Social Anxiety & Substance Use Disorder Were Linked In A New Study & Here’s What You Should Know

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At one point or another, you’ve probably met someone who identifies as “a social drinker” — you may even identify as one yourself. People drink casually for a host of reasons: to help them unwind, because they enjoy the taste, and even as a “social lubricant” to help feel less awkward and make socializing a little easier. While there’s nothing wrong with responsibly sipping some wine or beer at a party, alcohol also has the potential to be misused, particularly when it comes to dealing with social anxiety. A new study found that social anxiety disorder may be linked to substance use disorder, and specifically alcohol use, that weren’t reflected in other types of anxiety disorders.

Lots of people feel nervous when meeting someone new or entering new social situations, but social anxiety disorder is distinguished by a constant fear towards a variety of social situations where the person “is exposed to unfamiliar people or to possible scrutiny by others,” the National Institute of Mental Health (NIMH) writes. A person with the disorder may be anxious about embarrassing themselves to the point where it interferes with their ability to live their life, and NIMH estimates that roughly 12 percent of American adults experience social anxiety disorder in their lifetime. The new research, published in the journal Depression and Anxiety, focused on understanding how the disorder might affect an individual’s relationship with alcohol and their drinking patterns.

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Researchers interviewed roughly 2,800 adult twins, assessing level of alcohol consumption and mental health factors including panic disorder, specific phobias and agoraphobia, generalized anxiety disorder, and social anxiety disorder. People with the disorder were associated with a higher risk for potentially developing alcoholism later in life, while the other studied anxiety disorders didn’t appear to be risk factors. Alcohol abuse also had the most significant link with social anxiety disorder.

This link is significant because of how it could affect treatment for both disorders. “Many individuals with social anxiety are not in treatment. This means that we have an underutilized potential, not only for reducing the burden of social anxiety, but also for preventing alcohol problems,” study author Dr. Fartein Ask Torvik said in a statement. “Cognitive behavioral therapy with controlled exposure to the feared situations has shown good results.”

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Cognitive behavioral therapy, otherwise known as CBT, is a type of psychotherapy that helps patients by altering patterns of harmful and unhelpful thoughts, behaviors, and emotions. The therapy largely focuses on solutions that help patients question and confront “distorted cognitions and change destructive patterns of behavior,” according to Psychology Today, as well as to develop coping skills. It’s been proven effective as a treatment for a several mental health issues, including anxiety disordersdepression, and eating disorders.

Based on the study results, treating social anxiety and helping prevent it with therapies like CBT could potentially have the benefit of limiting alcohol abuse in patients. The relationship the study pinpointed between excessive drinking and social anxiety suggest further research on the topic is necessary, especially if people are drinking to deal with their mental health instead of seeking mental health treatment.

If you or someone you know is seeking help for substance use, call the SAMHSA National Helpline at 1-800-662-HELP(4357).

A Counselor Explains How Introverts Can Banish Social Anxiety

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A young introvert suffers from social anxiety.
I’m a counselor, and many of the introverts I see come to me because of anxiety. Some of the clients I see have diagnosable anxiety disorders, but those who don’t aren’t suffering any less. When I say anxiety, I mean “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure,” according to the American Psychological Association.Anxiety can come in many forms and have many different causes, but in this article, I’d like to focus on social anxiety. Let’s take a look at the major signs of social anxiety, plus how you can free yourself from it by fixing “thinking errors.”

Signs of Social Anxiety Disorder

According to the American Psychiatric Association, you might have social anxiety if you experience the following:

  1. Feeling anxious or afraid in social settings. You might feel extremely self-conscious, like others are judging or scrutinizing your every move. For an adult, this might happen on a first date or a job interview, or when meeting someone for the first time, delivering an oral presentation, or speaking in a class or meeting. In children, these behaviors must occur in settings with peers — rather than adult interactions — and will be expressed in terms of age appropriate distress, such as cringing, crying, or just generally displaying obvious fear or discomfort.
  2. Worrying quite a bit that you’ll reveal your anxiety and be rejected by others
  3. Consistently feeling distressed during social interactions
  4. Painfully or reluctantly enduring social interaction — or avoiding it altogether
  5. Experiencing fear or anxiety that’s disproportionate to the actual situation
  6. Having fear, anxiety, or other distress around social situations that persist for six months or longer
  7. Finding that your personal life, relationships, or career are negatively affected. In other words, your anxiety makes it quite difficult for you to function in day-to-day life.

