
Head to Health provides links to trusted Australian websites and apps to support the self-management of mental health symptoms, such as anxiety. visit Head to health
Fears of being embarrassed in social situations or of public speaking are widespread in the community. With social anxiety, the fear interferes significantly with the person’s:
Social anxiety has two sub types:
Veterans may go out of their way to avoid the feared situation, or suffer intense fear and anxiety when exposed to it. Situations that are commonly feared by people with social anxiety include:
People with social anxiety may also fear eating or drinking in public, using public toilets or writing in public (e.g. filling in a form).
Social anxiety is relatively common, yet it is often undiagnosed as veterans may be reluctant to talk about their fears. In some cases, being in the clinical setting may itself stimulate anxiety symptoms and a veteran’s fear of being scrutinised, humiliated or embarrassed.
A missed diagnosis can also occur if the practitioner confuses:
To ensure that a diagnosis of social anxiety is not overlooked, practitioners should consider the disorder whenever a veteran refers to feeling anxious in social situations.
Social Anxiety is common in civilian and veteran populations. The prevalence rates differ across cohorts and studies:
The following questions are recommended for the screening of panic disorder, social anxiety disorder and generalised anxiety disorder (Andrews et al., 2018):
Veterans who respond ‘yes’ to either question should be assessed further for symptoms of social anxiety. Practitioners may need to ask specifically about fear of a range of social and performance situations, as the person with social phobia is unlikely to spontaneously report the full range of their social fears.
None of the above tools are a diagnostic measure for social anxiety.
The practitioner should be careful to exclude the possibility that avoidance of social situations is associated with PTSD or agoraphobia. SAD and agoraphobia can be differentiated by determining what the principal underlying fear is – generally:
Psychological interventions for social anxiety include:
CBT is the psychological treatment of choice for social anxiety. Talking to a veteran, together with the veteran's family about his or her social anxiety is the start of treatment.
Whilst CBT has some general techniques applicable across a range of disorders, specific CBT techniques for targeting social anxiety are:
Psychoeducation is important as it helps to demystify the veteran’s symptoms, restore a sense of control and create hope for change. It is also important to encourage the veteran to do the following:
Social anxiety seen in clinical settings is often a severe and chronic disorder, requiring specialist treatment. Social anxiety can be treated in an outpatient setting. Treatment duration will vary between 8–12 sessions, although more sessions will likely be required for more severe or difficult cases. Treatment of social anxiety does not require hospitalisation, unless there is concurrent suicidal depression or substance use requiring detoxification.
Consideration should be given to the treatment of social anxiety on a group basis when this opportunity is available. Because the condition involves a fear of social and performance situations, group membership itself can be an important part of treatment, providing exposure to a feared situation. However, the intervention should be targeted to the needs of the individual, and group therapy may be too confronting for some in the first instance.
Newer generation antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are the recommended first line pharmacological treatment; veterans who fail to respond to either of these may benefit from monoamine oxidase inhibitors (MAOIs).
As with all anxiety disorders, benzodiazepines are not recommended for the treatment of social anxiety due to the potential for tolerance and dependency. If benzodiazepines are considered necessary to bring about control of acute anxiety symptoms, the course of treatment should be kept as short as possible.
Head to Health provides links to trusted Australian websites and apps to support the self-management of mental health symptoms, such as anxiety. visit Head to health
A program that teaches you strategies and skills for managing anxiety.