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What is Social Anxiety Disorder?
Social Anxiety Disorder (SAD), also known as social phobia, is a common mental health condition in which an individual experiences excessive and persistent fear or anxiety in social situations. People with social anxiety disorder experience overwhelming fear that they believe they cannot control.1
Some may find that this anxiety prevents them from going to work, school, or performing daily tasks. Others might be able to carry out these tasks, but they do it with significant worry and stress. People with social anxiety disorder may stress about participating in social situations weeks in advance. As a result, they occasionally find themselves avoiding situations or locations that make them feel uncomfortable or embarrassed.
According to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 75% of people with social anxiety disorder experience the onset between the ages of 8 and 15; the median age of start of social anxiety disorder in the US is 13 years old. A specific incident might either cause a gradual onset or a quick onset.2
In addition, social anxiety disorder prevalence rates are highest in high-income nations, the Americas, and the Western Pacific regions and lowest in low/middle-income and African and Eastern Mediterranean areas.3
Social anxiety disorder might resemble severe shyness or a need to avoid social settings or interactions. It affects females more commonly than males, and this gender disparity is pronounced in adolescence and early adulthood.4 Social anxiety disorder can persist for a long time, perhaps even a lifetime, without therapy. At some point in their lives, 12.1% of American adults are thought to suffer from social anxiety disorder.5
The DSM-5 identifies two subtypes of social anxiety disorder:
- Generalized Social Anxiety Disorder: This is the most common type of social anxiety disorder, characterized by a persistent fear of social and performance situations, such as public speaking, meeting new people, eating in front of others, or attending parties. People with generalized social anxiety disorder may also worry about being judged or humiliated in these situations.
- Performance-Only Social Anxiety Disorder: This type of social anxiety disorder is characterized by a fear of performing or speaking in public but does not involve social interactions in general. People with performance-only social anxiety disorder may experience anxiety specifically when they are the center of attention, such as giving a speech or performing on stage.
Causes of Social Anxiety
The exact causes of social anxiety disorder (SAD) are not fully understood, as it’s a complex condition, and its causes can vary from person to person. However, research suggests that a combination of biological, environmental, and psychological factors may contribute to its development. Some of the possible causes of SAD include:6
- Genetics: SAD appears to run in families, suggesting that genetic factors may play a role in its development.
- Brain chemistry: Research has shown that people with SAD may have an imbalance of certain brain chemicals, such as serotonin and dopamine, which can affect mood and anxiety levels.
- Environmental factors: Traumatic or negative experiences in social situations, such as bullying or ridicule, can contribute to developing SAD.
- Learned behavior: People with SAD may learn to fear social situations through negative experiences or messages they receive from others.
- Temperament: Some people may be more prone to developing SAD due to their temperament, such as being shy or sensitive to social situations.
Symptoms of Social Anxiety
Social anxiety disorder is characterized by excessive and persistent fear or anxiety in social situations. These symptoms can interfere with daily activities, work, and relationships. They can also cause significant distress and impairment in social and occupational functioning. The symptoms of social anxiety disorder can vary in intensity and may include the following:
- Intense fear or anxiety in social situations, especially those involving performance or scrutiny, such as public speaking or meeting new people
- Avoidance of social situations or enduring them with extreme distress
- Fear of being embarrassed, judged, or humiliated in front of others
- Physical symptoms like sweating, trembling, rapid heart rate, nausea, panic attacks, and difficulty speaking
- Worrying for days or weeks before a social event
- Difficulty making eye contact or speaking to others
- Fear of eating or drinking in front of others
- Avoiding social situations where one may be the center of attention
- Difficulty asserting oneself in social situations
- Feelings of inadequacy or low self-esteem
It’s important to seek professional help if these symptoms persist and interfere with your daily life.
Social Anxiety Disorder Treatments & Therapy
Social anxiety disorder treatment may involve therapy, medication, or a combination of both. Below are several options for social anxiety disorder treatment, which can help you manage your symptoms and improve your quality of life. These treatments include, but are not limited to, the following:
- Cognitive-behavioral therapy (CBT): CBT is often an effective social anxiety disorder treatment, which helps you to learn how to manage thoughts and emotions in social situations.7 It helps identify and change negative thoughts and beliefs contributing to your anxiety. It often involves exposure therapy, where you gradually face your fears in a safe and supportive environment.
- Cognitive Processing Therapy (CPT): With this treatment, you’ll learn to alter and refute harmful ideas about what may be causing your social anxiety.
