Panic Attacks and Social Anxiety: The Dance of Avoidance

Social anxiety is a major barrier for panic and anxiety sufferers. Certainly, a diagnosis of social anxiety disorder, a.k.a. social phobia, according to the DSM-IV-TR, may be appropriate. But, one could be experiencing agoraphobia. Actually, it could well be both. But it’s also possible a disorder doesn’t at all exist and one simply experiences a manageable touch of anxiety in social situations. This article’s focus will be upon social anxiety, my preferred term. And I believe no matter your circumstances, you’ll find the information interesting and helpful.

Does any of this hit home? It’s time to interact with others. Your hands tremble. Your whole body trembles, for that matter. And you sweat at the drop of a hat. You feel reasonably well until you stiffen-up like a board as you approach the sales counter to pay for your gasoline and ask for something of the cashier. The feeling of immobility – freezing – consumes you, even when it’s not immediately presenting. You can’t write the check at the grocery without a long litany of physical and emotional misery. You’re very uncomfortable when forced to interact with someone or in groups. Eating and drinking in front of anyone is unpleasant.

But, there’s more. You’re never able to say, “No.” And the prospect, and reality, of any sort of meeting or conversation runs chills up your spine, especially if it’s with an authority figure or someone you perceive as “better than you.” Indeed, you find it impossible to face potential evaluation and criticism, which you believe lurks around every corner. Talking on the telephone is extremely intimidating and uncomfortable. And forget about public speaking. Sure, you really want to voice your opinion, but after careful consideration you settle back in your chair. You find yourself anticipating distress even as you consider any form of social interaction, which causes you to shy away from it. And the hardest part of all of this is that you’re fully aware of what’s happening to you.

Well, the bottom-line, as far as you’re concerned, is the fact that all eyes are sure to be turned upon you; as scrutiny, criticism, embarrassment, and humiliation are sure bets when you walk out your front door. And sadly still, you experience similar unpleasant thoughts, feelings, and sensations even when you’re alone. Ultimately, avoidance becomes your best friend.

Any of this feel at all familiar? If so, welcome to the world of social anxiety. And since its fallout can kick a deep dent into anyone’s life, it must surely be discussed as we learn to daily manage our panic. I mean, I’m willing to bet that most of you have bouts with it. You may even have a comorbid diagnosis of panic disorder and social anxiety disorder. Now, I’ve elected not to get into details regarding DSM-IV-TR diagnostic criteria. I’ll leave that to you, okay? But, I’m thinking you have a good real-life feel for the typical symptomatology.

So, this social anxiety business is based in the over-the-top fear of being evaluated, flunking, and looking silly in social situations. It’s interesting to note that one of the dynamics that make social anxiety different from the specific phobias (fear of a specific object or event – elevators, flying, etc.) is the fact that with social anxiety there’s every reason to believe the anticipated social discomfort and humiliation may well occur exactly as anticipated and feared. This, as opposed to being frightened about an upcoming flight, but at least knowing the odds are incredibly stacked against the plane going down.

And as we consider social anxiety, I think it’s important to bring agoraphobia into the picture; because they both generate so much avoidance. Indeed, as avoidance presents, a most reasonable question to ask oneself would be, “Am I feeling this way because I’m socially anxious or agoraphobic?” Well, how ‘bout this simple rule of thumb? The foundational issue in social anxiety is fear and avoidance generated by external signals. Agoraphobia, on the other hand, is grounded in fear and avoidance triggered by internal signals. Make sense? But there’s an all important common ground with regard to the occurrence of social anxiety and agoraphobic events, and panic, for that matter. And that’s our chronic issues with misinterpretation and overreaction. It can’t be any great revelation that these two monsters come into play as one becomes consumed by the consequences of the ultimate social screw-up, as well as being consumed by the consequences of that unpleasant “I can’t breathe” feeling. And, again, as in panic, the snowball always furiously rolls downhill.

I assure you, like every other variation of anxiety, social anxiety is beatable. Just as with panic, we have the authority and ability to override our social misinterpretations and overreactions, as well as our goofy and primitive defense mechanisms, as we approach the next party or work presentation. I mean, come on, do you really believe people focus upon you in social situations as much as you think? Uh, no. And do you really believe everyone you come across in a social situation is out to test, scrutinize, and judge you and your perceived performance? Wrong again. And wait a second - why would we consider how we function socially a “performance?” Think about it. Just where does that come from? That wasn’t intended to be a rhetorical question. Truly, where does that come from? See if you can come up with some answers, as the insight will be of tremendous assistance.

Let me ask you this. After accepting how you traditionally think and feel, and introducing some logic to the process, do you really believe that some sort of stealthy assault awaits you as you function socially? Hmmm, I don’t think so. Again, give some thought as to where that errant notion comes from. Given all of your need-to-examine thoughts and feelings regarding your social being, don’t you think you have a lot with which to work regarding the relief of your social anxiety? Well, I sure think so, and that’s pretty darned hopeful in my book.   

I believe real-life therapy for social anxiety is much like that for panic and agoraphobia – a good starting dose of education, perspective, and hope; hard work on adjusting one’s shoot-myself-in-the-foot thinking and subsequent feeling and reacting; and slow, sure, and ever increasing steps of exposure within the context of brand new thought, feeling, and reaction patterns. Yes, this is all about realizing distress exists, understanding why it exists, confronting the underlying thought pathology, and taking the whole package to the world for experimentation, adjustment, and success. And you must do these things fully and confidently, believing no devastating and irreversible harm could ever befall you. No doubt, a psychotherapist can be of invaluable assistance as you invest in the new you.  

Any objective discussion of treatment for a psychiatric situation has to include mention of medication. Of course, medication interventions may be employed in conjunction with your psychotherapeutic work. At this writing, there are three FDA-approved meds for social anxiety, all of which are antidepressants - the selective serotonin reuptake inhibitors (SSRI’s), paroxetine (Paxil) and sertraline (Zoloft); and the selective serotonin-noradrenaline reuptake inhibitor (SSNRI), venlafaxine (Effexor). Now, those are the FDA-approved applications; however, there are any number of off-label interventions, to include other antidepressants, benzodiazepines, and beta-blockers. In addition to doing your own research, please review these alternatives with your psychotherapist and psychiatrist.

Yes, social anxiety is an uncomfortable and potentially crippling phenomenon; however, I believe deeply understanding it is the first confident step toward hope and its management and defeat. But isn’t that the case with all mind variances? You bet.