Are you feeling SAD? Social Anxiety Disorder and why it’s more than just shyness. Part Two.

Causes

It is unknown what causes social anxiety disorder. However, it is thought that a family history of social anxiety or depression could be a risk factor for others developing the illness.

Similarly, the more severe the anxiety or depression and the genetic closeness of the person suffering from anxiety/depression (e.g., parent or sibling), the more likely it is that someone may acquire social anxiety disorder.

According to one study, increased serotonin and dopamine activity was detected in brain areas associated with fear (amygdala) and rewards (nucleus accumbens), with more significant activity being connected to symptom intensity (Hjorth et al., 2019).

Imaging studies have shown that people with a social anxiety disorder had selective amygdala activation when exposed to fear-related stimuli (Birbaumer et al., 1998) or aberrant patterns of amygdala activation during aversive conditioning (Schneider et al., 1999).

A further study discovered that people with a social anxiety disorder had increased blood flow to their amygdala, whereas those without had increased blood flow to their cerebral cortex (area of thinking and evaluation).

This implies that people with social anxiety disorder have overstimulated fear regions in their brains, overriding the brain's sections involved in rational reasoning.

Environmental variables may also play a role in the development of social anxiety disorder. Work, school, or a tragic event in one's life can all prompt the start of social anxiety.

Early childhood education may also be a key element. Suppose a person's family is highly judgmental of the child, controlling, or overly protective. In that case, the youngster is more likely to become anxious.

Also, apprehensive parents could unwittingly transfer their worries and fears of social situations onto their children. If a parent is very concerned with what others think of them, the child may pick up on this and develop similar concerns.

Those suffering from social anxiety disorder frequently remember being shy or withdrawn as a youngster, possibly due to various environmental reasons. Suppose the shy youngster is the subject of bullying or abuse due to their shyness. In that case, this may reinforce shyness and lead to social anxiety.

Diagnosis and Symptoms

People suffering from social anxiety disorder frequently exhibit cerebral, bodily, and social symptoms.

These symptoms will not be the same for everyone suffering from a social anxiety disorder since some may only have a few while others may encounter several.

Cerebral Symptoms

• Fear of talking to strangers

• Fear of being embarrassed

• Fear of circumstances where you can be regarded adversely

• Fear that people will see your anxiety

• Fear of bodily symptoms

• Severe anxiety in social situations

• Fear of performance analysis

• Dread of forthcoming events

• Expecting the worst possible outcome following a negative experience in a social environment

Bodily Symptoms

• Blushing

• Sweating

• Rapid heartbeat

• Nausea

• Feeling breathless

• Feeling as though the mind has gone blank

• Light-headedness

• Muscle tension

Social Symptoms

• Avoiding speaking

• Avoiding being the centre of attention

• Leaving or avoiding social situations

• Using safety behaviours

• Missing school or work

A variety of issues might arise as a result of social anxiety symptoms. Individuals may struggle to form and maintain friendships or romantic connections.

They may lack social skills and consequently experience isolation or feelings of loneliness. They may also struggle with academic and employment accomplishments if they skip school or work or are too hesitant to ask for help or attend a job interview for a position they want for fear of being criticised.

Individuals suffering from social anxiety may also have low self-esteem, have negative thoughts about themselves, abuse substances such as alcohol and drugs, or suffer from comorbid mental health illnesses such as depression.

As a result, social anxiety can harm almost every aspect of a person's life if not treated.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines social anxiety disorder as a persistent worry or anxiety about one or more social situations in which the individual may be scrutinised by others.

Almost invariably, social events must elicit fear or anxiety out of proportion to the real threat. Social interactions are avoided or endured with great suspicion or anxiety, causing clinically substantial suffering or deficits in social, occupational, or other crucial areas of functioning.

According to the diagnostic criteria, the fear, worry, or avoidance must also be persistent, often lasting at least 6 months.

Finally, the dread or anxiety must not be due to the physiological effects of substances or medical problems. It cannot be explained by another disorder (e.g., panic disorder, body dysmorphic disorder, or autism).

