To Avoid & Suppress or To Explore: New Help for Social Anxiety Disorder

Social Anxiety Disorder (SAD) is a broad fear of being negatively evaluated in social and performance situations that prevent a person from enjoying time with other people and living a full and satisfying life. Although the prevalence of this disorder in the general population is higher in the United States (2.8% of the total population in a 12-month evaluation period), SAD is also prevalent in European (2.3%) and non-European countries. However, cross-cultural findings show that people’s social concerns need to be examined in the context of the person’s cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and social anxiety disorder. As you might expect occurrence rates go up with the cultural value for avoiding social embarrassment, as in the non-European countries of Japan, Korea and China (Culture Social Anxiety and Social Anxiety Disorder).

Despite SAD’s high rates of occurrence, especially in the United States (5.3 million American Adults), and that it is the third most common U.S psychiatric disorder, the condition has only recently achieved recognition as a distinct anxiety disorder (also known as social phobia). This is partly due to the challenge in differentiating SAD from other mental health conditions. Social Anxiety Disorder shares the symptoms of excessive fears, self-consciousness and withdrawing from social situations with obsessive-compulsive disorder, body dysmorphic disorder, panic disorder, agoraphobia, and major depression (National Center for Biotechnology Information).

Also, SAD is often mistaken as shyness, which is more a trait of personality than a mental health disorder. But, SAD is much more than a little shyness. Counter to intuition, there is a weak relationship between social anxiety disorder and personality shyness. Although the prevalence of social phobia is significantly higher among shy persons (18%) compared with non-shy persons (3%), the majority of shy persons (82%) are not socially phobic (National Center for Biotechnology Information). In contrast to people with SAD, shy persons do not avoid social situations because of an intense, irrational, and persistent fear of being scrutinized or negatively evaluated by other people. Too, the positive suggestion of the term social plays into a misbelief that SAD is trivial and undermines people less than some of the other mental health conditions, so that it has not received the same attention from the public or mainstream media as other mental health disorders.

In spite of these diagnostic and public awareness issues, SAD is a distinct psychiatric behavioral disorder that is far from trivial. It usually makes it presence around 13 years of age and can affect people’s functioning for their entire lives, if left untreated. Actually, 36 percent of people with social anxiety disorder report symptoms for 10 or more years before seeking help (Anxiety and Depression Association of America), as they are too embarrassed to let anyone know that they are socially afraid. But, if left untreated, SAD can have a significant impact on an individual’s personal and professional life. It is associated with lower levels of educational attainment, single marital status, unemployment, fewer days worked, and reduced work productivity (SAD: More Than Just a Little Shyness).

Cause and Symptoms

SAD’s distinguishing feature is a “marked and persistent fear of social or performance situations in which intense anxiety and embarrassment may occur” ( anxiety disorder). Being socially introduced, meeting a person in authority, job interviews, telephone conversations, being called upon in a class, giving a class or work presentation, and even having to sign one’s name while being observed by another person can cause a person with SAD considerable anxiety and distress that can be as intense as a panic attack (sweating, shaking, garbled speech, blushing, heart racing, mental confusion, and gastrointestinal and respiratory distress). Awareness that others may see visible signs of their anxiety further compounds their physical and mental anguish (DSM V).

Routine activities, for you and me, are torturous to them. Although they fear being scrutinized and judged by others, it is actually the overwhelming discomfort of high arousal that reinforces socially-avoidant behaviors. People with SAD have a strong tendency to avoid situations that activate high arousal in them that usually begins in childhood. The normal activities of going to school, socializing with other children, giving class presentations, social introductions, attending school parties, and making friends is highly stressful for them. As adults, they may arrange to be sick on days of work presentations, choose jobs that socially require very little of them, and pass on social opportunities that would open them up to friendship and romance.

Socially anxious people are not unsociable. They are very unhappy about their condition. But, the extreme discomfort of high physiological arousal overshadows their longing for social contact. They have learned to regulate the negative emotions they have around their fears by avoiding and suppressing their emotions rather than exploring them.

Stop Avoiding and Suppressing and Start Exploring!

Research shows that we are more apt to use coping strategies that regulate our emotions, if we explore our emotions rather than avoid and suppress them. One study found that by reappraising the meaning of the threat, anxiety lowers to the point where people stay in social situations that they fear (Emotion Regulation Strategies Influence Anxiety, Huffington Post, 2013).