For a diagnosis of Social Anxiety Disorder, these symptoms must be present for six months or longer and not be better explained by another mental health or medical diagnosis.

Why Is Social Anxiety Common in Introverts?

If you’re an introvert who experiences social anxiety, you’re not alone. The research shows that introverts are far more likely to suffer from it than extroverts. A small study done in 2011 found that “social phobia patients” were significantly more often introverts (93.7 percent) than not (46.2 percent). Although not all introverts suffer from social anxiety, this study suggests that us “quiet ones,” by nature, may be prone to it in one form or another.

Social anxiety can be excruciating. Introverts, in my practice, struggle with it because they tend to overthink and overanalyze situations. They may find themselves caught in a cycle of planning out a conversation only to have it go differently than their script. This puts them on the spot — an introvert’s nightmare — and creates a high level of anxiety.

They then may fall into the trap of mind-reading. Mind-reading is what some therapies, like Dialectical Behavioral Therapy, call “thinking errors.” These patterns of thinking can be helpful in some situations, but when overused, can actually be quite harmful.

Many introverts (especially highly sensitive introverts) are particularly vulnerable to the “error” of mind-reading because they’re so good at attuning to others’ body language, emotions, and energy that it feels like they always know what someone else is thinking — even though they don’t actually possess telepathy.

When a conversation goes off-script and anxiety is heightened, introverts may assume others are thinking critically of them and take this assumption as fact. The thoughts of “now he thinks I’m an idiot” — though most likely false — create even more anxiety. It’s a vicious and debilitating cycle.

But you can banish social anxiety. Let’s take a look at the power of identifying and correcting thinking errors.

The Power of Fixing Thinking Errors

Let’s take an example from my practice. One young woman who came to me had a hard time making new friends. This girl was more mature than her cohort and seemed to be having trouble initiating conversation. As we talked, it came to light that her introverted trait of thinking before speaking had spiraled out of control. She’d rehearse for hours what she was going to say to a certain person, then be caught off guard when the conversation didn’t go as scripted. She then feared that people thought she was stupid or awkward (she was mind-reading) and became highly anxious.

After a conversation like this, she’d ruminate over what she should have said for days or weeks. Obviously, this left her too anxious to start any new conversations with anyone, which lead to a cycle of reinforcing her anxiety about social situations and her avoidance of them.

What did we do about it? The first step was education; we discussed both overthinking and mind-reading and how they relate to her introverted nature. She discovered that her tendency to overthink was very helpful in situations where she needed to analyze information and come to a conclusion, like schoolwork, but that with friends and family, it was creating a barrier to close relationships.

She was also able to see that while she is very attuned to others’ emotional states, she isn’t telepathic and can’t actually read others’ minds.

This education into the thought patterns that were feeding her anxiety gave her some valuable insights. For instance, she realized that the thoughts of “stupid” weren’t what she feared others would think of her, but what she thought of herself. Once we hit on this critical insight, she began to understand that her overthinking and mind-reading were actually ways to distract her from the mean things she was saying to herself.

It took quite a few sessions to help this girl become more self-compassionate and to lessen her overthinking. However, by the end of the school year, she was able to not only talk to new people, but to tackle intense, conflict-laden conversations she’d always avoided before.

Anxiety Doesn’t Have to Rule Your Life

This example gives us some valuable insight into how the introvert’s natural penchant for deep thinking and attunement to others can sometimes lead to harmful inner states. It also gives us a road map to moving forward and feeling better.

If you’re an introvert who suffers from social anxiety, the first step is to do what you do best: look inside and bring awareness to the thought patterns that are no longer helping you. Some of the best ways to do this are mindfulness, yoga, and journaling. Mindfulness trains the mind to be non-judging and discerning of thoughts and feelings; yoga helps relieve stress and is a moving meditation; and journaling brings up the unconscious thoughts, feelings, and beliefs we aren’t aware of in daily life that may be holding us back.

