CINCINNATI—To a certain extent, just about everyone has some sort of social anxiety—from the reluctance to chat with an airplane seat mate to the nervousness that comes with public speaking.
The problem, psychiatry specialists with UC Physicians say, comes when the anxiety interferes with your ability to function in your daily life. In other words, shyness isn’t a drawback if you’re a lighthouse keeper, but it is if you’re selling encyclopedias door-to-door.
“Most people never seek treatment for social anxiety,” says Stephen Strakowski, MD, chair of the psychiatry department at the University of Cincinnati and a UC physician. “They just struggle their way through life and limit some of their activities.”
But there is a point, Strakowski says, at which treatment should be considered:
“The key question is: Is it impacting your life? Is it damaging your work or social relationships, your marriage, your interactions with your kids? If it is, it’s considered an impairment or a disorder, and it’s at that point that you should seek treatment.”
Treatment for social anxiety problems, according to Strakowski, generally begins with cognitive behavioral therapy.
“That’s not ‘couch therapy,’” Strakowski points out. “It’s a very pragmatic interactive therapy where you identify specific behaviors that you want to change—in this case, how to interact with others.”
Treatment starts with relaxation techniques, then proceeds to a series of exposures that help patients manage their anxiety.
If your fear is public speaking, for example, a therapist might have you simply imagine yourself speaking to a room full of people. You would progress through increasingly more difficult exposures, such as practicing a speech in front of family members, then friends, as you work toward your goal.
In some cases, Strakowski says, a medication such as Inderal that reduces nervous system arousal can be used to address the peripheral responses to social anxieties such as sweating and elevated heart rate. “Those responses can make you even more nervous,” Strakowski says, “so if you can stop them, you might prevent some of the anxiety.”
If the social anxiety persists, antidepressants or anxiety medications might be used for a short time to work through exposures, Strakowski says, “but most people can improve with behavioral intervention if they stick with it.”