Cognitive reappraisal does alter emotional experience, and today, there’s brain research that supports these findings. When you get a person to look at a social stressor in a new way (alter perspective), the areas of the brain instrumental in creating positive emotions and mitigating negative ones (frontal lobes) activate so that feelings are brought into line with the realistic demands of a situation (

Dr. Salvatore R. Maddi’s hardiness approach to turning adversity into opportunity first identified the power of reappraisal (1984) in resilience and coping, in his landmark study on personality hardiness at the Illinois Bell Telephone Company (Turning Lemons into Lemonade, American Psychological Association, S. R. Maddi). By reframing and reappraising our emotions and ideas around stressful situations, we come to meanings that transform strong, negative emotions, gain distance from what is happening, and find healthier ways to cope with stressors. (Hardiness Institute, Inc).

Treatment of Social Anxiety Disorder

1. Treat the state of high-arousal. Remember, people with SAD are physiologically in distress. Although learning emotional regulation strategies is key in the recovery process, sometimes we have to treat the high arousal first, so that one can be calm enough to transform meanings around their fears. It’s hoped that over-time, when the person is calm enough to stay in situations he or she fears, they can cut back on medication or may no longer need it (SAD, Treatment and Drugs, Mayo Clinic).

2. Comprehensive Cognitive Behavioral Treatment (CBT). Cognitive-behavioral therapies include reappraisal techniques for regulating emotions. Treatment involves reappraising negative ideas around high arousal from a downfall to a benefit (“My arousal will do me  in” to “I need some arousal to perform well”). Such transformations promote approach-oriented patterns of responding to stressful social situations while still maintaining stress arousal necessary for optimal performance (Changing the Conceptualization of Stress in Social Anxiety Disorder). You can try reappraising your emotional fears on your own. Or seek out a trained CBT professional who can guide you in this treatment.

3. Mindfulness-Based Therapies (MBT). As you know by now, social anxiety disorder has to do with an unreasonable estimation of threat. Cognitive behavioral therapies (CBT) see the actual thoughts as causing the unrealistic estimation of threat. They aim at replacing distorted thoughts with more realistic ones, so that threat lowers and the person can approach situation once feared. Mindfulness-based therapies (MBT) see the relationship one has to thinking as the problem in social anxiety. If we believe that we are our thoughts, we give thinking great power over us. For example, I have the thought that I will fall apart in this social situation. In CBT, I actually fall apart because I am my thoughts. If we gain enough distance between our self and thinking, then thinking has less power over us. Now, when I have the thought that I may fall apart in this social situation, I do not, because I know that I am separate from my thoughts. The same idea applies to physical arousal involved in social anxiety. If we stay present to anxiety, observe it as a state that does not dictate our actions, then, it dissipates.

Also, people with social anxiety often try to avoid what they fear by diverting their gaze from people and things that threaten them. It is the fleeing part of the fight-or-flight response to threat. Meditation increases their ability to stay focused (visual attention) on the feared stimulus rather than running away from it. They learn to explore rather than to express their feelings around it, which in turn helps them to positively reappraise the threat  (Meditation Helps People with Social Anxiety).

Social anxiety disorder can be diagnosed through a careful history and can be treated successfully with the treatments I suggest here. Adequate relief from social anxiety is the goal. So that a comprehensive range of treatment is the best way to treat social anxiety disorder. Working with cognition, behavior, and self-awareness are critical to getting as much relief from SAD as possible. A trained and skilled CBT and MBT therapist will know the methods, strategies, and ideas most useful to treatment. As with all mental health disorders, there is no quick fix and recovery is a process. Embrace it and get better today!

I hope you liked my post today and learned something new about social anxiety disorder. If you did, please let me know by selecting the Like icon that immediately follows. You can also Tweet or Google+1 today’s post to let your friends know about it. Be well friends. Warmly Deborah.

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37 Responses to “To Avoid & Suppress or To Explore: New Help for Social Anxiety Disorder”

  1. avatar Zerevan M Xalid says:

    Thank you very much. Really useful these things for our daily lives. Wishing you all the best. ^_^

    • Hello Zerevan, thank you. I’m so glad that my articles are useful to everyone’s lives. And, thank you for your friendship and support. Be well Zerevan. Warmly Deborah.

      • avatar zalmon says:

        i have a problem…i want to b somthing else..but am studying smthing else…but i cannot convince my family to give me permision whatever i want to b….sometime i get stucked while giving presentation in front of my fellows…whats the basic problem with me?

        • avatar Dr. Deborah Khoshaba says:

          Hello Zalmon, I’m unsure exactly what the trouble is. But, you mention anxiety (getting “stuck”) when giving presentations. If you have this problem in many situations, then, you may have an anxiety problem. Zalmon, if possible you should go to a professional who can help you to make the proper diagnosis. You take good care. Warmly Deborah.