Ask yourself if there are thinking errors that are contributing to your anxiety. Are you like the girl I described above? The next time you notice yourself committing a thinking error, don’t judge or beat yourself up for it. Instead, simply notice it — there’s power in this alone! You might go a step further and intentionally replace your thinking error with a positive thought (even if you aren’t totally feeling it yourself at the moment). Try something like, “even though I’m scared, it’s going to be okay” or “I’m a likable person, and people enjoy being around me.”

Here are some more tips to help you mindfully control anxiety, and here’s a great explanation of mindfulness for introverts.

Your social anxiety won’t disappear overnight. But by stepping into mindfulness and identifying/correcting thinking errors, you can stop it from ruling your life.

Help For Introverts Who Have High-Functioning Anxiety

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High-functioning anxiety is often called a “secret” anxiety, because on the outside, people who have it seem to be doing just fine. What no one knows is that on the inside, they’re driven by nervousness and fear.Although high-functioning anxiety is not an official diagnosis, it’s something that many people identify with. It’s closely related to Generalized Anxiety Disorder, a condition affecting 6.8 million adults in the U.S., with women being twice as likely to suffer from it as men. Although both introverts and extroverts experience anxiety, introverts are more prone to it, according to Dr. Laurie Helgoe, author of Introvert Power.

Living With — and Controlling — Your Anxiety

Anxiety is a normal part of life, and having some measure of it can actually make you perform better and keep you safe. But, for some introverts, it’s debilitating. Anxiety shrinks your world and makes you miss out on opportunities that would be really good for you.

Personally, I’ve struggled with anxiety in many forms throughout my life, from panic attacks to the hidden “high-functioning” kind. Once, I snuck out the back door of my office when my anxiety exploded over an upcoming meet-and-greet with a returning coworker. Other times, I’ve checked and re-checked my luggage almost obsessively before a flight to make sure everything I would need was there.

So, how do you get rid of anxiety? Research suggests that people who have anxiety see the world differently and can’t just “turn it off.” But, even though it may always be a part of your life on some level, there are ways to control your anxiety — and feel better.

If you’re struggling with high-functioning anxiety, here are seven ways to calm it, based on recent research and my own experiences.

How to Calm High-Functioning Anxiety

1. Know the symptoms of high-functioning anxiety.

Symptoms include being over-prepared, constantly feeling the need to stay busy, being deeply afraid of disappointing others, perfectionism, and more. To determine if you have it, check out my article, 15 Signs That You’re an Introvert With High-Functioning Anxiety. The more signs you identify with, the more likely it is that you suffer from anxiety.

2. What’s the real reason behind your fear?

Before anxiety strikes again, take some time to reflect. As an introvert, self-analysis probably comes naturally to you. Journal about the last time you felt anxious, or if you feel comfortable, talk to a trusted friend or therapist. For me, I’ve determined that my anxiety often stems from wanting others to like and approve of me. If I can do everything perfectly, no one can criticize me! (At least that’s what my anxious brain thinks.) If you can get to the root of your anxiety, it will have less power over you.

3. Observe your mental state like you’re someone else.

This one will take time to master, but you can train yourself to look at your mind from the perspective of a neutral observer. As your yoga teacher might say, “bring your awareness” to your mind. What’s happening in there right now? Are you having dark thoughts? Negative thoughts? Anxious thoughts? Rather than labeling those thoughts as good or bad, beating yourself up about them, or choosing to act on them right away, simply become aware of what you’re experiencing. 

Then, name those feelings. Is it anxiety? Sadness? Worry? Fear? Research shows that you can lessen what you experience simply by recognizing a negative emotion and calling it what it is.

4. Your inner thermostat isn’t always right.

The heating/cooling system in my apartment drives me crazy, because it isn’t always accurate. It can say that it’s 70 degrees in the room, but it feels much, much cooler. I suspect that due to its location in the apartment, the thermostat sometimes produces false readings.

Many times, our brains are like my apartment’s thermostat — they produce false readings. They tell us to be afraid or anxious in situations that aren’t actually threatening. This response likely has something to do with the amygdala, the primitive part of the brain associated with processing emotion. Studies have found that animals subjected to chronic stress developed larger and more connected amygdalae, and that in children and adults, a large amygdala is a predictor of anxiety.

It doesn’t mean that we should never trust what our feelings tell us. On the contrary, our emotions provide us with valuable data. But sometimes, the data is off, through no fault of our own. When you feel anxious, remind yourself that your feelings may not be accurately reflecting the situation.

