Understanding and Working with Clients Dealing with Social Anxiety

Social anxiety is extremely common and represents a serious barrier to the recovery of many clients.  In the past it was virtually ignored by most clinicians but it has gotten more attention recently as researchers have documented that it is associated with a range of serious problems including reduced social support, work and school problems, increased risk of depression, and risk of suicide (Barnett, Maciel, Johnson & Ciepluch, 2021).  When it is present in your clients, it is likely to make it more difficult for that client to engage in work, school, and in relationships with family and friends.

You will want to understand how social anxiety and Social Anxiety Disorder work and how to address them so that you can be of help to the large group of clients who have to deal with this.  There are still many clinicians who have relatively little training related to social anxiety and may not recognize it or provide treatment for it.  While this is changing, you will want to look for opportunities to raise awareness of this challenge and encourage clients and your clinical team to respond with treatment and support.

DEFINITION

Social anxiety is characterized by an intense fear of social situations in which the person feels they may be negatively evaluated or scrutinized by other people (Leichsenring, & Leweke, 2017). 

When social anxiety is severe, it qualifies as “Social Anxiety Disorder”.  This more disabling form of social anxiety is very common, being found in around 7% of the population at any one time, with about 12% qualifying for the disorder at some point in their lifetime (Stein & Stein, 2008).  When examined over time, many people with social anxiety go on to develop other mental health conditions including depression, substance use disorders and other anxiety disorders (Koyuncu, İnce, Ertekin & Tükel, 2019) suggesting that you are likely to find high rates of social anxiety among the people you serve if you work with mental health services.

Individuals with social anxiety are typically shy when meeting new people and in unfamiliar social settings. When they are in groups, particularly groups of people they do not know well, they tend to be relatively quiet and cautious in what they say.  They typically have strong desire to be in the company of others and to be comfortable in social settings, but their anxiety often leaves them afraid that other people will consider them “stupid” or unlikeable.  Their behavior can be misinterpreted as being aloof, snobbish, or just reserved, missing the underlying anxiety driving their actions.

ASSOCIATED PROBLEMS

Social anxiety typically begins early in life, typically in early teenage years.  More than 90% of people with Social Anxiety Disorder report that it causes them problems in community functioning, including higher rates of dropping out of school, impaired romantic relationships, poor work performance, reduced income, and poor quality of life (Stein & Stein, 2008).  The disorder has an early onset (mean age, 13 years) and is often chronic, in part because people do not typically seek treatment, and partly because many clinicians do not routinely look for it and when they do, don’t routinely refer for treatment.

 CURRENT INTERVENTIONS

People rarely seek treatment for social anxiety, and so the condition often lasts for many years.  This has been changing, in part because researchers are finding that talking therapies are quite effective in reducing or eliminating Social Anxiety Disorder (Powers, Sigmarsson & Emmelkamp, 2008).  Talking therapies often take the form of group or individual Cognitive Behavioral Therapy or Exposure Therapy.  Medications are often used as well.  Enthusiasm about the effectiveness of treatment has given rise to a host of new treatments including internet-based therapies (Mechler et al., 2024), therapies using virtual reality (Baghaei et al., 2021), and even therapies using social robots (Rasouli, Gupta, Nilsen, & Dautenhahn, 2022).

As a Peer Support Specialist, you can have an important role in ensuring clinicians and clients take social anxiety more seriously and are more active in helping those clients address their anxiety as part of their recovery.  Peers who have personal experience with social anxiety can be particularly pursuasive, helping others understand the ways it undermines recovery and the ways that it can be successfully addressed.

Strategies for Peer Support Specialists to consider include:

1.      Learn as much as you can about this challenging and often hidden barrier to recovery.  Look for trainings and other materials to build your expertise.

 2.      Look for peer support resources specific to social anxiety.  If you have personal experience with social anxiety, think about how you can talk about that in a way to support your clients.  Consider developing recovery stories that focus on the recognition and experience of social anxiety, the treatment of social anxiety, and the recovery from social anxiety.  If you have no experience, look for other Peer Support Specialists who do, and refer to them whenever it would be helpful. 

 3.     When working with new clients, look for evidence of social anxiety disorder in available clinical records and clinical team discussion.  Always ask new clients about social anxiety, shyness, fear of “being evaluated”, etc.

 4.      When you find that social anxiety is a barrier for a client, ask about ways it has interfered with specific functioning in the past, including friendships, family, romantic relationships, work, and school.  Help them see the impact of the anxiety, and make sure your clinical team recognizes it as well.

 5.     Consider referring those clients for targeted treatment.  You may need to find out who is providing this treatment in your organization or in the community.  Help your team recognize the common need to refer clients with social anxiety to a targeted treatment.

 6.     Educate and raise awareness with your client of social anxiety and how it works, and that recovery is common with treatment.  Share your learnings widely so that you help the healthcare and social service systems to better recognize and address this common barrier to recovery.

 7.      Look for peer support groups that may be helpful for this client.  Joining new groups can be particularly difficult for clients with social anxiety, but they can also be extremely helpful.  Look for online group supports and other forms of peer support.  If you can’t find a support group nearby, consider working with other peers to create one.

 8.      Recognize that community integration is likely to be more challenging for this client than clients with no social anxiety.  As a Peer Support Specialist, you can have a key role in supporting your clients’ integration into their communities.  For clients with social anxiety, your persistence and patience will help them maintain hope that they can fully recover and be truly engaged in community life.

REFERENCES

Baghaei, N., Chitale, V., Hlasnik, A., Stemmet, L., Liang, H. N., & Porter, R. (2021). Virtual reality for supporting the treatment of depression and anxiety: scoping review. JMIR Mental Health, 8(9), e29681.

Barnett, M. D., Maciel, I. V., Johnson, D. M., & Ciepluch, I. (2021). Social anxiety and perceived social support: Gender differences and the mediating role of communication styles. Psychological Reports, 124(1), 70-87.

Koyuncu, A., İnce, E., Ertekin, E., & Tükel, R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in Context, 8.

Leichsenring, F., & Leweke, F. (2017). Social anxiety disorder. New England Journal of Medicine, 376(23), 2255-2264.

Mechler, J., Lindqvist, K., Magnusson, K., Ringström, A., Krafman, J. D., Alvinzi, P., ... & Carlbring, P. (2024). Guided and unguided internet-delivered psychodynamic therapy for social anxiety disorder: A randomized controlled trial. Npj Mental Health Research, 3(1), 21.

Powers, M. B., Sigmarsson, S. R., & Emmelkamp, P. M. (2008). A meta–analytic review of psychological treatments for social anxiety disorder. International Journal of Cognitive Therapy, 1(2), 94-113.

Rasouli, S., Gupta, G., Nilsen, E., & Dautenhahn, K. (2022). Potential applications of social robots in robot-assisted interventions for social anxiety. International Journal of Social Robotics, 14(5), 1-32.

Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. The Lancet, 371(9618), 1115-1125.