Nothing helps my Social Anxiety Disorder


Nothing helps my Social Anxiety Disorder


your avatar   David, 28-year-old man

I am 28 years old and I suffer from Social Anxiety disorder. I have tried many things to overcome this - self-help books, motivational tapes, Paxil, counseling, and nothing has helped. What can I do?


    Pat Ryan,

Dear David,

Social phobia or social anxiety disorder is, as its name suggests, one of the anxiety disorders. When we wrongly label a situation as dangerous, we unconsciously set up the fight or flight reaction or fear response which is extreme anxiety. The Fight or Fight reaction is a prehistoric mechanism meant to protect us from say dangerous animals by preparing us to fight or flee the perceived danger. But in social anxiety, situations and events have been mislabeled as dangerous when they are not. The ensuing anxiety is a consequence of the fear of scrutiny and/or negative judgment or evaluation of us by others. That is: fear of ridicule, humiliation, rejection and/or disapproval or embarrassment because some behavior may be perceived as socially unacceptable according to society's rules. Social situations are not generally dangerous in the sense that they physically threaten us.

What happens is we feel psychologically threatened in the sense that we feel we must perform well to be accepted which in some sense might also be a carry over from prehistoric times: that is, I must perform well to be accepted into the group since my survival depends on my being a member of the group. Today, however, our physical survival is not generally threatened, and it is also not generally necessary for us to be members of the group to survive. However, in social anxiety, events wrongly labeled as fearful such as visits to the bathroom, signing one's name in front of others, giving a speech, drinking a coffee alone in a coffee bar, speaking to strangers. or just being in a crowd may trigger overwhelming fear.

Guilt and shame, arising perhaps out of an abusive childhood, may cause some to feel socially anxious because as a child they made an inference that there must be something wrong with them and that others can see this flaw. One might experience a feeling of worthlessness. Some feel that others will judge them and find them deficient: permanently flawed and worthless. Then there are the negative messages received by the child from an important authority figure, perhaps in an alcoholic environment. If these messages were repeated over and over, they become your automatic thoughts and form a negative core belief (or schema) about self. This causes uncertainty, loss of identity, and feelings of invisibility, loss of self-esteem and self-respect. One may become extremely passive instead of assertive because one has learned to think that what one has to say is not important. Not true, of course.

Such feelings may trigger what is known variously as panic attack, or a state of arousal, or the fight or flight reaction. The symptoms of the fight or flight mechanism are similar to those of panic attack and can be hyperventilation, tense muscles, dizziness, sweating, increased heart rate and many more. Avoidance is when we avoid doing that which causes anxiety and in the short-term this makes us feel good giving a great sense of relief. However, in the long-term, avoidance serves only to exacerbate anxiety which ultimately leads to more avoidance. That is, when we avoid confronting a fearful situation, the fear may grow, and spread until we have no safe areas left. When we confront our fears, over time and with practice, they shrink.

Thus recovery from social anxiety is largely based on confronting your fears. Start with the mildest fear and work up to the harder ones. Do not avoid fearful situations and remember that more practice is better than less practice. When you confront a fear, remember to take deep even breaths, relax your muscles and check your thoughts. That is, say to yourself: "It's OK. I can do this. It's frightening but I am not going to die or lose control. It's only discomfort after all which I can manage. With practice it will get better. And if people think negatively of me... So What! They have to fixate their eyes somewhere just as I do. Maybe they are thinking about tonight's dinner and not about me at all." Exposure to your fear/s is essentially about managing fear, of which we all need a little to warn us of danger. But let us not mislabel a social event as a dangerous situation which it is not.

The rationale in confronting fear is that the body cannot maintain its high emotional level of intensity forever but will eventually (after half an hour to one hour and a half) return to normal functioning. With practice, gradually one becomes used to the situation wrongly labeled fearful. When one fear is overcome, allow a feeling of confidence to flow over you with the realization that you have conquered a fear, albeit a minor one to begin with. Use positive self talk to congratulate yourself. Than confront another fear and work on that until you have overcome it.

David, it is important for you to have a medical checkup because certain physical illnesses can mimic the symptoms of anxiety. In terms of social anxiety, there are medications that can be prescribed but these can sometimes be addictive and do not bring the inner strength that comes from having overcome your fears yourself. If you can confront and overcome your fears you will be a stronger person because you will have done it, not the medication or someone else (say someone using hypnosis). In the latter case, hypnosis may remove a distressing symptom of the Fight or Flight syndrome but later, another may occur. Fear or anxiety, in fact, will express itself physically in some way or other, so it is better to manage fear than hypnotize it away for some anxiety is an essential part of our mental make-up otherwise we would not run away before the oncoming out of control truck.

So David, many have learned to manage social anxiety to a level no longer troubling and you can too. Perhaps you might like to work with a psychologist who practices cognitive therapy to give support and to work with you through the cause of social anxiety. The general consensus of opinion is that we are genetically pre-disposed to certain illnesses but that some traumatic event is needed to trigger a particular disorder. My belief is that both ends of the spectrum (cause and symptom) need to be attended to so that your anxiety symptoms will not disappear only to reappear later or in some other form. That is, treat the cause of anxiety (some childhood trauma perhaps) as well as the symptoms (social anxiety).

At the same time recovery is about raising self-esteem (read "6 Pillars of Self Esteem" by Nathaniel Brandon) and learning to value your achievements and to have further aims and goals in life. If you wish to read further on the subject of Anxiety, go to the book list on

With best wishes for your future, a future without fear.


Pat Ryan

This question was answered by Pat Ryan. Pat is a registered psychologist and has a private practice in Wollongong, Australia, having worked in several esteemed drug & alcohol therapeutic communities. Her aim is to empower: to safely explore relationships, emotions, unresolved conflicts, patterns of behavior and symptoms of disease--a structured cognitive behavioral approach as the predominant theoretical context with psychodynamic contribution.


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