The more you socialize, the more socially confident you become. But what if you can’t even bear the thought of showing up?
That’s how the 15 million Americans who have social-anxiety disorder (a persistent, debilitating form of shyness) feel. Some are in such a panic about interacting with people that they have a hard time holding down a job or making friends. In extreme cases, even dining out can be a challenge, because they feel self-conscious about being observed by strangers as they eat. Fortunately, “people can get better,” says John R. Walker, Ph.D., a professor of clinical-health psychology at the University of Manitoba, in Canada, and a coauthor of Triumph Over Shyness. “But because social-anxiety disorder can have so much of an impact on work and relationships and can lead to other mood disorders, such as depression, treatments work most efficiently when you seek them early—as soon as you realize that the condition is interfering with your quality of life.” Here, a few options, often recommended in combination, that will help you muster the confidence to mingle.
There are many types to choose from, but the best established is cognitive behavioral therapy (CBT), which helps patients identify the negative thoughts that prevent them from socializing and then reappraise them. (For instance: replacing the idea that “people will laugh at me” with “chances are, they won’t, and if they do, it has no impact on my happiness.”) As you progress, the therapist will then create social homework assignments that gradually expose you to social situations (such as saying hi to your mail carrier). Typically, patients may start to see improvement after four to six weekly sessions. In a study published in the journal JAMA Psychiatry last fall, subjects who completed 16 sessions reported feeling lower levels of negative emotions. In addition, scans of the brains of the subjects showed increased activity and connectivity in the areas of the brain that are related to emotional regulation.
Selective serotonin reuptake inhibitors (SSRIs), frequently used to treat depression, are also often prescribed for social anxiety. By altering your levels of serotonin (a neurotransmitter that regulates mood, including stress), these medications may help you feel less inhibited about interacting with others. Side effects (such as fatigue, nausea, and weight gain) affect up to 40 percent of patients. If the side effects don’t go away in the first few days, your doctor may be able to manage them with a change in dosage or a switch to a similar medication, says Beth Salcedo, a psychiatrist and the medical director of the Ross Center for Anxiety & Related Disorders, in Washington, D.C. An SSRI typically takes two weeks to begin to work, Salcedo notes, and eight weeks to yield full improvements, though these may fade if you discontinue your prescription.
A range of mind-body techniques (including acupuncture, meditation, and yoga) can be used daily, weekly, or on an as-needed basis before a taxing social event. These alternative therapies appear to calm anxiety through relaxation, but there may be other factors at work, says Salcedo. Yoga and meditation train the brain to focus on the present, so that the mind doesn’t wander into “what if” territory. A 2012 Boston University School of Medicine study reported that, when compared with a control group that walked for exercise, subjects who did an hour of yoga three times a week for 12 weeks experienced less anxiety in general and had elevated levels of GABA (gamma-aminobutyric acid), a neurotransmitter associated with lower levels of stress hormones, such as cortisol. Acupuncture is thought to affect blood circulation, which in turn may influence the way a person experiences anxiety. More research is needed to determine how this works, but a 2013 Journal of Endocrinology study on stressed-out rats suggests that the needles, like yoga, may actually affect the levels of stress hormones in the body.
Find tested confidence-boosting strategies in How to Overcome Shyness.