This month, I talked with Vanessa Finkelman, Psy.D. As a postdoctoral fellow, she will be treating various anxieties and mood disorders at our center, beginning in September. One of her special interests is in working with those who are challenged by social anxiety, which is the fear of being judged or negatively evaluated in social interactions.
In its simplest form, social anxiety is about the fear of being judged. Anxiety about interacting with peers or coworkers can result in missed opportunities at work or in school, problems with making friends, and withdrawal and isolation from others.
“Social anxiety is something that everyone can relate to,” Dr. Finkelman told me. “We all have butterflies in our stomachs, perhaps before an event or before giving a speech or attending a gathering, but for some this unease can be more intense, and can significantly impact how they function.”
“I want people to know that being nervous is okay. These types of responses are meant to help us stay safe, but sometimes we respond to a less threatening event more severely than we need to,” she said.
“We respond this way because the event or conversation is important to us, so we feel more stress. We want to be sure it’s a positive experience.” If these exaggerated responses happen frequently and to the point of impacting daily life, however, the anxiety has likely become a disorder.
Dr. Finkelman told me that it’s important to treat social anxiety disorder for reasons other than simply wanting to feel more comfortable in a social situation.
“People may be able to sidestep it in childhood, but their anxiety may become more widespread over their life if it isn’t addressed. It can impact their work and ability to have relationships. Sometimes it takes bypassing a work promotion or wanting to have a significant relationship, maybe feeling lonely for years, before people realize they need to seek treatment.”
The risk of depression and other comorbid conditions, such as alcohol use disorder, are another reason it is important to address social anxiety.
“While comorbidities or other conditions can develop, social anxiety disorder can also be a precursor to depression. The negative emotions that come from feeling shame or hopelessness about our social fears affect our self-esteem,” Dr. Finkelman said. “So, let’s treat it before the social anxiety becomes bigger and leaves the person depressed.”
How Does Someone Know They Have Social Anxiety?
I asked Dr. Finkelman how someone could tell the difference between social anxiety and simply being shy.
“If you are shy, a social setting or experience may make you feel uncomfortable, but you can do it,” she explained. “Social anxiety, however, causes avoidance.”
“Maybe you worked very hard on a work presentation, but having to get up in front of coworkers to actually present your project becomes undoable for you, so you call in sick that day. In teens and adolescents who are challenged by social anxiety, we see reduced school attendance, higher dropout rates, and lower grades. Avoidance is a big test of whether or not the person is experiencing social anxiety.”
Is Social Anxiety More Prevalent Since The Pandemic?
I asked whether Dr. Finkelman has noticed if social anxiety is on the rise since the pandemic.
“People with social anxiety might have felt pretty happy to be out of discomfort during the pandemic,” she responded. “The problem is that the shut downs and quarantines kept people from becoming more independent in terms of social interaction, both at work and in school.”
“We learn and practice our social skills during our time in school, but children didn’t get that peer-to-peer practice or have to do things, like give speeches in the classroom, so now they’re out of practice. In the office, many adults could distance themselves behind the camera of a virtual meeting, which took away the worry about having actual face-to-face communication.”
“That means we missed out on learning challenges and discovering that things weren’t as hard or strange as we’d anticipated. For example, we didn’t learn that we could blush or stumble over words in front of peers without being rejected, because we didn’t get that experience. We couldn’t challenge ourselves to do something uncomfortable and then evaluate the outcome. Now that we are back to more typical work and school situations, these types of interactions may seem even more threatening to someone who is socially anxious.”
What Are Some Strategies For Treating Social Anxiety?
“In some ways, treatment is similar to those we use for other anxieties,” Dr. Finkelman said. “Cognitive behavioral therapy (CBT) is the gold standard. We combine CBT with an individualized approach, depending on the person’s needs or accompanying anxieties. It isn’t a one-size-fits-all approach. CBT is targeted to the person’s exact presenting concerns and combined with exposures and other modalities as needed to achieve their goals.”
She stressed that the objective of treatment is to teach the skills people need to be able to interact without irrational fear. “We aren’t trying to change someone into becoming the life of the party,” she emphasized. “We want them to learn that they can accept and tolerate some discomfort while still moving forward.”
“You have to become comfortable with being uncomfortable to seek relief,” she continued. “When you have social anxiety, you are overestimating the threat and underestimating how well you can handle it. You can learn how to be okay with feeling some discomfort in a social situation, though, particularly in order to move forward with your goals and values in life.”
Dr. Finkelman told me that she finds treating social anxiety to be very rewarding – both for her clients and on a personal level. “The treatment helps to push a client gently out of their comfort zone. But as they take baby steps and see their successes, it becomes easier and encourages them to continue with more difficult challenges.”
She offered some encouragement for those who worry they’ll be pushed too far, too fast in therapy. “Challenges will come into play during treatment, yes, but not on the first, second or maybe even the third time you meet with us. Instead, we’ll first dig into the aspects behind the fears and the person’s individual experience, which may include several physical symptoms, too.”
“It’s only when we have addressed their experience and worked on some helpful skills and strategies that we’ll we start with small challenges, like a coffee shop visit where you’d place a face to face order. Once these types of challenges become easier, clients often start looking forward to them because their successes are exciting!”
She also told me that social anxiety treatment protocols have been effectively adapted to virtual counseling while we are still in the pandemic. “For example, a challenge might be to make dinner reservations over the phone and talk to the hostess about a particular menu item. Treatment can definitely be done well over the phone.”
Treatment Can Be Life Changing
“Anxiety is not going to go away completely,” Dr. Finkelman said, “and treatment is not going to mean the complete elimination of the anxiety. Instead, the goal is to reduce the discomfort and accept it so we can move forward with the things that are important to us, even when they feel uncomfortable.”
“This is so important for all anxiety, not just social anxiety. Avoidance of what makes us uncomfortable just perpetuates our anxiety. We may get invited to a party, but we come up with reasons why we shouldn’t go, which is avoidance. The party could have been a learning experience, but avoiding it means we don’t get that experience, so we don’t gain the understanding that “I wasn’t that weird/annoying/clumsy” person I thought I would be, after all.”
“Ask yourself what is your anxiety holding you back from? Know that it’s okay to be uncomfortable, if you are. What are your fears about the event or experience? Maybe you worry that you’ll spill something or people will think you dressed wrong. So what if people laugh or make a joke? In 10 days or 10 weeks, will it matter? Most of the time, the people who would have witnessed your mishap won’t think it was a big deal in the first place or if they do, even remember it by the next day.
“Remember that social anxiety is a common experience – we all have some aspect of it,” Dr. Finkelman said. “I want people to know that there is really effective treatment for the disorder. Your life doesn’t have to be limited by this discomfort because there are ways to move forward. Even though working through it may be uncomfortable at times, treatment can be very be successful and life changing.”
We Can Help
If you or someone you love has questions or would like further information about treatment for social anxiety or other mental health concerns, the professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-223-6568.
About Vanessa Finkelman, Psy.D.
Dr. Vanessa Finkelman is a postdoctoral resident who earned both her master’s and Doctor of Psychology degree in Clinical Psychology from Nova Southeastern University. She graduated from Northwestern University with double bachelor’s degrees in Psychology and Art Theory and Practice. Dr. Finkelman is part of Order of Omega and Psi Chi academic honor societies. She is fluent in conversational Spanish. During her graduate program, Dr. Finkelman conducted research and co-authored academic and professional posters and presentations related to culturally sensitive psychological assessment and mindfulness-based art therapy strategies for stress management.