- Prolonged Exposure Therapy: Prolonged exposure teaches you how to approach traumatic memories, feelings, and circumstances gradually. By confronting what has been avoided, you will likely discover that the social situations are safe and do not need to be avoided.
- Eye Movement Desensitization and Reprocessing (EMDR): This structured therapy urges you to concentrate on your anxiety while undergoing bilateral stimulation, such as eye movements or tapping. This is correlated to a decrease in the vividness and strong emotion attached to social anxiety.
- Medications: Antidepressants, anti-anxiety medications, and beta-blockers are some of the medications that may be prescribed to manage symptoms of social anxiety disorder.8
- Mindfulness-based interventions: Interventions such as mindfulness meditation or mindfulness-based stress reduction (MBSR) can help you reduce stress and anxiety and improve your ability to manage social situations.
- Support groups: Support groups can provide you with an effective, safe, and supportive environment to share experiences, receive support and guidance, and learn coping skills from others who have similar experiences.9
- Lifestyle changes: Regular exercise, getting enough sleep, practicing relaxation techniques, and avoiding alcohol and caffeine can also help reduce symptoms of social anxiety disorder.
The first step in social anxiety therapy is typically an assessment, during which a qualified therapist will gather information about your symptoms, history, and current social functioning. This information helps the therapist understand your unique situation to tailor social anxiety disorder treatment accordingly.
After the assessment, the therapist will work with you to set goals. These goals may include reducing anxiety symptoms, improving social skills, and increasing social functioning. Based on the assessment and goals, the therapist will develop a treatment plan that outlines the specific strategies and techniques that will be used to address your social anxiety.
Therapy sessions may take place individually or in a group setting. Depending on the specific treatment plan, they may involve various techniques, such as CBT, exposure therapy, or mindfulness-based techniques.
You may need to practice new social skills outside of therapy sessions to progress in therapy. The therapist may assign homework assignments or encourage you to practice new skills in real-life social situations.
During therapy, the therapist will monitor your progress toward your goals and adjust the treatment plan as needed. Once the treatment goals have been met, you and the therapist may work together to develop a plan for maintaining progress and preventing relapse.
There are many significant benefits of going to social anxiety disorder treatment, including, but not limited to, the following:
- Reduced anxiety and distress: Therapy can help you learn coping strategies and techniques to manage social anxiety and reduce distress in social situations.
- Improved relationships: By learning effective communication and social skills, therapy can help improve relationships with others.
- Increased confidence and self-esteem: Therapy can help you build self-confidence and self-esteem by challenging negative self-beliefs and replacing them with positive ones.
- Improved quality of life: By reducing symptoms and increasing social functioning, therapy can improve the overall quality of life and reduce the impact of anxiety on daily activities, work, and relationships.
- Prevention of other mental health conditions: Other mental health conditions, such as depression or substance use disorders, often accompany social anxiety disorder. Therapy can help prevent the development of these conditions by providing you with tools to manage anxiety and improve overall mental health.
- Support and guidance: Group-based social anxiety counseling can provide a safe and supportive environment to discuss experiences, receive guidance, and learn from others with similar experiences.
When seeking a therapist for social anxiety counseling, it’s important to find someone experienced in treating this specific condition and with whom you feel comfortable working. It’s also important to consider factors such as location, availability, and insurance coverage.
Several types of mental health professionals can help with social anxiety disorder. Here are some of the most common types of professionals:
- Psychologists: Psychologists are trained in the assessment, diagnosis, and treatment of mental health conditions, including social anxiety disorder. They may provide evidence-based therapy, such as cognitive-behavioral therapy (CBT).
- Psychiatrists: Medical doctors specializing in diagnosing and treating mental health conditions who can also prescribe medications.
- Licensed Professional Counselors (LPC): LPCs are mental health professionals who provide therapy to individuals with mental health conditions. They may use various approaches, including CBT, and provide support and guidance to help individuals manage their symptoms.
- Licensed Clinical Social Workers (LCSW): LCSWs are trained mental health professionals who provide therapy and support to individuals with mental health conditions. They may use a variety of evidence-based treatments and provide support and guidance to help manage symptoms.
- Marriage and Family Therapists (MFT): MFTs are trained mental health professionals who provide therapy to individuals, couples, and families with mental health conditions. They may use a variety of evidence-based treatments and provide support and guidance to help individuals manage their symptoms and improve their interpersonal relationships.
