Social Anxiety: Overcoming Fear in Familiar Settings

Social Anxiety Disorder?

Hello, Doctor: When I engage in general social activities alone, I usually don't feel too anxious because I know they are just strangers I've met once and will forget quickly.
I don't have to be responsible for them.
However, when it comes to interacting with acquaintances or people I need to work with long-term, such as during work, presenting in front of classmates, or speaking with teachers, I feel awkward and uncomfortable.
I find myself unconsciously biting my nails or shaking my legs.
In casual conversations, I often overthink what others might say, what I should say, and whether my comments might make others uncomfortable.
I can't be as relaxed as when I'm alone; I tend to overprepare and hesitate to express my opinions, always fearing negative feedback or consequences from my decisions, including being labeled negatively.
When I'm doing tasks, I sometimes lose track of what I was doing and complete them purely on instinct, occasionally making thoughtless mistakes.
Only after finishing do I feel my brain start functioning again and experience a sense of relief.
Could this be social anxiety disorder? If so, how can I overcome it? Should I try to engage more and speak up, or should I focus on improving my social skills? Thank you, Doctor.

Niming, 20~29 year old female. Ask Date: 2016/03/16

Dr. Ding Shuyan reply Psychiatry

Hello, regarding your inquiry about disease diagnosis, it is actually not permissible to conduct remote consultations online.
However, let's share some medical knowledge for your reference.
If someone exhibits the behaviors you described, they may be experiencing social anxiety disorder.
Many individuals face this issue, but the severity varies.

One of the simplest and most effective methods is to practice relaxation techniques and diaphragmatic breathing.
With consistent practice, you can effectively relax your muscles, which can help reduce psychological tension.
When we encounter situations that previously caused us anxiety—such as increased heart rate, trembling, sweating, nail-biting, muscle tension, and difficulty breathing—if we have practiced relaxation, these physical symptoms may become less pronounced, leading to greater psychological confidence.
You can practice muscle relaxation whenever you have free time; short sessions done frequently are beneficial, and the more you practice, the better you will become.
Engaging in more social interactions and conversations is also important, but forcing yourself into situations without any changes can sometimes lead to frustration.

If you practice relaxation techniques and combine them with real-life exposure to anxiety-provoking situations, you will gradually build courage and confidence.
Improving social skills is also beneficial, but it may not be our primary focus at this moment.
Moreover, qualities such as sincere communication, kindness, and reliability may be more important than social skills themselves.
Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2016/03/16

More Info

Social anxiety can be a challenging condition to navigate, especially in familiar settings where the stakes feel higher due to existing relationships. Your experience of feeling more at ease with strangers but anxious around acquaintances, colleagues, or classmates is quite common among individuals with social anxiety disorder (SAD). This condition often manifests as an intense fear of being judged or negatively evaluated by others, leading to avoidance behaviors and significant distress in social situations.

From your description, it seems that you experience anticipatory anxiety, where you worry excessively about how others will perceive you and the potential negative outcomes of social interactions. This can lead to physical symptoms such as nail-biting or fidgeting, as well as cognitive distortions, where you may overthink your responses or actions. The feeling of being on autopilot during interactions, where you complete tasks without fully engaging, is also indicative of the mental strain that social anxiety can impose.

To address your concerns, it is essential to understand that social anxiety is a treatable condition. Here are several strategies that can help you manage and overcome your fears:
1. Cognitive Behavioral Therapy (CBT): This is one of the most effective treatments for social anxiety. CBT helps you identify and challenge negative thought patterns and beliefs about social situations. By reframing these thoughts, you can reduce anxiety and improve your confidence in social interactions.

2. Exposure Therapy: Gradual exposure to feared social situations can help desensitize you to anxiety triggers. Start with less intimidating scenarios, such as speaking to a classmate or colleague in a low-stakes environment, and gradually work your way up to more challenging situations, like giving a presentation.

3. Mindfulness and Relaxation Techniques: Practicing mindfulness can help you stay present during social interactions, reducing the tendency to overthink. Techniques such as deep breathing, progressive muscle relaxation, or meditation can also help manage anxiety symptoms.

4. Social Skills Training: Building your social skills can enhance your confidence in interactions. This may involve role-playing scenarios, learning effective communication techniques, and practicing active listening. The more comfortable you become with these skills, the less anxious you may feel.

5. Gradual Engagement: Instead of forcing yourself to engage in social situations all at once, set small, achievable goals. For example, aim to contribute one comment during a group discussion or initiate a brief conversation with a colleague. Celebrate these small victories to build your confidence.

6. Seek Professional Help: If your anxiety significantly impacts your daily life, consider consulting a mental health professional. They can provide tailored strategies and support, and if necessary, discuss medication options that may help alleviate symptoms.

7. Self-Compassion: Be kind to yourself. Recognize that everyone experiences anxiety in social situations to some degree. Accepting your feelings without judgment can reduce the pressure you place on yourself.

In summary, your experiences do align with symptoms of social anxiety disorder, and it is crucial to approach this condition with a combination of self-help strategies and professional support. By gradually exposing yourself to social situations, challenging negative thoughts, and building your social skills, you can work towards feeling more comfortable and confident in your interactions with others. Remember, progress takes time, and it's okay to seek help along the way.

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