Selective Mutism: Overcoming Social Anxiety Challenges

Selective Mutism

I am John from last time.
I feel that everyone is very friendly, but I am still very scared.
Is this social anxiety disorder? I don't mind what the staff say, but when I am at a breakfast shop with a lot of people, I take a long time to mentally prepare and still don't dare to ask, "Excuse me, are my fries and milk tea ready?" I even sweat a lot because there are so many people around.
After looking more closely at the responses and questions, I realize that I seem to have selective mutism, but it seems very selective.
I am afraid to speak in public with one person (unless everyone around knows each other).
If there is a one-on-one conversation without anyone I know nearby, I can speak, but if the other person has someone listening nearby, I can't do it.
Later, I looked at Wikipedia, and it seems that these two methods are what I used after making my first friend in the new class: 1.
Stimulus Fading - the patient is brought into a controlled environment with someone they feel comfortable talking to.
Through several small steps, another person is gradually introduced.
These steps are often completed in different stages, bringing the other person into the patient's speaking circle, known as "infiltration." The person brought in often requires a longer time.
2.
Desensitization - the patient first communicates indirectly to prepare psychologically for the next step.
These indirect methods include phone calls, recorded messages, emails, and online chats until they can communicate more directly.
However, in the new class, everyone already knows each other, and even if there is someone I know, I still don't dare to speak because I am still afraid.
I want to join the conversation, but I just quietly watch them chat without saying anything.
Do the two methods mentioned above still apply? Is selective mutism a form of social anxiety disorder? Is it possible to overcome this on my own?

Yuehan, 10~19 year old female. Ask Date: 2015/08/09

Dr. Ding Shuyan reply Psychiatry

Hello, online discussions are not very suitable for making medical diagnoses, but let's assume you indeed have social anxiety disorder and exchange some opinions.
Psychotherapy is highly individualized; while there are theories and guidelines available, their application to each person still depends on individual characteristics.
There is a significant gap between the resources available online, the knowledge found in books, and how to apply them to specific cases.
The duration of psychotherapy may be longer compared to pharmacotherapy, especially for issues related to personality traits rather than short-term stressors.
Therefore, discussing your psychotherapy online cannot delve into too much detail, and typing is a very inefficient substitute for conversation.
In the past, when we learned psychotherapy, transcribing a 50-minute audio recording could take several hours.
Even if you have the time, there are few therapists online willing to engage in such an unproductive manner with a client they have never met.
Regarding the behavioral therapy you mentioned, if it involves cooperation from those around you, it might be more feasible in kindergarten or elementary school settings.
However, it is rare for high schools to reach such levels of involvement, and even family members are often unwilling to invest that much time.
The reason is that modern individuals often lack sufficient time; if they do have time, they tend to use it for their own activities.
If it becomes too complicated, they would rather suggest you see a doctor and leave it to the professionals.
Hospital psychologists should provide you with a more comprehensive treatment plan.
Lastly, my advice is that you need to confirm the diagnosis before discussing subsequent treatments; this logic is indisputable.
For example, if a person has a fever and insists on believing it is a urinary tract infection while researching related issues, but ultimately sees a doctor and is diagnosed with pneumonia, this process not only delays treatment but also wastes time and energy.
Medical care in Taiwan is very affordable; visiting advanced countries in Europe and the U.S.
makes you realize how inexpensive it is to see a doctor in Taiwan—it's almost unbelievable.
Even if you end up not being ill, neither the doctor nor the health insurance bureau will penalize you.
If you are afraid, you can wear a mask, sunglasses, and a hat; many people go to the hospital this way.
Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2015/08/09

More Info

Selective mutism is a complex anxiety disorder that primarily affects children but can persist into adulthood. It is characterized by an inability to speak in certain social situations, despite being able to speak comfortably in other settings, such as at home or with close family members. Your experiences of feeling anxious in social situations, particularly when surrounded by unfamiliar people, align with the symptoms of social anxiety disorder and selective mutism.

From what you've described, it seems that your fear of speaking in public settings, like the breakfast shop, is indeed a manifestation of social anxiety. The physical symptoms you experience, such as sweating and the need for extensive mental preparation before speaking, are common indicators of anxiety. The fact that you can speak comfortably with one person but struggle when others are present suggests a heightened level of anxiety in group settings, which is characteristic of both social anxiety and selective mutism.

The two methods you mentioned—stimulus fading and desensitization—are effective therapeutic approaches for addressing selective mutism and social anxiety.
1. Stimulus Fading: This method involves gradually introducing the individual to social situations in a controlled manner. For example, you might start by practicing speaking in a low-pressure environment with a trusted friend or family member. Once you feel comfortable, you can gradually increase the complexity of the situation by introducing more people or moving to a busier environment. This gradual exposure helps reduce anxiety over time.

2. Desensitization: This technique focuses on reducing anxiety through indirect communication methods before progressing to direct communication. You might begin by engaging in conversations through text messages or social media, which can feel less intimidating than face-to-face interactions. Once you feel more comfortable with this form of communication, you can transition to speaking in person.

Both methods can be beneficial for you, especially as you navigate new social environments like your new class. It's important to remember that overcoming selective mutism and social anxiety is a gradual process, and it's okay to take small steps.
Additionally, it’s crucial to seek professional help. A mental health professional can provide tailored strategies and support to help you manage your anxiety. Cognitive-behavioral therapy (CBT) is particularly effective for social anxiety and can help you challenge negative thoughts and beliefs about social situations.
Moreover, consider joining support groups where you can connect with others who share similar experiences. This can provide a sense of community and understanding, which may ease some of your fears about social interactions.

In summary, while selective mutism and social anxiety can be challenging, they are treatable conditions. With the right strategies and support, you can learn to manage your anxiety and improve your social interactions. Remember, progress may be slow, but every small step counts. Don't hesitate to reach out for help; you don't have to face this alone.

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