Treating Social Anxiety Disorder with Mindfulness

by Paul Jozsef

It’s completely normal to feel anxious in social situations. Be it giving a speech or talking on the phone, social anxiety affects a surprisingly large percentage of the population. However, when one experiences considerable distress and an impaired ability to function in at least some parts of their daily life, it is likely to be diagnosed as social anxiety disorder.

Many people with social anxiety disorder do not know that they have it. They may recognize that there is something ‘wrong’, but do not know what it is or what to do about it. This is where mindfulness can help. By being ‘mindful’, aware of the present moment, one can identify that they feel ‘some kind of way’. Through practice, rather than being self-critical, or judging the anxiety-provoking situation, one can learn to accept things as they are rather than the way they ‘ought’ to be. This, in turn, can lead to an increase in self-compassion and the reduction of social anxiety symptoms.

What is Social Anxiety Disorder?

Social anxiety disorder is generally understood to be characterized by a marked fear of situations in which there is potential for embarrassment or humiliation in front of others. It is important to note, it is merely the ‘potential’ for embarrassment or humiliation, not necessarily any actual negative experience. It is this fear that makes social anxiety disorder so insidious.

Social Anxiety Disorder Symptoms

The symptoms of social anxiety disorder are generally triggered by two main social categories: performance situations and interpersonal interactions. Performance situations are where people feel they are being observed by others. Situations such as public speaking, eating in front of others or using a public washroom can all be triggering to someone who suffers from social anxiety disorder. Interpersonal interactions are those where people are interacting with another person. Interactions such as talking to friends or co-workers, dating or ordering food at a restaurant can also be extremely triggering.

When triggered by one of these social situations, an individual with social anxiety disorder may experience physical, emotional, and behavioural symptoms. Physical symptoms may include rapid heartbeat, stomach issues, shaking or trembling, excessive sweating and blushing. Emotional symptoms may include extreme fear and anxiety, nervousness, panic attacks and body dysmorphia (particularly concerning the face). Behavioural symptoms include avoidance of social situations, refraining from social activities due to fear of potential embarrassment, isolating oneself and excessive alcohol and substance abuse.

Age of Onset

Social anxiety disorder has a relatively early age of onset. Symptoms generally manifest at around 13 years of age. A significant number of people who develop social anxiety disorder in adolescence recover before reaching adulthood. However, only about half of those with the disorder ever seek treatment. Moreover, those who do seek treatment, generally only do so after 15-20 years of experiencing symptoms. There are several explanations for this: it may be due to embarrassment or fear about seeing a professional or because they feel their shyness is part of their personality, or ironically, a function of the disorder itself.

Prevalence of Social Anxiety Disorder in Canada

Social anxiety disorder is one of the most common anxiety disorders in Canada. Lifetime prevalence rates of up to 12% have been reported compared with lifetime prevalence estimates for other anxiety disorders of 6% for generalized anxiety disorder, 5% for panic disorder, 7% for post-traumatic stress disorder (PTSD) and 2% for obsessive-compulsive disorder (OCD).

What is Mindfulness?

Mindfulness is a mental state achieved by focusing one’s moment-by-moment awareness, while calmly acknowledging and accepting one’s thoughts, feelings, physical sensations and surrounding environment, in a gentle, non-judgmental way.

It is important to note, that mindfulness involves a sense of acceptance. That is, paying attention to thoughts and feelings without judging them—without believing, for instance, that there’s a “right” or “wrong”, “good” or “bad”, way to think or feel in a given moment.

Though mindfulness has its mindfulness roots in Buddhism, secular mindfulness has become popular in the West due in part to the work of Jon Kabat-Zinn and his Mindfulness-Based Stress Reduction (MBSR) program developed during the late-1970s.

How to Practice Mindfulness?

The practise of mindfulness is not overly difficult. The real work is remembering to practice it. There are many ways to practice mindfulness, below is a short ‘formal’ practice to help get you started:

1. Take a seat – Find a place to sit that feels safe, calm and quiet.
2. Set a time limit – It can help to choose a short time, such as 5 or 10 minutes.
3. Notice your body – Notice how your body feels against the chair or cushion. Notice any aches or pains. Notice any need to fidget.
4. Follow your breath – Follow the sensation of your breath as it goes out and as it goes in.
5. Notice when your mind has wandered – Your mind will wander, it’s what minds do. Your attention will leave the sensations of the breath and wander to other places. When you notice this, in a few seconds or a few minutes, simply return your attention to the breath.
6. Be kind to your wandering mind – Try not to judge yourself or obsess over the content of the thoughts you find yourself lost in. Just come back to the breath and start again.

Mindfulness is essentially the practice of paying attention to the present moment – thoughts, feelings and physical sensations. With practice, one can learn to gain psychological ‘distance’ from their worries and negative emotions, seeing them as an observer, rather than being engrossed with them . As one gets better at recognizing unhelpful thoughts, uncomfortable emotions and/or sensations as they arise, they will also get better at choosing how they react, or not react, to said thoughts and sensations.

How can Mindfulness be Used to Treat Social Anxiety Disorder?

Through the practice of mindfulness, one can learn to notice their ‘social’ discomfort arising. For example, in a social situation, someone with social anxiety may be reluctant to join a conversation or make a phone call for fear of being judged or criticized. They may begin thinking, “everyone thinks I’m stupid”. Their heart rate may increase and they may begin to sweat. Through the practice of mindfulness, the person may be able to recognize these thoughts as unhelpful and as merely thoughts, which may or may not be true. With practice, the person may be able to accept these thoughts as fleeting, return to the breath and try to calm down. At this point, the person may be able to join the conversation or make the phone call.

It must be emphasized, that mindfulness is practice. The same way one cannot expect themselves to be able to play Mozart’s Symphony No. 5 on their first try, it is the same with using mindfulness to treat social anxiety disorder. Mindfulness needs to be practiced to be ‘good at it’. Accepting the fact that overcoming social anxiety is hard, and will probably be hard for a while, is part of the practice. Through acceptance, a sense of self-compassion may also arise – “I have these negative thoughts about myself. I may not like them, but for now, it is part of me, my experience. I am OK, experiencing social anxiety doesn’t lessen my self-worth.”

Social anxiety disorder is a very common anxiety disorder affects approximately 7% of Canadian every year. It can be treated using a variety of methods. However, one of the most efficacious is mindfulness. Mindfulness is essentially paying attention to present moment thoughts and sensations. By practicing mindfulness regularly, one can begin to reduce the anxiety felt in social environments, be it in performance situations or interpersonal interactions.

The practise itself is not difficult, however, remembering to do it is. This is why it is important to establish a regular practice: notice the discouraging thought, accepting that one is experiencing social anxiety, coming back to the breath, letting the go of the discouraged, starting again. This is the practice.