Social anxiety disorder is a condition that causes you to feel anxious in social situations. It is also called social phobia. You may fear that people are watching or judging you. This fear can cause issues with work, school, or other daily activities.
Listen as Alicia Krueger, CNP explains Social anxiety disorder and that if left untreated, may become a long-term condition that can affect your quality of life.
Are Social Anxieties Keeping You Home?
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Learn more about Alicia Krueger, CNP
Alicia Krueger, CNP
Alicia Krueger, CNP is a board-certified psychiatric nurse practitioner with professional interests in mental health and the inflammatory process, alternative and integrative medicine practices; and genetics in relation to pharmacology and diet/ food intake.Learn more about Alicia Krueger, CNP
Transcription:
Are Social Anxieties Keeping You Home?
Melanie Cole (Host): About 15 million American adults have social anxiety disorder, and although they recognize that the fear is excessive and unreasonable, people with social anxiety disorder may feel powerless against their anxiety. My guest today is Alicia Krueger. She’s a Psychiatric Nurse Practitioner at Allina Health Mental United Clinic. Welcome to the show, Alicia. So, what is social anxiety, and how is that different from a generalized anxiety disorder?
Alicia Krueger (Guest): Sure, thank you for having me. Social anxiety is a marked fear or anxiety about social situations where the individual is really fearful, or anxious about being scrutinized by other people. Generalized anxiety is a little bit different, where it’s excessive anxiety or worry, where it’s occurring most days of the week, about not just social situations, or not scrutiny by others, but pertaining to different events or anxiety in day-to-day life.
Melanie: What are some of the signs and symptoms that one would notice in either themselves or a loved one in regards to social anxiety disorder so that they would know that it’s time to seek help?
Alicia: Signs and symptoms of social anxiety are having fears that you’re going to act, or appear a certain way, demonstrating anxiety – some of those physical responses, such as flushing, or sweating. Sometimes people—when they have social anxiety they’re very worried about stumbling over their words, not being accepted by others, so they're very fearful and have a lot of worry and anxiety that they’re going to be judged and rejected by other people. They also have – one of the symptoms can be that they’re fearful, that they’ll be viewed as anxious or crazy, or unlikeable, or sometimes dirty. The main symptom is excessive worry or anxiety about how others perceive you.
Melanie: Alicia, are there certain reasons, or causes, that can bring on the disorder?
Alicia: Predisposing you to individuals that fear negative evaluation, can sometimes be more predisposed to social anxiety. Also, it is a heritable disorder, so first degree relatives do have a 2-6 times greater chance of having social anxiety disorder if they have an immediate family member that also has social anxiety disorder.
Melanie: Is it something that can lead to other disorders if it’s not treated, such as agoraphobia?
Alicia: Usually the other disorders associated with it are M-D-D -- major depressive disorder -- or substance abuse. It doesn’t usually lead to agoraphobia.
Melanie: So, people are saying, “Oh, she’s just shy.” How is being shy different from having that social anxiety?
Alicia: Shyness is a common personality trait, but is not considered pathological. Social anxiety is when it impairs function, so when people are demonstrating avoidant behaviors because they are so fearful of being scrutinized by others in social situations, it starts to affect if they can give a speech in front of other people, or if they can participate in sports or group activities. When their function is impaired because they are avoiding social situations, or they are avoiding participation in some of those examples, that’s when we want to have it evaluated, and it’s not just a matter of being a personality trait and possibly being shy.
Melanie: So what are the steps to take if you’re going to see a psychologist for the first time, or should you see a psychiatrist first? Who do you go to when you feel that that time has really affected your quality of life?
Alicia: From a research standpoint, there actually isn’t more evidence that individual therapy is better for social anxiety versus medication management. They both are equally efficacious. There are some mental health disorders where it’s recommended that you get both therapy and medication management. They feed off of one another and help each other out. That doesn’t seem to be the case in social anxiety disorder. It can be one or the other. What the research and evidence is showing, though, is that if a person works with an individual therapist, that tends to be longer-lasting than medication management, so sometimes it’s a matter of determining what your needs are. If you’re hoping to tackle this problem more long-term, then probably the individual therapy route is a better way to go, but if there are certain immediate needs, especially if it’s performance-related, or related to public speaking, then medications can be extremely beneficial.
Melanie: Before I ask you about ways to cope with social anxiety that don’t involve medication and some things that people can do at home every day, when is it appropriate to treat it with medication? What kinds of medications are we talking about?