Management and Treatment

Medication and cognitive behavioural therapy (CBT) are the most popular treatments for social anxiety disorder, with a combination of both being the most beneficial.

People can also utilise strategies like breathing retraining and progressive muscle relaxation on their own to help them relax.

Medications

The following drugs are commonly used to treat the symptoms of social anxiety disorder:

Benzodiazepines are anti-anxiety drugs that frequently act immediately. These can have instant effects, but they can be sedating. Thus they are rarely prescribed for long-term use.

Beta-blockers function by inhibiting epinephrine's stimulating effects (known as adrenaline). These may lower heart rate, blood pressure, trembling limbs, and shaking voice. These side effects are usually most effective when used to control the physical symptoms of a specific scenario rather than as a generic medication.

MAOIs (monoamine oxidase inhibitors) inhibit the enzymes that break down serotonin, dopamine, and norepinephrine neurotransmitters. This means more chemicals will circulate in the brain, improving mood and anxiety.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly recommended drugs for anxiety because they are more acceptable than other treatments. SSRIs function by preventing serotonin reuptake, allowing more of the neurotransmitter to circulate in the brain. These have been demonstrated to considerably improve mood and anxiety.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) - These act similarly to SSRIs in that they block serotonin reuptake while also blocking norepinephrine reuptake. Because extended use has been linked to manic or hypomanic episodes, SNRIs are typically only given for short-term use.

Cognitive-behavioral treatment (CBT)

CBT is a method of psychotherapy that is particularly useful for people suffering from a social anxiety disorder. This therapy is working with a skilled cognitive behavioural therapist to identify negative beliefs and working together to confront them to replace them with more realistic thoughts.

CBT employs many strategies that can be adjusted to each individual and their circumstances. Some people with social anxiety may work with their therapist to complete exposure-based treatment exercises.

This implies individuals can progressively begin confronting feared social settings to build their confidence and coping skills in dealing with these anxiety-inducing events.

They may also engage in role-playing exercises to hone their social skills and build comfort and confidence in interacting with others. Another CBT strategy is to question the individual's thinking.

The therapist may ask the person to consider a fundamental belief they have about themselves. Core beliefs are firmly held, dogmatic, and inflexible ideas that can be traced back to childhood, for example, 'Nobody wants to be my buddy.'

The therapist will ask the subject to write evidence supporting or refuting this core belief. They will be challenged not to overlook data that contradicts their idea and to write down a more acceptable and balanced core belief.

'Nobody wants to be my buddy,' for example, could be changed to 'Although I find it difficult to make friends, I have many excellent attributes that people admire about me.

Retraining of Breathing

Many patients with social anxiety disorder have nervous and disturbed breathing. Dizziness, headaches, weakness, and muscle stiffness can all be symptoms of unbalanced breathing.

Anxious breathing can also increase the likelihood of people reacting to stressful events with acute anxiety or panic. Breathing retraining is a technique that can be learned to help people get back to their standard breathing patterns.

This basic technique involves inhaling deeply, holding your breath for a few seconds, and then gently exhaling.

This method, which can be utilised as a coping mechanism in stressful social circumstances rather than employing counterproductive safety behaviours, can be done twice a day to be effective.

Muscle Relaxation in Stages

Muscle tension is a frequent reaction to fear and worry, and it can produce discomfort and increase anxiety. Progressive muscle relaxation is a technique that can be performed whenever a person is in a comfortable position, most commonly lying down.

When the individual is at ease, they can purposefully tense a muscle group (e.g., the feet or hands). They can contract this muscle group for a few seconds before relaxing it.

They can then tense another muscle group and repeat the tensing and releasing process for each muscle group until all of them have been contracted and relaxed.

People may find it helpful to begin from the feet and work up to the head. This gradual muscle relaxation tries to relax each muscle group instantly until the entire body is calm.

This can be helpful for people who have social anxiety and can be used before or after a frightening social situation.