlikable. 1 In such environments, they focus all their attention on themselves, begin to observe how they behave, think about how they appear in the eyes of others, and think that while they evaluate themselves negatively, they also evaluate others in this way.

Social Anxiety Situations

Which social situations cause anxiety varies from person to person. In general, anxiety-provoking situations in people with social anxiety disorder can be grouped as follows:

  • Situations that require speaking or performing in an ensemble : such as making presentations, singing on stage, participating in sports games, where talent, knowledge and skill can be evaluated by the ensemble.
  • Environments that require communication with people : going to social gatherings, starting and maintaining conversations with strangers, talking on the phone, expressing disagreement, flirting with romantic interest.
  • Situations where the behavior is observed by another person : working, writing, eating, drinking while others are watching.

The person with social anxiety disorder avoids entering social situations that cause constant anxiety, or tries to endure by reducing his anxiety in some way when he enters these situations . Some people very intensely avoid almost all social situations (e.g., not going to social gatherings, not making presentations, not speaking in public, not greeting anyone, etc.), while others display unobtrusive avoidance behaviors (e.g., not eyeing anyone at social gatherings). not to be seen, to be overly prepared for the presentations, to repeat what he will say in his mind many times before speaking in the community, etc.).

What is Social Phobia?

social phobia ; It was an anxiety disorder that characterized a relatively limited social anxiety problem in the previous classification system of psychiatric disorders. Social phobia , which is basically the same problem as social anxiety disorder , was defined as a person’s fear and anxiety in a particular social or performance-requiring environment. 2 For example, if a person was only worried about public speaking but not being in different social situations, interacting with people, or being in situations where they could monitor their behavior, the problem was called social phobia . A generalized type of social phobia if the person reports fear and anxiety associated with many different social situations.was seen as Today, this problem is called social anxiety disorder instead of social phobia, as scientific research shows that social anxiety is a problem that varies depending on the number of situations that the person fears, worries, and avoids on a line from mild to severe violence . If social anxiety is limited to situations where one’s knowledge, skills and abilities are tested in front of a community, it is called performance anxiety . People with performance anxiety generally do not have difficulties in social relationships.

Function of Social Anxiety

The human brain throughout its history; It has evolved to allow it to produce complex tools, build language and culture, develop a sense of self, and eventually create complex social systems. 3 In order to sustain these complex social systems, people act in a motivation to seek the attention, protection, support, help, and approval of other people. 4As a matter of fact, people need to be liked, approved and valued in order to survive, to be cared for by their parents, to find a partner, to establish and maintain relationships with their peers. The exclusion of people from their social groups means that they are deprived of the social resources necessary for their survival, which poses a life-threatening threat. Therefore, people act within the framework of certain social rules and expectations with the anxiety of being excluded from the group in their relations with each other. This anxiety is normal and functional. It helps the person stay in the group, gain control over social resources and survive. However, when this social anxiety, which has an evolutionary function, exceeds the ideal limit and the person’s work, school, family, socialIt becomes a psychological problem when it begins to cause trouble in your life .

Causes of Social Anxiety Disorder

Multidimensional theoretical approaches explaining the emergence mechanisms of anxiety disorders argue that biological, psychological and social factors interact and cause anxiety problems to emerge. 5

When we look at the biological findings related to social anxiety, we see that two important factors predispose to this problem. As mentioned above, because of the importance of being accepted in social systems for survival, it is thought that humans have a genetically encoded readiness to fear people who are angry, critical, or disapproving . 6 Studies have shown that the fear response in humans develops more easily (compared to other expressions) against angry faces, and the developing fear decreases in a longer time. 7, 8 In studies conducted with people with social anxiety disorder, it was found that they recognize angry faces faster than normal people. and it was seen that they remembered more . It has been determined that the second biological predisposition towards social anxiety is behavioral inhibition , which is a temperament feature . Behavioral inhibition can be defined as the fear, timidity, shyness and cautiousness of some innate children towards new people, objects or events. 11th

The most important factor that creates a general psychological predisposition to social anxiety is the person’s perception of whether stressful life events are controllable and whether they can cope with the consequences of these events. 5, 6 The control perceptions of people who develop from childhood on the events they face in their lives are important in determining how much they will be affected by these events. Studies show that there is a strong relationship between low perception of control towards social stressors and social anxiety (see Mineka and Zinbarg, 2006). 6

Finally, it is thought that the interaction of the person with his/ her past learning experiences and general biological and psychological predisposition may trigger social anxiety. 5, 6 In learning experiences, the person directly experiences an experience that he/she thinks he/she is humiliated in front of others, and observes or hears that such an event has happened to someone elsecountable. For example, if a child raises his/her finger and says something that makes everyone laugh at him/her, if he/she has the relevant predisposition, he/she may be conditioned to fear in similar environments and this fear may be generalized to various social situations. Similarly, a child who observes or hears about a child who raises a finger in class and says something that makes everyone laugh at him may have similar fear conditioning. Since the family’s attitude towards social relations is a model that the child observes, it creates an important social learning . 6 Studies have shown that families of people with social anxiety avoid social interaction more than normal people. 12

Recommended Treatment Approach in Social Anxiety Disorder

International clinical practice guidelines, which are prepared in the light of scientific data and aim to guide clinicians in their decisions about the treatment of certain psychological problems , state that the treatment of choice for the treatment of social anxiety disorder is Cognitive and Behavioral Therapies ( CBT ) . 13, 14 These treatments are recommended because many clinical studies reveal strong scientific findings that CBT protocols are effective in social anxiety disorder . 13, 14, 15

The main purpose of cognitive and behavioral approaches to social anxiety disorder is to weaken the relationship between various social situations and the anxiety they cause, and to provide a new learning opportunity about anxiety by giving the person new social experiences. To this end, treatment intervenes in the person’s thoughts and avoidance behaviors that perpetuate their anxiety. Thought and behavior are often combined in treatment, but clinical studies show that working on behavior change alone in treatment is equally effective in improving social anxiety disorder. 16

Finally, international clinical practice guidelines do not recommend the use of tricyclic antidepressants (TCA), benzodiazepines (sedative drugs), and antipsychotic drugs for the treatment of social anxiety disorder . 13, 14 Similarly, guidelines do not recommend mindfulness- based interventions (mindfulness-based stress reduction, mindfulness-based cognitive therapy) for the treatment of this problem . 14 Guidelines recommend that clients who want to use drugs be informed about cognitive and behavioral therapies, and first of all, they should clear their doubts about this approach.13, 14 These people suggest that if they still want to use drugs, a new generation antidepressant treatment (SSRI) can be started, and if there is a partial or no response to the drug after 10-12 weeks of treatment, the treatment should be continued with a CBT protocol. 13, 14 Similarly, if a partial response to a 16-week CBT application is obtained or if no response is obtained, CBT is recommended to be continued with a new generation antidepressant (SSRI) treatment. 1


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