Aunt Agatha Advocates: Social anxiety disorder

Written by: Liew Yi Xuan (21-E1), Carissa Aletha Liem (21-I1) , Tan Le Kai (21-I4)

Designed by: Lay Kai En, Ashley (21-O1)

We have all seen movies or TV shows where characters display traits of social anxiety, some of which such as “Eternal Sunshine of the Spotless Mind” fully capturing the essence of what it is like to live with such a disorder as artfully played by Jim Carrey. 

Social anxiety disorder (SAD), also known as social phobia, is an intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation. It is the second most commonly diagnosed anxiety disorder following a specific phobia and the average age of onset for social anxiety disorder is during the teenage years. 

In Singapore alone, 10% of the population is plagued by anxiety disorders – one of which includes SAD. People with social anxiety disorder tend to avoid or endure, with extreme fear or anxiety, social and performance situations, which can cause significant distress and affect their personal, social and work life. ​Some common physical symptoms people with social phobia might experience are blushing or stammering when trying to speak, excessive sweating, racing heart and nausea. 

Debunking myths about SAD 

However, not many people understand what having SAD truly entails. A common misconception is that it only refers to public speaking fears. In fact, social anxiety refers to anxiety and fear in various different social and performance situations such as informal speaking and interaction (meeting strangers or going to a social event), difficult situations (expressing disagreement or experiencing disputes), or even everyday, mundane activities such as eating in front of others can be difficult for people with the disorder. The commonality among each of these triggers is that there is the potential of being evaluated by others, causing their hands to shake, and an increasing urge to escape a social situation. 

Another common misconception is that SAD and shyness are one and the same thing. Although the two are very similar, they each have their distinct differences. For instance, social anxiety involves feelings of fear about social or performance situations, but it does not always involve the avoidance of or withdrawal from these situations, unlike shyness. Some people may appear to be very outgoing, but on the inside, they may be feeling an entirely different whirlwind of emotions. This simply means they are very good at hiding their feelings, but it does not take away the fact that they do suffer from the disorder.

A prominent example are celebrities who are diagnosed with social anxiety. That in itself seems like an oxymoron as celebrities are supposedly the centre of global attention and are in many ways involved in social and performance situations. This is exemplified in the famous Grammy-award English singer, Adele, who experiences severe anxiety attacks that makes it incredibly hard for her to perform in front of large audiences. Despite the fact that she has SAD, she has managed to build a successful career off her astounding performances, showing how people you would never have expected to have anxiety can be diagnosed with SAD.

How do people with SAD cope?

With 1 in 10 Singaporeans suffering from anxiety and depressive disorders, it may be puzzling why we may not observe it in our daily lives. This is due to the fact that most symptoms and coping mechanisms of SAD and other anxiety disorders are more mental than physical. One might withdraw themselves from social situations to cope with SADs and avoid the activities that induce anxiety. An example of this is the usage of smartphones in the presence of social anxiety. Other more extreme coping mechanisms include usage of drugs and alcohol.

These, however, are less ideal methods of coping. They might be temporal fixes but do not solve the issue. Cognitive Behavioural Therapy is known to help with SAD. Research has also shown positive correlation between a healthy, active lifestyle and better coping of SADs. Staying active, as we know, releases endorphins and dopamines that help us feel happy and remove negative thoughts. Reduction of consumption of alcohol has also led to reduced levels of anxiety. 

Positive self affirmation is good for coping as well. For example, a “yes, but” technique could help. Acknowledge the situation that causes the anxiety, but counterbalance it with positive affirmation. For example, “Yes, I am going to meet a lot of people I have never met before, but I am funny and have lots of hobbies I could share about.” One could also try to list 3 good things that they have done to cope with social anxieties. These are simple acts like having a conversation with someone new or making others laugh. Positive self affirmations allow us to see our true selves in a better light. 

What we should and should not do to them

To avoid putting people with social phobia in high-pressure situations, we should not dismiss their anxiety and understand that they might need more time than others to adjust to a social situation. It is useful to know what not to say to someone with social anxiety, lest we unintentionally make things worse. More importantly, we should instead find out what to say to someone with social anxiety. 

Firstly, we should never say something like “It’s all in your head”. Though people with social anxiety know that their worries may be psychological, it does not make their anxiety or fears any less real and daunting. Saying this phrase dismisses their very real concerns and the impacts social anxiety has on their lives. We can empathise with them and offer to find them a quiet place to recollect their thoughts instead of invalidating their worries. 

Next, instead of blatantly rescinding offers that involve social situations, it is more helpful to come up with a plan for how they can attend without feeling uncomfortable. We could even try practising conversation so the person feels more confident. There is a fine line between being understanding and being overly accommodating. By excluding them entirely from our plans, we are only perpetuating their anxieties and confirming that they are, in fact, unable to get through social situations on their own. Thus, by always giving them the ability to make their own choices, we allow them to gradually and systematically face their fears.

Lastly, never ask the person why they are feeling anxious. Instead, ask them how they are feeling and encourage them to list their symptoms. Give them the space to feel without interruption. If they are crying, let them cry as it would help release the pressure faster. Simply being a listening ear and a shoulder for them to cry on would help tremendously.

Though most people have good intentions and are eager to help, they might unintentionally make hurtful comments as they do not truly understand the nature of the disorder. Thus, we should always learn with an open mind and try our best to be empathetic and understanding of people with social anxiety.

Conclusion 

With the prevalence of mental illnesses, it is likely we know or have interacted with those suffering from it. Educating ourselves to know more about mental illnesses and acting with kindness and compassion could go a long way to those who need it. With more sensitivity and empathy, we could build a more inclusive society.

References:

1. Cohut, M (2019) 4 top tips for coping with social anxiety

https://www.medicalnewstoday.com/articles/326211#3.-Reframe-your-thoughts

1. Cuncic, A. (2021, April 13). 5 Myths the General Public Believes About Social Anxiety. Verywell Mind. https://www.verywellmind.com/myths-about-social-anxiety-3024711

2. Eastham, C. (2019, November 7). 5 Ways to Really Help Someone with Social Anxiety. Healthline. https://www.healthline.com/health/anxiety/5-ways-to-help-social-anxiety#1.-Work-with-their-emotions

3. Fink, J. L. W. (2019, September 29 ). 9 Things Not to Say to Someone with Anxiety. Healthgrades. https://www.healthgrades.com/right-care/anxiety-disorders/9-things-not-to-say-to-someone-with-anxiety

4. House, A. (2021, April 8). 9 Famous People & Celebrities With Social Anxiety Disorders. Alo House Malibu. https://alorecovery.com/9-famous-people-celebrities-with-social-anxiety-disorders/

5. Social Anxiety Disorder. (2020, July 21). National University Hospital. https://www.nuh.com.sg/Health-Information/Diseases-Conditions/Pages/Social-phobia.aspx

6. Understanding Anxiety. (2021, June 11). Anxiety & Depression Association of America. https://adaa.org/understanding-anxiety/social-anxiety-disorder