  2. avatar Amy says:

    Dr Deborah, is it possible to have Generalized Anxiety Disorder (GAD) but not SAD-
    Or is it all pretty much the same- ??
    Loved the article!
    Thank You

    • Hi Amy, yes! It is possible to have GAD, but not SAD. In fact they are different anxiety disorders. One is specific to social situations (SAD) while the other is a generalized anxiety that does not have one specific target as a fear.

      I have a post on GAD that describes its cause and treatment too. What a great question. Thank you for taking the time to write. Warmly Deb.

  3. This is a great article, Debbie. Thank you so much for showing that HardiTraining and HardiAssessment are an important part of dealing well with stresses.

  4. avatar deana says:

    Thank you for your treatment of this disabling condition. I am not sure what the research says, but I think many persons with undiagnosed SAD end up smoking marijuana to ease their anxiety. Unfortunately, marijuana further reduces motivation to work and seems to make anxious persons even more comfortable hanging out alone.

    Incidentally, do you know whether systematic de-sensitization therapy is another effective treatment for SAD, or just specific phobias?

    In any case, I have evaluated and found co-morbid SAD in a good number of teens and young adults with Asperger’s Disorder. In these cases, the anxiety about social interaction and performance extends beyond concerns related to social communication deficits associated with Autism Spectrum Disorder. I like the idea very much of assigning job coaches and mentors to such persons in order to help them and others feel comfortable and cope effectively along with the disabled person.

    Thanks for all you do. xoxo dd

    • avatar Dr. Deborah Khoshaba says:

      Hello Dr. Deana. Thank you for taking time to comment today and sharing with all of us your good comments and questions. Yes, I’m sure systematic de-sentization therapy helps with feared situations in SAD. I see why you mention it here–in some ways, it is a reappraisal technique where people lower arousal and slowly desensitize themselves toward the feared social and performance situation by pairing it with realistic thinking.

      Also, thank you for the information on the relationship between Autism, Asperger’s and SAD. Love if you wrote an article on this for us. Warmly Deborah.

  5. avatar Dr. Tallat says:


    As I’m working in drug rehabilitation Facility, here in islamabad, Pakistan. This article really amazing and would certainly help me professionally. I will invite my colleagues to go through it and will also share on my wall so my friends also read it. Thanks

    • avatar Dr. Deborah Khoshaba says:

      Hello Dr. Tallat, thank you for taking the time to comment today. I’m so glad that this article will be helpful. Yes, people who tend to go for drugs and so forth often are medicating high arousal. Thank you again and for your dedicated work in mental health. Talk with you soon. Warmly Deborah.

  6. avatar Rachel Saunderson says:

    What are the main differences between SAD and Avoidant Personality Disorder? I’d like to know please because I’ve read the traits of AvPD and I have most if not all of them but when I did an anxiety course I was told that I didn’t have a personality disorder.

    • avatar Dr. Deborah Khoshaba says:

      Hello Rachel, you ask an excellent question that is an ongoing debate in psychiatry and psychology. We used to distinguish between SAD and APD based on one as an acute mental health condition and one as an issue in personality development that actually becomes part of the personality. Rachel, whenever the word personality disorder is used in psychiatry, it means that the way of being is now a part of the personality and thus not experienced as extreme discomfort and distress in the person. In other words, it’s not a foreign feeling to the person. In contrast, an acute condition as in social anxiety disorder, the symptoms cause the person much distress–they are not integrated into the personality and thus have just become a normal way of being.

      But, again, this is an ongoing debate in the field. Thank you for an excellent question. Good to say hello. Warmly Deborah.

  7. avatar zartasha says:

    Great articl that was…..superb… boast up my knowledge about SAD…..i wanna linked up with you for further info…

    • avatar Dr. Deborah Khoshaba says:

      Hello Zartasha, thank you. I’m glad the article increased your knowledge of SAD. This is what I hope for. Warmly Deborah
      You can link to me on FB ( and also on Twitter (Deborah.Khoshaba).

  8. avatar Laiba says:

    This is great article i myself is a patient of by-polar disorder sometimes its really difficult to deal with the mess during high moods.I want to be a normal one like past days.Hope u can help me.I m getting medication taking, resperidone and carbamazepine and procyclidine HCL daily.