5. Change your surroundings or your activity.

Sometimes, no matter how much mental effort I put into soothing myself, my body refuses to calm down. My brain gets stuck in a loop of anxious thinking, playing frightening scenarios or negative thoughtsover and over. That’s when I need a change. And by that, I mean a change in my environment or the activity I’m doing.

Making a change will force your brain to move down a different track. Stop whatever you’re currently doing, get up, listen to a podcast, go to your favorite coffee shop, do a household chore, or run some errands. If you’re at work or school, if possible, take a break, go to the bathroom, put on your headphones and listen to music, start working on a different task entirely — or anything that’s different from what you’re doing at the moment.

When your schedule allows, do some aerobic exercise, like fast walking or jogging. After only five minutes of aerobic exercise, your brain will start to stimulate anti-anxiety effects. Some studies have even found that regular exercise works just as well as medication for some people to reduce anxiety symptoms — and it has long-lasting effects.

6. Have a mantra, and use it regularly.

You might try:

“I’m doing my best.”

“It’s only a moment. This too shall pass.”

“I may not be okay right now, but I’ll be okay soon.”

“I’m calm. I’m loved. I’m at peace.”

Mine is, “Things will not be as bad as you think they’ll be.”

7. Spend a little time each day unwinding and relaxing.

As an introvert, you already know that you need downtime to feel at your best. If you’re an introvert who has anxiety, that downtime is even more crucial. According to psychotherapist Linda Esposito, you can proactively tackle anxiety by intentionally setting aside time each day to relax. This will help you practice calming techniques before your anxiety gets the best of you.

 

15 Signs That You’re An Introvert With High-Functioning Anxiety

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Anxiety is the voice in the back of your head that says, “something bad is going to happen.” It’s what keeps you awake at 2 a.m. thinking about something embarrassing you did — five years ago.

Not all introverts have anxiety, and extroverts and ambiverts can struggle with it, too. To be clear, introversion and anxiety aren’t the same thing. Introversion is defined as a preference for calm, minimally stimulating environments, whereas anxiety is a general term for disorders that cause excessive fear, worrying, and nervousness.

However, for many introverts, anxiety is a regular part of their lives. And indeed, anxiety is more common among introverts than extroverts, according to Dr. Laurie Helgoe.

What Is High-Functioning Anxiety?
Sometimes anxiety is obvious (think: panic attacks and sweaty palms), but that’s not always the case. Many people live with a secret form of anxiety called “high-functioning anxiety.” Outwardly, they appear to have it all together. They may even lead very successful lives. No one can tell from the outside that they’re driven by fear. Sometimes they don’t even realize it themselves.

Do you have high-functioning anxiety? Although not an official diagnosis, high-functioning anxiety is something countless people identify with. It’s closely related to Generalized Anxiety disorder, which affects 6.8 million adults in the U.S., women being twice as likely to experience it as men.

Symptoms of High-Functioning Anxiety
Here are fifteen common symptoms of high-functioning anxiety.

1. You’re always prepared.
Your mind frequently jumps to the worst-case scenario in any given situation. As a result, you may find yourself over-preparing. For example, you might pack underwear and makeup in both your checked luggage and your carry-on, just in case the airline loses your suitcase. People see you as being the reliable one — and often your preparations do come in handy — but few people (if any!) know that your “ready for anything” mentality stems from anxiety.

2. You may be freaking out on the inside, but you’re stoic on the outside.
Interestingly, many people with high-functioning anxiety don’t reveal just how nervous they are, which is another reason why it’s often a secret anxiety. You may have learned to compartmentalize your emotions.

3. You see the world in a fundamentally different way.
Your anxiety isn’t “just in your head.” Researchers from the Weizmann Institute of Science in Israel found that people who are anxious see the world differently than people who aren’t anxious. In the study, anxious people were less able to distinguish between a safe stimulus and one that was earlier associated with a threat. In other words, anxious people overgeneralize emotional experiences — even if they aren’t threatening.

4. You constantly feel the need to be doing something.
Which can be a real problem if you’re an introvert who needs plenty of downtime to recharge. This doesn’t necessarily mean you’re attending lots of social events; instead, you may feel a compulsion to always be getting things done or staying on top of things. Staying busy distracts you from your anxiety and gives you a sense of control.

