Psychosomatics of social anxiety
Social anxiety is a strong and lasting fear of social situations: meeting people, conversations, other people's eyes. According to the NHS it is more than shyness, but it can be helped, best of all with cognitive behavioral therapy. If the fear gets in the way of work, study or relationships, book a GP or a psychotherapist. The Ladder method helps you notice the fear of judgment, and it does not replace treatment.
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When to see a doctor
A GP, then a psychotherapist or psychiatrist. The doctor will ask about feelings, behavior and symptoms in social situations and refer you for a full assessment (NHS). Asking for help is hard, but the doctor knows that many people face this. Come if the fear strongly affects your life.
In the Ladder method
In the Ladder method social anxiety is not explained by the words you are just shy and is not counted as weakness. You are not to blame: it usually starts in the teenage years, and it can be helped. A doctor or psychotherapist comes first, and the questions to yourself go alongside treatment, not instead of it.
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In the method this fear fits the image of another person's gaze: when it feels as if you are judged all the time, you want to become unnoticeable. This is an image, not a cause of the anxiety, and it does not replace therapy.
On the ladder this shows up as the steps I may be judged and I am not allowed to make mistakes. You can work through them at your own pace.
These are questions for reflection, not an explanation of what causes the condition and not a treatment.
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How it shows up
Book a doctor’s appointment if you notice:
- Strong fear of meetings, introductions and conversations
- Fear of being judged, of blushing or sweating
- Avoiding parties, group lunches and calls
- Hard to do anything when people are watching
- Nausea, trembling and a pounding heart before events
- Worry before, during and after a meeting
What medicine knows
Social anxiety, or social phobia, is a lasting and strong fear of social situations. Most often it starts in the teenage years. It is more than shyness: the fear does not go away and affects confidence, relationships, work and study. For some it gets easier with age, but for many it does not pass without treatment (NHS).
You may worry before, during and after meetings, fear meeting people, starting a conversation, phone calls, lunches with others and parties, and expect to do something awkward: blush, sweat, seem incompetent. It is hard to do anything when people are watching, and it feels as if you are judged all the time. There can be nausea, sweating, trembling, a pounding heart, avoiding eye contact and panic attacks (NHS).
Many people with social anxiety have other difficulties as well: depression, generalized anxiety disorder or panic disorder (NHS). A doctor will ask about feelings, behavior and symptoms and refer you to a mental health specialist for a full assessment.
The main kinds of help according to the NHS: cognitive behavioral therapy, which is seen as the best method and helps you notice and change negative thoughts and behavior; self-help from a workbook with a therapist's support; antidepressants, which only a doctor can choose. At home a thought diary, breathing exercises, breaking a hard situation into parts and focusing on what people actually say, not on worst guesses, all help.
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Frequently asked questions
How does social anxiety differ from shyness?
According to the NHS, it is more than shyness: the fear does not go away, you worry before, during and after situations, and it gets in the way of relationships, work and study.
How can I help myself at home?
The NHS advises keeping a diary of thoughts and behavior in social situations, doing breathing exercises, breaking the hard into small parts and listening to what people say rather than imagining the worst. If it does not help, see a GP.
Which treatment helps?
The NHS names cognitive behavioral therapy as the best method, and also self-help from a workbook and antidepressants, most often SSRIs. Sometimes a combination is needed. In the Ladder method the fear of judgment is a reason to notice where it is hard for you to be yourself, and it does not replace treatment.
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Answers to common questions
Psychosomatics does not replace tests and treatment. Only a doctor can make a diagnosis.