I practiced with three classmates in middle school to be in the school talent show.

But as it got closer, I became increasingly anxious about being a failure in front of everybody.

What if I couldn’t remember the words?

What if I tripped coming on the stage?

What if I got sick in front of everyone?

What if they thought I was awful?

These worries became so bad that I dropped out two days before the show. No surprise, my friends were mad at me for the sudden departure.

They did fine without me, but I was still embarrassed that people knew I had bailed on my obligation.

I have had many instances where those types of worries made it hard for me to perform socially, in school, or in my profession.

I finally got a handle on it so that it didn’t stop me from going forward in life, talking to patients, and even doing presentations and all-day seminars in front of strangers throughout the country.

But the feelings were always there.

Using the logic part of my brain, I learned to turn around the “what ifs” and have a plan to avoid or deal with the unexpected.

Eventually, I started taking medication for anxiety issues beyond social anxiety, which lowered the intensity of the conversation in my brain. Still, I also learned how to change the conversation, which is equally or more important than using medication to treat the symptoms.

What is Social Anxiety Disorder?

According to the National Institute of Mental Health, Social Anxiety Disorder is an intense, persistent fear of being watched and judged by others. This fear can affect work, school, and other daily activities. It can even make it hard to make and keep friends. It differs from Generalized Anxiety Disorder in that the latter involves intense worries about many areas of life, such as finances and health.

How common is Social Anxiety Disorder?

Social Anxiety Disorder is widespread, affecting about 5.3 million people (one in 15) in the United States. It is usually first seen in children and adolescents between 11 and 19 years of age– just where I was when I couldn’t participate in the talent show. It’s one of the most common mental disorders affecting males and females.

What symptoms do you notice with Social Anxiety Disorder?

You will notice some behaviors in yourself that others may see also. These are:

• Being self-conscious in social situations
• Having persistent, intense, and chronic fear of being judged by others
• Being shy and uncomfortable when being watched (giving a presentation, talking in a group)
• Being hesitant to speak to others
• Avoiding eye contact

You may also have the following physical symptoms that others may not see unless you tell them:

• Rapid heartbeat
• Muscle tension
• Dizziness and lightheadedness
• Blushing
• Crying
• Sweating
• Stomach trouble and diarrhea
• Inability to catch a breath
• An “out-of-body” sensation

What causes Social Anxiety Disorder?

Several factors can make someone more vulnerable to having Social Anxiety Disorder. These are:

• Genetics or inherited traits
• Brain Structure – Amygdala which is in charge of your fight or flight emotions
• Environmental – either through learned behavior or experiences

Are there risk factors for developing Social Anxiety Disorder?

Several factors increase a person’s risk for developing Social Anxiety Disorder, such as:

Family history – Family members with a history of Social Anxiety Disorder or other anxiety disorders.

Negative experiences - If you have ever experienced teasing, bullying, or rejection, you will be more hesitant to take social and other chances. You would likely have social anxiety problems if you experienced adverse childhood experiences (ACEs), such as abuse, trauma, or family conflicts.

Temperament - Children who are slow to warm up are more hesitant to engage with others they don’t know or in unfamiliar situations. They can develop Social Anxiety Disorder if not supported in their activities.

New social or work demands - Even if you didn’t have problems before, you might experience performance anxiety, a part of Social Anxiety Disorder, whenever you are put on the spot to meet new people or do presentations.

Having an appearance or condition that draws attention – If you have a disfigurement (or feel like you do, such as pimples in teens), tremoring, or stuttering, you could develop Social Anxiety Disorder due to an extreme sense of self-consciousness.

How do you treat Social Anxiety Disorder?

It is essential to realize that treating or caring for your Social Anxiety Disorder is not a one-method approach.

I mentioned that I did start medication (I will not discuss different medications since this is not a medical treatment site) to help with other aspects of my anxiety, which also helped my social anxiety.

Medication can help quiet many physical symptoms, but it does not shut out the thoughts and emotional aspects of the disorder.

Dealing with the thoughts of anxiety is where therapy, usually called cognitive-behavioral therapy (CBT), can be used to help you find ways to answer all those “what if” questions in your mind and reframe all the negative self-descriptions.

Therapy can be a combination of:

 Talking (cognitive-behavioral) therapy,

 Exposure therapy, where you have increasing exposures to the situations which trigger your anxiety, and

 Journaling, where you can privately go through your thoughts, feelings, and beliefs and ask yourself why you believe your mind; if you know facts, say otherwise.

I have a friend who is a licensed marriage and family therapist (LMFT) who published a book last year, which I had the honor to review. It is called “Conquer Social Anxiety Journal: Guided Exercises to Find Calm and Build Confidence.”  Richard Gallagher has done an excellent job of bringing together the questions we need to consider and how to reply to understand better and control our Social Anxiety Disorder. As he notes, it does not substitute for a therapist and possible medication but supports the other elements to change the internal conversation.

The nice thing about journaling, especially in a guided fashion, such as with Conquer Social Anxiety Journal, is that it is private. You can be completely honest about what your brain is saying, believing, or bothering you. However, it would be best if you did that to gain control over the anxiety.

Can social anxiety be cured?

While you can’t say, you have been cured of Social Anxiety Disorder, finding help will allow you to understand and control it much better. You will be more aware of your triggers and be able to prepare for them to get through them successfully.

I know because I was able to give full-day seminars for over ten years by preparing myself beforehand.

I know you can do it too. Be willing to use the methods of medication, talk therapy, and journaling. You will feel much better about yourself.