Alicia: So most anxiolytic, or antidepressant medications, the first line medications such as the S-S-R-I’s, or the selective serotonin reuptake inhibitors, are utilized. When you meet with your medical professional, they can go over the risks and benefits of each one of those. There isn’t one particular S-S-R-I though, that’s specific to social anxiety, so again, your provider can go over what would be a good match for you, or not. If it’s pertaining to performance, or public speaking specifically, a medication that is sometimes prescribed -- it’s actually not an anxiolytic medication, it is an anti-hypertensive medication called propranolol. What that does is it -- one of the side effects of the medication can be that it lowers heart rate, so sometimes people find that very effective that when they’re needing to public speak or perform to take this medication right before they need to do that.
Melanie: How interesting that they’re using a beta blocker for that because of its effect of slowing down the heart rate. That is a really interesting way to look at this. Now, what can people do that don’t involve medication? What are some cognitive behavioral therapies -- things that they can try at home, or with their loved ones – to get them a little bit past that social anxiety, and out, and not quite as afraid?
Alicia: Certainly there are individual therapists -- and some very good ones [LAUGHS] – within Allina that do specialize in the cognitive behavioral therapy, which is what is recommended for social anxiety. As far as things that you can do on your own, I always recommend to patients to monitor their caffeine intake. This isn’t specific to social anxiety, but just in general, caffeine can illicit being irritable, feeling agitated, disrupting sleep patterns. All of those things can contribute to feeling anxious, and then on top of that, making it difficult to perform in certain social situations. Caffeine is a very common substance that is used in our daily lives, that people don’t realize can be a contributing factor to anxiety in general, but then can also affect social anxiety, as well.
Melanie: So, wrap it up for us, Alicia, with your best advice for people who suffer from social anxiety disorder, or the people who they love might be suffering. What would you tell them every day to do about this, and when to seek help?
Alicia: You need to evaluate how it’s impacting your functionality in life. Social anxiety usually affects teenage and adolescent persons. The onset is usually at 13-years-old and usually affects 18 to 15-year-olds, so I would encourage parents to examine the avoidant behavior and how it’s impacting their children’s ability to have normal social functioning with their peers. If there’s concerns or problems with that, then going in and getting evaluated is definitely important. Also, another way that loved ones can support the person who has social anxiety is just offering mock role-modeling, so that way people can practice certain situations, which seems like a silly thing to do, but when you are prepared and ready, or if you tried to create situations where something might happen, then you know what to expect, and you’re less likely to feel anxious and worried about what others are thinking about you, or worried that you’re being scrutinized and analyzed by everyone.
Melanie: Thank you, so much, for being with us today, Alicia. You’re listening to the WELLcast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole, thanks, so much, for listening.
Are Social Anxieties Keeping You Home?
Melanie Cole (Host): About 15 million American adults have social anxiety disorder, and although they recognize that the fear is excessive and unreasonable, people with social anxiety disorder may feel powerless against their anxiety. My guest today is Alicia Krueger. She’s a Psychiatric Nurse Practitioner at Allina Health Mental United Clinic. Welcome to the show, Alicia. So, what is social anxiety, and how is that different from a generalized anxiety disorder?
Alicia Krueger (Guest): Sure, thank you for having me. Social anxiety is a marked fear or anxiety about social situations where the individual is really fearful, or anxious about being scrutinized by other people. Generalized anxiety is a little bit different, where it’s excessive anxiety or worry, where it’s occurring most days of the week, about not just social situations, or not scrutiny by others, but pertaining to different events or anxiety in day-to-day life.
Melanie: What are some of the signs and symptoms that one would notice in either themselves or a loved one in regards to social anxiety disorder so that they would know that it’s time to seek help?
Alicia: Signs and symptoms of social anxiety are having fears that you’re going to act, or appear a certain way, demonstrating anxiety – some of those physical responses, such as flushing, or sweating. Sometimes people—when they have social anxiety they’re very worried about stumbling over their words, not being accepted by others, so they're very fearful and have a lot of worry and anxiety that they’re going to be judged and rejected by other people. They also have – one of the symptoms can be that they’re fearful, that they’ll be viewed as anxious or crazy, or unlikeable, or sometimes dirty. The main symptom is excessive worry or anxiety about how others perceive you.
Melanie: Alicia, are there certain reasons, or causes, that can bring on the disorder?
Alicia: Predisposing you to individuals that fear negative evaluation, can sometimes be more predisposed to social anxiety. Also, it is a heritable disorder, so first degree relatives do have a 2-6 times greater chance of having social anxiety disorder if they have an immediate family member that also has social anxiety disorder.
