Ask The Therapist: “I’ve been struggling with social anxiety and negative thoughts for a long time. I try to keep calm but nothing works…”

In 2016, the number of people estimated to be suffering from mental health issues like depression and anxiety amounted to roughly 1.1 billion. Since then, numbers have likely continued to rise. Moreover, studies have also shown women especially on average are a) more likely to suffer from mental health issues, and b) less likely to talk about them. The taboo in Pakistan surrounding depression and anxiety disorders only serve to aggravate the individuals suffering even more. For the women who cannot seek out full time therapy, or simply need advice about their problems, we’ve enlisted the help of a trained counsellor. You sent us in your questions – here are the answers!

“I’ve been struggling with social anxiety and a lot of negative thoughts for a very long time. I try my best to calm myself down but nothing works and my situation worse is only getting worse. I NEED HELP.”

Haya’s Response:

Dear Anonymous,

We all know the feeling of being nervous or uncomfortable in a social situation. Most of us at some point have clammed up when meeting someone new or gotten sweaty palms before making a big presentation. Public speaking or walking into a room full of strangers isn’t exactly thrilling for everybody, but most people can get through it.

If you have social anxiety disorder, though, the stress of these situations can be too much for you to handle. You may avoid all social contact because things that other people consider ‘normal’ — like making small talk and eye contact – may make you very uncomfortable. In turn, all aspects of your life, not just the social part, could start to fall apart.

To answer your query, let’s look at social anxiety in more detail; what it is and how you can learn to manage it.

What Is Social Anxiety

Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.

In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:

• Be out of proportion to the situation or age inappropriate
• Hinder your ability to function normally

Anxiety refers to anticipation of a future concern and is more associated with muscle tension and avoidance behavior. In simple terms, it is the fear of the future. When we fear situations that have not happened yet and that are about to happen.

Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But for a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

When Does It Happen?

Anyone with social anxiety disorder can experience it in different ways. But here are some common situations that people tend to have trouble with:

• Talking to strangers
• Speaking in public
• Dating
• Making eye contact
• Entering rooms
• Using public restrooms
• Going to parties
• Eating in front of other people
• Going to school or work
• Starting conversations

Even if you suffer from social anxiety, not all of these have to be a problem for you. For example, giving a speech may be easy, but going to a party might be a nightmare. Or you could be great at one-on-one conversations but not at stepping into a crowded classroom.

All socially anxious people have different reasons for dreading certain situations. But in general, it’s an overwhelming fear of:

• Being judged by others in social situations
• Being embarrassed or humiliated — and showing it by blushing, sweating, or shaking
• Accidentally offending someone
• Being the center of attention

What Does It Feel Like?

Again, the experience may be different for everyone, but if you have social anxiety and you’re in a stressful situation, you might have physical symptoms like:

• Rapid heartbeat
• Muscle tension
• Dizziness and lightheadedness
• Stomach trouble and diarrhea
• Inability to catch breath
• ‘Out-of-body’ sensation

You may start having symptoms immediately before an event or you might spend weeks worrying about it. Afterward, you could spend a lot of time and mental energy worrying about how you acted.

What Causes It?

There’s no one thing that causes social anxiety disorder. Genetics has something to do with it. If you have a family member with social phobia, you’re more at risk of having it, too. It could also be linked to having an overactive amygdala — the part of the brain that controls your fear response.

Social anxiety disorder usually comes on at around 13 years of age. It can be linked to a history of abuse, bullying, or teasing. Shy kids are also more likely to become socially anxious adults, as are children with overbearing or controlling parents. If you develop a health condition that draws attention to your appearance or voice, that could trigger social anxiety, too.

How Can I Manage It?

Anxiety disorders are generally treated with psychotherapy, medication, or both.

Psychotherapy or ‘talk therapy’ will help you become more aware of your patterns and triggers. In addition Cognitive Behavioral Therapy may be helpful to you. It will teach you different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help you learn and practice social skills, which is vital for treating social anxiety disorder.

In addition to seeking to the above, you also need to practice mindfulness.

You need to practice becoming aware of when you are going through social anxiety. And when you become aware that you are facing anxiety, don’t fight it. Instead, accept it in the moment and allow yourself to feel what you are feeling. Be aware of not using judgmental words to yourself and criticizing yourself. Be mindful of the way you speak to yourself, this will help you deal with both your social anxiety and negative thoughts. Even when a negative thought pops up, ask yourself how can I see this in a positive light? Can I say something to myself in a kinder way?

You may also practice pre visualization. This is when you generate mental imagery (with eyes closed or open) of future situations and visualize the best possible way you would respond in that situation. This will help you enhance the capacity to cope when interacting with others and your therapist would be able to further aid you in this.

Moreover, there is also the option of medication. However, medication does not cure anxiety disorders but can help relieve symptoms. Bear in mind, only a psychiatrist can prescribe anxiety medication.

Here are a few more tips that may help you control or lessen your symptoms:

• Cut down on foods and drinks that have caffeine, such as coffee, tea, cola, energy drinks, and chocolate. Caffeine is a mood-altering drug, and may worsen your symptoms.
• Eat right, exercise, and get better sleep. Aerobic exercises like jogging and biking help release brain chemicals that cut stress and improve your mood. I cannot emphasize on this enough – getting a workout will directly impact the wellness of your mental health.
• Sleep problems and anxiety disorder often go hand in hand. Make getting proper rest a priority. Talk to a mental health professional if you still have trouble sleeping.

Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help prepare us. Anxiety disorders differ from normal feelings of anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect nearly 30 % adults at some point in their lives (over 40 million adults have an anxiety disorder and women are 60% more likely to be diagnosed than men). But anxiety disorders are treatable and a number of effective treatments are available.