The above mental health professionals must undergo rigorous educational and training requirements. For example, In Tennessee, psychologists are required to have the following education and training:10
- A doctoral degree in psychology from an accredited institution
- Completion of an American Psychological Association (APA) accredited internship
- Pass the Examination for Professional Practice in Psychology (EPPP)
- Completion of two years of supervised professional experience
- Pass the Tennessee Jurisprudence exam
After meeting these requirements, psychologists in Tennessee can become licensed to practice independently. In addition, they must complete continuing education requirements to maintain their license and stay up-to-date with developments in the field.
Social Anxiety Therapy Treatment Costs & Insurance Coverage
The cost of social anxiety therapy can vary depending on the therapy approach and the therapist’s credentials, among other factors. As the Affordable Care Act requires, most insurance policies must provide some type of coverage for mental health treatment.11 Furthermore, health insurance companies often cover the cost of inpatient therapy programs, especially when co-occurring disorders like substance abuse are present.
In the US, psychotherapy, also known as talk therapy, costs between $100 and $200 per session, on average.12 In addition, name-brand drugs can cost hundreds of dollars for a month’s supply. For example, a month’s supply of selective serotonin reuptake inhibitors (SSRIs), such as Zoloft, at 50 mg can cost up to $358. In comparison, a month’s supply of Paxil at 10 mg can cost up to $210.13
Social Anxiety Therapy Treatment Success & Outlook
There is no such thing as a quick fix regarding social anxiety disorder treatment. Each person’s treatment experience will vary. The kind of therapy you need, the skills you gain, and how long you will need treatment will depend on the severity of your symptoms and any possible comorbid conditions, such as depression.
One typical misconception about therapy is that you’ll feel better immediately. While this is true sometimes, you frequently feel worse before feeling better. Most of the time, when you decide to begin social anxiety counseling, it’s because you can’t control your symptoms alone. You will delve more deeply into the reasons for your anxiety in therapy. As a result, your anxiety may temporarily heighten, and feeling worse is usually a sign that treatment is working.
Some patients respond to treatment within a few weeks or months, while others may need more time. Although cognitive-behavioral therapy, for example, is generally considered a short-term therapy.
While studies and clinical trial results vary and conflict, demonstrating the need for additional research, below are some statistics on the success and outlook of social anxiety disorder treatment:
- Remission rates for social anxiety disorder (SAD) ranged between 3% and 80% in retrospective studies and 36% and 93% in prospective trials. SAD may have multiple course types (short, variable, and chronic). However, according to the wide variety in remission rates, it is not always a chronic condition.14
- The Anxiety & Depression Association of America (ADAA) reports that only 36.9% of people obtain medical treatment for anxiety disorders, although these conditions are highly treatable.15
- According to one study, combined cognitive and behavioral interventions for social anxiety disorder were not significantly more effective than cognitive or exposure treatments alone.16
- Another study found that exposure-based therapies produced the most significant effect when paired with cognitive restructuring or simply by itself.17
- Only half of individuals with social anxiety ever seek social anxiety counseling and those who do often do so only after experiencing symptoms for 15 to 20 years.18
How to Get Started With Therapy for Social Anxiety
If you are interested in starting social anxiety disorder treatment, here are some general steps you can take:
- Talk to your primary care doctor: Your doctor can help you find a therapist to get started with social anxiety counseling. They may also be able to prescribe medication to help manage your symptoms.
- Find a therapist who accepts your insurance: Find a therapist who specializes in treating social anxiety by searching online directories or contacting your insurance company for a list of in-network providers. Look for therapists who have experience with cognitive-behavioral therapy (CBT) or exposure therapy, as these are effective treatments for social anxiety. Athena Care is in-network with most major insurance plans. Filling out our free, confidential online insurance verification form is the simplest, most efficient method to verify your insurance benefits.
- Our highly skilled care coordinators at our multiple mental health treatment clinics will handle the challenges of contacting your insurance carrier for information about your social anxiety disorder treatment coverage in Tennessee. After you’ve completed the no-obligation form, a care coordinator will review your policy and thoroughly explain your options. Any information provided and discussed will remain confidential.
- If you don’t have insurance, or your insurance doesn’t cover social anxiety counseling, don’t worry. There are alternatives and financial options for receiving the care you need. You can discuss these concerns and address any questions with one of Athena Care’s coordinators, Monday through Friday, 7 am – 6 pm.
- Schedule an appointment: Once you have found a therapist you want to work with, schedule an appointment. Many therapists offer a free initial consultation to help you determine if they are a good fit.
- Attend your first session: During your first session, your therapist will ask questions about your symptoms, medical condition and history, and treatment goals. Then, they will work with you to develop a treatment plan that meets your needs and preferences.