Melanie: Is it something that can lead to other disorders if it’s not treated, such as agoraphobia?
Alicia: Usually the other disorders associated with it are M-D-D -- major depressive disorder -- or substance abuse. It doesn’t usually lead to agoraphobia.
Melanie: So, people are saying, “Oh, she’s just shy.” How is being shy different from having that social anxiety?
Alicia: Shyness is a common personality trait, but is not considered pathological. Social anxiety is when it impairs function, so when people are demonstrating avoidant behaviors because they are so fearful of being scrutinized by others in social situations, it starts to affect if they can give a speech in front of other people, or if they can participate in sports or group activities. When their function is impaired because they are avoiding social situations, or they are avoiding participation in some of those examples, that’s when we want to have it evaluated, and it’s not just a matter of being a personality trait and possibly being shy.
Melanie: So what are the steps to take if you’re going to see a psychologist for the first time, or should you see a psychiatrist first? Who do you go to when you feel that that time has really affected your quality of life?
Alicia: From a research standpoint, there actually isn’t more evidence that individual therapy is better for social anxiety versus medication management. They both are equally efficacious. There are some mental health disorders where it’s recommended that you get both therapy and medication management. They feed off of one another and help each other out. That doesn’t seem to be the case in social anxiety disorder. It can be one or the other. What the research and evidence is showing, though, is that if a person works with an individual therapist, that tends to be longer-lasting than medication management, so sometimes it’s a matter of determining what your needs are. If you’re hoping to tackle this problem more long-term, then probably the individual therapy route is a better way to go, but if there are certain immediate needs, especially if it’s performance-related, or related to public speaking, then medications can be extremely beneficial.
Melanie: Before I ask you about ways to cope with social anxiety that don’t involve medication and some things that people can do at home every day, when is it appropriate to treat it with medication? What kinds of medications are we talking about?
Alicia: So most anxiolytic, or antidepressant medications, the first line medications such as the S-S-R-I’s, or the selective serotonin reuptake inhibitors, are utilized. When you meet with your medical professional, they can go over the risks and benefits of each one of those. There isn’t one particular S-S-R-I though, that’s specific to social anxiety, so again, your provider can go over what would be a good match for you, or not. If it’s pertaining to performance, or public speaking specifically, a medication that is sometimes prescribed -- it’s actually not an anxiolytic medication, it is an anti-hypertensive medication called propranolol. What that does is it -- one of the side effects of the medication can be that it lowers heart rate, so sometimes people find that very effective that when they’re needing to public speak or perform to take this medication right before they need to do that.
Melanie: How interesting that they’re using a beta blocker for that because of its effect of slowing down the heart rate. That is a really interesting way to look at this. Now, what can people do that don’t involve medication? What are some cognitive behavioral therapies -- things that they can try at home, or with their loved ones – to get them a little bit past that social anxiety, and out, and not quite as afraid?
Alicia: Certainly there are individual therapists -- and some very good ones [LAUGHS] – within Allina that do specialize in the cognitive behavioral therapy, which is what is recommended for social anxiety. As far as things that you can do on your own, I always recommend to patients to monitor their caffeine intake. This isn’t specific to social anxiety, but just in general, caffeine can illicit being irritable, feeling agitated, disrupting sleep patterns. All of those things can contribute to feeling anxious, and then on top of that, making it difficult to perform in certain social situations. Caffeine is a very common substance that is used in our daily lives, that people don’t realize can be a contributing factor to anxiety in general, but then can also affect social anxiety, as well.
Melanie: So, wrap it up for us, Alicia, with your best advice for people who suffer from social anxiety disorder, or the people who they love might be suffering. What would you tell them every day to do about this, and when to seek help?
Alicia: You need to evaluate how it’s impacting your functionality in life. Social anxiety usually affects teenage and adolescent persons. The onset is usually at 13-years-old and usually affects 18 to 15-year-olds, so I would encourage parents to examine the avoidant behavior and how it’s impacting their children’s ability to have normal social functioning with their peers. If there’s concerns or problems with that, then going in and getting evaluated is definitely important. Also, another way that loved ones can support the person who has social anxiety is just offering mock role-modeling, so that way people can practice certain situations, which seems like a silly thing to do, but when you are prepared and ready, or if you tried to create situations where something might happen, then you know what to expect, and you’re less likely to feel anxious and worried about what others are thinking about you, or worried that you’re being scrutinized and analyzed by everyone.
Melanie: Thank you, so much, for being with us today, Alicia. You’re listening to the WELLcast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole, thanks, so much, for listening.