Spotlight on social anxiety

Imagine the scene – you’re about to stand up in front of 50 of your colleagues to give a presentation. How do you feel? Does your heart beat faster? Are your hands shaking? In this type of situation, nerves are completely normal. But what happens if your anxiety starts to overcome you with paralysing physical symptoms? Social anxiety is an incredibly isolating and debilitating condition and yet, like with many mental health disorders, it’s something we don’t talk about enough.

According to anxiety expert Dr Harry Barry, social anxiety is one of the most common types of anxiety disorder.

“You’re looking at probably between five and eight per cent of the population has some form of social anxiety. At least five per cent anyway. It’s very common.”

Dr Barry, author of the best-selling Anxiety and Panic: How to Reshape your Anxious Mind and Brain (Orion Spring, €16.99), says it’s important to note that there are two distinct types of social anxiety – interactional and performance.

“The best way of describing it is that there are two kinds of social anxiety situations people get anxious in. The first one is called social interactional situations – that’s where, for example, suppose I have to go down to the local pub to meet a group of friends or to a party or to meet a group of people in some other situation. What the person then will find that they become incredibly anxious before even going into the situation and then in the situation,” says Dr Barry.

“The second one is what we call social performance anxiety, that’s the typical one we all know so well. Where the person becomes incredibly anxious if they have to give a talk or a presentation or a wedding speech. They are simply losing it before they do it. The one that causes the paralysis in general is the social interactional [anxiety] that’s the one that creates a problem.”

The symptoms of social interactional anxiety can be all-consuming and Dr Barry says they begin as soon as a social outing is planned.

“Suddenly you find you start to get all these physical symptoms. You notice that your heart is going quickly, your stomach is in knots, you’re shaking maybe sweating, muscles all tense. And what actually starts to happen then is that the person in the social interactional situation is worried [that] people will notice that they’re anxious. They worry that they [other people] will see that they’re anxious…

“What they’ll actually do, it’s very interesting to look at their behaviours because this is the simplest way for a person to recognise is they’ll notice that before they go out, they’ll spend a lot of time checking in the mirror, seeing do they look anxious, also rehearsing in the mirror what they might say if somebody starts to talk to them.”

This hyper-focus on other people seeing them sweating, blushing or exhibiting anxious behaviour takes over and causes the person to obsessed over the interaction – during a group situation they’re keenly aware of their appearance, they’re planning what to say and worrying whether they’ll appear stupid or silly and, after all of that, once the interaction is over, they will do a full “post mortem” on the situation wonder what they could have done better or different.

Dr Barry says that social anxiety is an “exhausting” condition and due to this, sufferers often begin to withdraw and isolate themselves to avoid social situations.

Performance anxiety is similar, Dr Barry notes, as that it also focusses on what people will notice about you and then think about you. The good news is that social anxiety is very treatable.

“It’s an incredibly simple condition to get rid of. One of the real reasons for writing Anxiety and Panic was to try and get people to understand that conditions like panic attacks and social anxiety are incredibly easy to treat. I can get rid of social anxiety for a person probably in about three sessions.”

They key is to understanding the difference between “perception versus reality” says Dr Barry. He recommends also educating yourself about the condition, as the more you know, the easier the condition is to treat and, if after educating yourself you still have problems, to explore Cognitive Behavioural Therapy (CBT).

“What I would appeal to people with social anxiety – do not continue suffering from it. Don’t be suffering in silence. This is a very easy condition to treat. Understanding it is about 50 per cent of it. If I can understand what’s going on and realise why I have a problem, well then it’s so much easier to deal with. That would be my main appeal,” says Dr Barry.

“Read the book. Learn what it’s about. See if you can put it into practice yourself and if you’re still having trouble go to a CBT therapist and get a bit of help for a couple of sessions.”

Dr Harry Barry is an author and medic, with 36 years experience as a GP. With a keen interest in the area of mental health and suicide prevention, he is the author of numerous books addressing various aspects of mental health including depression and toxic stress.