- Be open and honest: Remember that therapy can be challenging, and it may take time to see results. But with persistence and dedication, therapy can be a powerful tool for managing social anxiety and improving overall well-being. It’s essential to be open and honest with your therapist. This will help them understand your experiences and develop a comprehensive treatment plan specific to your needs.
- “Social Anxiety Disorder: More Than Just Shyness.” National Institute of Mental Health (NIMH), www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness.
- Herbert, James D., et al. “Assessment of Social Anxiety and Its Clinical Expressions.” Elsevier eBooks, Elsevier BV, Jan. 2014, pp. 45–94. https://doi.org/10.1016/b978-0-12-394427-6.00003-0.
- Stein, Dan J., et al. “The Cross-national Epidemiology of Social Anxiety Disorder: Data From the World Mental Health Survey Initiative.” BMC Medicine, vol. 15, no. 1, Springer Science+Business Media, July 2017, https://doi.org/10.1186/s12916-017-0889-2.
- “Social Anxiety Disorder.” National Institute of Mental Health (NIMH), www.nimh.nih.gov/health/statistics/social-anxiety-disorder.
- Harvard Medical School. “National Comorbidity Survey.” Harvard.edu, 2005, www.hcp.med.harvard.edu/ncs/index.php.
- “Social Anxiety Disorder (Social Phobia) – Symptoms and Causes – Mayo Clinic.” Mayo Clinic, 19 June 2021, www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561.
- Kaczkurkin, Antonia N., and Edna B. Foa. “Cognitive-behavioral Therapy for Anxiety Disorders: An Update on the Empirical Evidence.” Dialogues in Clinical Neuroscience, vol. 17, no. 3, Laboratoires Servier, Sept. 2015, pp. 337–46. https://doi.org/10.31887/dcns.2015.17.3/akaczkurkin.
- Le, Kevin, PharmD, BCPS, BCPPS. “Which Medications Work Best to Treat Social Anxiety Disorder?” GoodRx, 4 Nov. 2022, www.goodrx.com/conditions/social-anxiety-disorder/medications-for-social-anxiety-disorder.
- Wersebe, Hanna, et al. “Psychological Group-Treatments of Social Anxiety Disorder: A Meta-Analysis.” PLOS ONE, vol. 8, no. 11, Public Library of Science, Nov. 2013, p. e79034. https://doi.org/10.1371/journal.pone.0079034.
- “Tennessee, TN: Psychology License to Become a Certified Psychologist – Human Services Edu.” Human Services Edu, www.humanservicesedu.org/tennessee-psychology-requirements.
- “About the Affordable Care Act.” HHS.gov, Mar. 2022, www.hhs.gov/healthcare/about-the-aca/index.html.
- Lauretta, Ashley. “How Much Does Therapy Cost?” Forbes Health, 27 June 2022, www.forbes.com/health/mind/how-much-does-therapy-cost.
- Croot, Emily. “The Financial Costs of Anxiety.” Thrive Global, 10 Jan. 2019, thriveglobal.com/stories/the-financial-costs-of-anxiety.
- Vriends, Noortje, et al. “Social Anxiety Disorder, a Lifelong Disorder? A Review of the Spontaneous Remission and Its Predictors.” Acta Psychiatrica Scandinavica, vol. 130, no. 2, Wiley-Blackwell, Aug. 2014, pp. 109–22. https://doi.org/10.1111/acps.12249.
- Facts and Statistics | Anxiety and Depression Association of America, ADAA. adaa.org/understanding-anxiety/facts-statistics. Accessed 26 Sept. 2022.
- Powers, Mark B., et al. “A Meta–Analytic Review of Psychological Treatments for Social Anxiety Disorder.” International Journal of Cognitive Therapy, vol. 1, no. 2, Springer Science+Business Media, Jan. 2008, pp. 94–113. https://doi.org/10.1521/ijct.2008.1.2.94.
- Gould, Robert O., et al. “Cognitive-behavioral and Pharmacological Treatment for Social Phobia: A Meta-analysis.” Clinical Psychology-science and Practice, vol. 4, no. 4, Wiley-Blackwell, Dec. 1997, pp. 291–306. https://doi.org/10.1111/j.1468-2850.1997.tb00123.x.
- Ehlers, Anke et al. “Low Recognition of Posttraumatic Stress Disorder in Primary Care.” London journal of primary care vol. 2,1 (2009): 36-42. https://pubmed.ncbi.nlm.nih.gov/23814612/
If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.
One of our friendly associates will help you get the help you need. Take this first step to feel better and take control.