How to Bring Severe Social Anxiety Under Control

Social anxiety is an extreme and irrational fear of being judged by people in a social setting. Sometimes this fear is so extreme that it can disrupt your day to day functioning. This anxiety often stems from distorted thinking that causes an excessive fear of embarrassment. Therefore, you may choose to avoid social situations altogether. However, there are things that you can do to decrease your anxiety.

Method 1
Method 1 of 5:

Getting Your Thoughts Under Control

  1. Often anxiety begins when a person is engaging in cognitive distortions, or distorted and unhelpful ways of thinking. Distorted thoughts are thinking errors that start in your subconscious mind and make you feel anxious. Once you realize that you are engaging in a thinking error, then it’s much easier to change your thinking pattern. Here are four unhelpful thinking errors that often make anxiety worse: [1]
    • Fortune telling is when you try to predict the future without any real evidence to support your prediction. Typically you’re assuming the worst. For example, you may think, “I know that everyone is going to laugh at me.” When you find yourself doing this, ask yourself for the evidence.
    • Personalizing is when you believe, without any evidence, that people are negatively focused on you. For example, if you see someone talking to another person while looking in your direction, you may assume, “That person is talking about my outfit.”
    • Mind reading is when you assume that you know what other people are thinking. For example, you may think, “She thinks I’m stupid” when you have no idea what she is really thinking.
    • Catastrophizing is basically when you blow things out of proportion or “make a mountain out of a molehill.” You turn everything into a catastrophe when you use this thinking pattern. For example, if your friend forgets to compliment you on your performance, you might automatically think, “Oh my goodness. I did awful. Everyone probably thinks I’m completely incompetent.”
  2. When you think that you may be engaging in cognitive distortions, take a minute to determine if your thoughts are real or distorted. You can do this by asking yourself for the evidence. Say to yourself, "What real evidence do I have that supports this thought?" When you take this approach, it helps you identify the thinking error and allows you to think more helpful and realistic thoughts. Here are examples of asking for the evidence based on the cognitive distortions above:
    • "What actual evidence do I have that everyone will laugh at me during my presentation?"
    • "How do I know that she is really talking about my outfit and not about something else?"
    • "What actual evidence do I have that she really thinks I'm stupid?"
    • "What evidence do I have that the audience thought that I was incompetent?"
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  3. Negative automatic thoughts are usually at the foundation of your anxiety. [2] They are quick flashes of thought that enter your consciousness without you really being aware of them. Unfortunately they have often been reinforced since early childhood so you no longer even realize that they are present. They also usually contribute to your thinking errors.
    • For example, if every time you stood up in class in elementary school to speak, a peer laughed at you, you may have internalized that people laugh at you when you speak. Your automatic thought as an adult might now be, “If I speak in public, I will be embarrassed because people will laugh at me.”
    • When you find yourself feeling anxious, reflect on your thoughts. Ask yourself, “Why am I feeling anxious?” Take note of your response and then dig deeper by asking yourself, “What else?” For example, if you ask yourself why you are feeling anxious, you may think, “I don’t want to speak in public.” If you dig a little deeper by asking, “What else?” you may discover that the real negative thought is “I’m afraid people will laugh at me.”
  4. Once you understand the negative thoughts that are causing you to feel anxious, now it’s time to replace them with more helpful thoughts. Ask yourself questions that will help you identify a healthier opposite thought. [3] Using the same example from above about public speaking, here are some questions that you could ask yourself:
    • Do people ALWAYS laugh at me when I speak?
    • When was the last time someone laughed at me when I said something?
    • Even if someone does laugh, is that the end of the world?
    • A healthier alternative thought could be “I am going to speak to the best of my ability. The people who need the information will hear it, even if the delivery is not perfect. It doesn't have to be perfect in order for me to do a good job.”
  5. Try to avoid listening to your internal chatter by focusing on the external world. Observe what people are doing and saying. Try to really tune into conversations so that you aren’t preoccupied with your thoughts or uneasy bodily sensations. [4]
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Method 2
Method 2 of 5:

Practicing Deep Breathing

  1. Deep breathing encourages more oxygen into your lungs, slowing your heartbeat and lowering or stabilizing your blood pressure, and therefore reducing your anxiety. [5]
    • Many people prefer a chair with a back to support their spine. However, you can sit anywhere that is comfortable for you. You can even stand if necessary, especially if a panic attack ensues abruptly.
  2. The purpose of doing this is so that you know that you are inhaling properly. When you practice deep breathing, the hand on your stomach should rise higher than the hand that you have placed on your chest. [6]
    • Beginners typically find that using the hand placement is helpful. However, as you master the technique, you may no longer need to use your hands.
  3. You may want to count in your head as you inhale to keep yourself focused. Do not exceed seven before you begin to exhale. [7] When inhaling, the air should come through your nose and travel down into your belly.
  4. Exhale slowly out of your mouth. You should feel the air leave your stomach, enter into your chest, and then exit your mouth.
    • In general, it should take you twice as long to exhale as it does for you to inhale. [8]
  5. When you have taken five deep breaths at a rate of one breath per ten seconds, it will help you relax. When you are in a relaxed state, your anxiety level is more likely to decrease.
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Method 3
Method 3 of 5:

Creating an Exposure Hierarchy

  1. Exposure therapy is a common treatment for social anxiety. It helps relieve social anxiety by encouraging you to face your fears and reduce your fearful or anxious reaction to them. You start with things that make you feel just a little anxious, and work up to sources of high anxiety. [9] You may feel comfortable trying this on your own, but if not, you can seek out a therapist to help you with this treatment. [10]
    • Experts have several theories on why exposure treatment works, but most agree that it weakens your "conditioned response" to the things that make you anxious. In other words, it retrains your brain to react differently to those things. [11]
    • If your anxiety is severe enough to cause panic attacks or intense fear, you should consider seeking professional treatment first. While exposure therapy is highly successful, it can make fears and anxieties worse if not done correctly. [12]
  2. The activities should cause varying levels of anxiety. This means that you will want to balance some activities that cause mild stress with other activities that cause more significant levels of anxiety. This list will help you identify which type of activities make you feel most anxious and help you prioritize which activities you'll want to reduce your anxiety.
  3. Identify which activity is the least anxiety-provoking for you and mark it as one. Continue to number each activity in increasing severity.
    • You can determine how anxiety-provoking each activity is to you by rating them on a 100 point scale. [13] Ask yourself, “On a scale of 1-100, how much anxiety does this activity cause me?” The activities that are higher on the scale will be higher on the list.
  4. Use your imagination to pretend that you are fully engaged in the activity. [14] Visualize each step in the process.
    • For example, if you’ve been invited to a party where you think you will embarrass yourself, this might be a great activity to rehearse.
      • You could start by visualizing that you are arriving to the location.
      • Next you can visualize walking up the driveway and knocking on the door.
      • Imagine that you are sitting down next to an attractive person.
      • Visualize yourself talking to the person, laughing, and both of you enjoying the conversation.
      • See yourself having a drink or eating without soiling your clothing.
      • Continue to visualize each step of the anxiety-provoking event.
    • As you mentally rehearse the event, try to imagine the details in your mind’s eye. Pretend that you’ve teleported yourself there so that you can see all of the vivid details of your surroundings. Also, incorporate your other senses during the rehearsal. This will help it to feel more real.
  5. After you’ve finished mentally rehearsing the activity, it’s time to practice it in real life. [15] Complete each step exactly the way that you imagined it.
    • You will probably still feel some anxiety even after mentally rehearsing the event, but tell yourself “It’s okay that I’m anxious. I’m going to do this anyway.” Continue to practice this activity until the anxiety that is currently associated with the event subsides.
  6. Continue to expose yourself to the activities on your list. Be sure to move in order from the least anxiety-provoking activity to the most anxiety-provoking situation. This is important because if you start with activities that cause severe anxiety, it may be too overwhelming for you.
    • Professional therapists may sometimes recommend a "flooding" approach to exposure therapy, where you immediately face your most anxiety-provoking events. This approach does work, but because it is often extremely uncomfortable for the person, most therapists do not use it. It is not recommended that you use the "flooding" technique at home. [16]
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Method 4
Method 4 of 5:

Keeping Anxiety under Control

  1. Typically there are some things that cause you to feel more anxious than others. Some common triggers of social anxiety include: [17]
    • Meeting new people
    • Going on a date
    • Public speaking
    • Taking exams
    • Using public restrooms
    • Parties or eating in public
  2. Once you identify the trigger, try to do these things more often. The more that you do anxiety-provoking activities, the better you will get at them. Consequently, you will begin to experience less anxiety.
    • For example, if meeting new people is anxiety-provoking for you, practice saying hello first or be intentional about making eye contact when speaking to other people. [18] Try speaking to three people each time you go to the grocery store.
    • Although you can avoid some anxiety-provoking situations, it’s probably not the best idea in the long run. In fact, avoidance can make your fear worsen over time. [19] Instead, try facing your fears one step at a time.
  3. If you know that a particular situation may trigger your anxiety, try preparing for it in advance. For example, you could read the newspaper in advance to discover conversation starters before going on an outing with other people. Or maybe you could practice going to dinner with a family member or friend before going on a date. [20]
  4. A great way to conquer your fears is to participate in more social activities. [21] Here are some great ways to interact with others in a more positive way:
    • Volunteer for a cause that you’re passionate about.
    • Go to places where you have to use your social skills, such as a restaurant. You could also take a social skills workshop. Community colleges may conduct these types of workshops.
    • Take an assertiveness class.
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Method 5
Method 5 of 5:

Getting Professional Help

  1. There are various treatments available that will help you learn how to prevent and reduce anxiety. Many therapists like to use Cognitive Behavior Therapy (CBT) to treat excessive anxiety with patients. [22] Talk to your physician for a referral or do an internet search for providers in your area and schedule an appointment.
    • Cognitive Behavior Therapy (CBT) focuses on both negative thoughts and negative behavior that are exacerbating your anxiety.
    • CBT helps you see how your negative thoughts are contributing to your anxiety. It focuses on changing your negative thoughts to healthier alternative thinking.
    • CBT also helps you learn better behavioral responses to situations that trigger your anxiety.
  2. There are many medications that can be used to help you keep your anxiety under control. Discuss these options with your physician. If you decide to take this approach, be sure that you take your medication as prescribed. [23] Here are some types of medication that your doctor might prescribe for you: [24]
    • Antidepressants are sometimes prescribed to help with anxiety. Keep in mind that this type of medication make take a few days to a couple of weeks to build up to therapeutic levels in your body. Therefore, you may not experience immediate relief. But don’t stop taking your medication. Instead talk to your doctor about expectations, especially if you haven’t experienced any relief after several weeks.
    • Anti-anxiety medications such as benzodiazepines may also reduce your anxiety. Be careful with these because they can be habit-forming. They should only be used for short-term use.
    • Beta blockers helps with anxiety by blocking the stimulating effects of adrenaline. These medications help to reduce blood pressure, heart rate, and shakiness that occur with increased anxiety. They should only be used right before a specific anxiety provoking situation.
  3. Getting support from others who have similar experiences could be very helpful. You can get some insight into strategies that work for other people and share with them what has worked for you. It may be especially helpful to have a support group available when an event is nearing that you know may cause you some anxiety and distress. The Anxiety and Depression Association of America may be able to link you to a support group in your area. [25]
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      Tips

      • Some lifestyle changes can also reduce your overall anxiety level. For example, you may want to stop smoking and start drinking only in moderation, getting enough sleep, and limiting your caffeine intake. [26]
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      • Don’t give up if these remedies do not work immediately. Keep trying. It takes time to get excessive anxiety under control.
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      Warning

      • Sometimes loneliness and depression coexist with social anxiety. Some people even report feeling suicidal at times. If you ever have suicidal thoughts or feelings, be sure to contact your local suicide helpline or call 1-800-SUICIDE immediately.

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      References

      1. ↑ https://share.upmc.com/2021/05/cognitive-distortions/
      2. ↑ http://www.helpguide.org/articles/anxiety/social-anxiety-disorder-and-social-phobia.htm
      3. ↑ https://psychcentral.com/depression/replacing-your-negative-thoughts
      4. ↑ http://www.helpguide.org/articles/anxiety/social-anxiety-disorder-and-social-phobia.htm
      5. ↑ http://www.health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-errant-stress-response
      6. ↑ http://psychcentral.com/lib/learning-deep-breathing/
      7. ↑ http://psychcentral.com/lib/learning-deep-breathing/
      8. ↑ http://psychcentral.com/lib/learning-deep-breathing/
      9. ↑ http://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
      1. ↑ http://www.helpguide.org/articles/anxiety/therapy-for-anxiety-disorders.htm
      2. ↑ http://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
      3. ↑ http://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
      4. ↑ http://psychcentral.com/lib/6-ways-to-overcome-social-anxiety/
      5. ↑ https://www.psychologytoday.com/blog/anxiety-files/201410/how-overcome-your-social-anxiety
      6. ↑ https://www.psychologytoday.com/blog/anxiety-files/201410/how-overcome-your-social-anxiety
      7. ↑ http://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
      8. ↑ https://www.therecoveryvillage.com/mental-health/anxiety/related/anxiety-triggers/#:~:text=Specific%20situations%20or%20actions%20that,of%20severe%20and%20debilitating%20fear .
      9. ↑ https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
      10. ↑ http://www.helpguide.org/articles/anxiety/social-anxiety-disorder-and-social-phobia.htm
      11. ↑ https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
      12. ↑ http://www.helpguide.org/articles/anxiety/social-anxiety-disorder-and-social-phobia.htm
      13. ↑ http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml
      14. ↑ https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/treatment/
      15. ↑ https://www.rxlist.com/anxiety_medications/drugs-condition.htm
      16. ↑ https://adaa.org/find-help/support
      17. ↑ http://www.helpguide.org/articles/anxiety/social-anxiety-disorder-and-social-phobia.htm

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