    • avatar Dr. Deborah Khoshaba says:

      Hello Laiba, bipolar disorder can be hard to manage because of the ups and downs in moods. I understand Laiba. It’s hard to not have biology in our control. Okay, so you are on medication; that is good. It should help stabilize your moods. Have you read my article on Bipolar disorder. This is the link to it;

      Laiba,the best way to be normal with bipolar is to stay on your medication and if possible to get therapy to help with any emotional issues related to the disorder. Thank you for sharing with me today. Take good care of yourself Laiba. Warmly deborah.

  9. avatar Scream says:

    It was very helpful for me, Now I understand what I am suffering from. Thank you very much for the nice article.

    • avatar Dr. Deborah Khoshaba says:

      Hello Scream (is your screen name a ref. to Munch’s famous painting?) I like it! I’m so glad that you know now what has been troubling you. I hope you get the help you need, because there is much help for SAD today. And, as you learned in my post — you are not alone. Warmly Deborah.

  10. avatar Faisal says:

    Hi Dr Deborah , is it possible that Anxiety makes ur legs or spinal very weak that u cant sit and stand properly like normal peoples do ?

    • avatar Dr. Deborah Khoshaba says:

      Hello Faisal, yes, it definitely can make your legs and back feel weak. Anxiety can make us tremble and take a lot of energy out of us so that we feel weak. Faisal, you may wish to talk to someone professionally about this to get the right diagnosis. But, just to let you know that anxiety can definitely do what you describe here. You take good care. Warmly Deborah.

  11. avatar shruti sharma says:

    Ma’am it’s a rich source of literature which you’ve rendered to all of us.Extremely informative piece of writing.I truly enjoyed reading it!

    • avatar Dr. Deborah Khoshaba says:

      Hello dear Shruti, thank you dear. I’m so glad you liked this article. I hope your studies are going very well. I’m sure they are. Warmly Deborah.

  12. avatar Ashim Ghosh (Dilu) says:

    Dr. Deborah, At first- Loved the article! thanks a lot for your article. I am always thinking negative. But I realize that it’s not good. But I can say that I would like change it & try think Positive. I also try change my Attitude. Would You help me by your great Tips.

    Thank You,

    Your Loving,


  13. avatar Alishpa Majeed says:

    Great article Dr.Debora Khoshaba.
    Most of the time it happens to me that I cannot communicate effectively with my friends, family and in class. I plan everything which I want to say but when the time actually comes I remain silent.I do not know either it is fear of rejection or something else. This problem is creating lot of problems in my life.I want to ask is it some type of disorder?Can you guide me?


    • avatar Dr. Deborah Khoshaba says:

      Hello Alishpa, thank you. I know this must cause you some pain, because there’s much inside of you you want to communicate and interact with people. It is a disorder that does have a biological basis — your fears overcome your best intentions. Yes, I’m happy to guide you. Alishpa, I don’t know you live, but you should go to a psychologist or psychiatrist where you live and talk about this problem. There is real help for this disorder. You may have to take a medication for a while to lower your anxiety enough to let you overcome your fears. Then, you can practice the reappraisal techniques I mention in the article. Alishpa, I hope this is an option. Let me know how it goes for you will you? Warmly Deborah.

  14. avatar Zahid Hussain Mirani says:

    Indeed a best effort to pen down a real cure of the social disorder

    • avatar Dr. Deborah Khoshaba says:

      Hello Zahid, thank you for your comment. I am glad that you found the article helpful to treating the disorder. Good to say hello. Warmly Deborah.

  15. thank u for a detailed and very useful
    information on sad

    • avatar Dr. Deborah Khoshaba says:

      You are so welcome. Dr. Syed. I’m very glad this post will be useful. Thank you for taking time to write me today. Warmly Deborah.

  16. avatar ayesha says:

    mam my problem is shyness…. when i start giving presentation my body getting cold,,,, and start shivering….. my voice getting unclear…. so plz help me?

  17. avatar Syed Zohaib says:

    Informative article I am trying to read with concentration with practice of given techniques to coup up my SAD….thanks Dr Deborah for giving me right info and line of action….awaited for more fruitful tools to enhance confidence and personality…..

    • avatar Dr. Deborah Khoshaba says:

      Hello Syed, please let me know how it all goes. Thank you for your nice comments. But, mostly, I appreciate your dedication to your well being and life. Warmly Deborah.

      • avatar Syed Zohaib says:

        Well Dr Deborah I just trying to get control my thoughts but triggering just stuck me in various situation.. but I have a courage to cure SAD with your positive and effective research and techniques sharing…..Regards Zohaib

  18. avatar Syed Zohaib says:

    Well Dr Deborah I just trying to get control my thoughts but triggering just stuck me in various situation.. but I have a courage to cure SAD with your positive and effective research and techniques sharing…..Regards Zohaib


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