5. You’re outwardly successful.
Achievement-oriented, organized, detail-oriented, and proactive in planning ahead for all possibilities, you may be the picture of success. Problem is, it’s never enough. You always feel like you should be doing more.

6. You’re afraid of disappointing others.
You might be a people-pleaser. You’re so afraid of letting others down that you work hard to make everyone around you happy — even if it means sacrificing your own needs.

7. You chatter nervously.
Even though you’re an introvert who prefers calm and quiet, you chatter on and on — out of nervousness. For this reason, sometimes you’re mistaken for an extrovert.

8. You’ve built your life around avoidance.
You’ve shrunk your world to prevent overwhelm. You stick to routines and familiar experiences that give you a sense of comfort and control; you avoid intense emotional experiences like travel, social events, conflict, or anything else that might trigger your anxiety.

9. You’re prone to rumination and overthinking.
You do a lot of negative self-talk. You often replay past mistakes in your mind, dwell on scary “what if” scenarios, and struggle to enjoy the moment because you’re expecting the worst. Sometimes your mind races and you can’t stop it.

10. You’re a perfectionist.
You try to calm your worries by getting your work or your appearance just right. This can bring positive results, but it comes at a cost. You may have an “all-or-nothing” mentality (“If I’m not the best student, then I’m the worst”). You may have unrealistic expectations of yourself, and a catastrophic fear of falling short of them.

11. You have aches, repetitive habits, or tics.
According to psychotherapist Annie Wright, your anxiety might manifest physically in your body as frequent muscle tension or aches. Similarly, you might unconsciously pick at the skin around your nails, tap your foot, scratch your scalp, or do other repetitive things that get your nervous energy out — even if you appear composed in other ways.

12. You’re tired all the time.
Your mind is always going, so you have trouble falling asleep or staying asleep. Even when you sleep well, you feel tired during the day, because dealing with a constant underlying level of anxiety is exhausting.

13. You startle easily.
That’s because your nervous system is in over-drive. A slammed door, an ambulance siren, or other unexpected sounds really rattle you.

14. You get irritated and stressed easily.
You’re living with constant low-level stress, so even minor problems or annoyances have the power to frazzle you.

15. You can’t “just stop it.”
Anxiety isn’t something you can tell yourself to just stop doing. In fact, the above-mentioned researchers from the Weizmann Institute of Science found that people who are anxious have somewhat different brains than people who aren’t anxious. They noted that people can’t control their anxious reactions, due to a fundamental brain difference. (However, you can learn to cope with your anxiety and greatly lessen it — see the resources below).

12 Signs You Might Have an Anxiety Disorder

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What’s normal?

Everyone gets nervous or anxious from time to time—when speaking in public, for instance, or when going through financial difficulty. For some people, however, anxiety becomes so frequent, or so forceful, that it begins to take over their lives.

How can you tell if your everyday anxiety has crossed the line into a disorder? It’s not easy. Anxiety comes in many different forms—such as panic attacks, phobia, and social anxiety—and the distinction between an official diagnosis and “normal” anxiety isn’t always clear.

Here’s a start: If you experience any of the following symptoms on a regular basis, you may want to talk with your doctor.

Excessive worry

The hallmark of generalized anxiety disorder (GAD)—the broadest type of anxiety—is worrying too much about everyday things, large and small. But what constitutes “too much”?

In the case of GAD, it means having persistent anxious thoughts on most days of the week, for six months. Also, the anxiety must be so bad that it interferes with daily life and is accompanied by noticeable symptoms, such as fatigue.

“The distinction between an anxiety disorder and just having normal anxiety is whether your emotions are causing a lot of suffering and dysfunction,” says Sally Winston, PsyD, co-director of the Anxiety and Stress Disorder Institute of Maryland in Towson.

Sleep problems

Trouble falling asleep or staying asleep is associated with a wide range of health conditions, both physical and psychological. And, of course, it’s not unusual to toss and turn with anticipation on the night before a big speech or job interview.

But if you chronically find yourself lying awake, worried or agitated—about specific problems (like money), or nothing in particular—it might be a sign of an anxiety disorder. By some estimates, fully half of all people with GAD experience sleep problems.

Another tip-off that anxiety might be involved? You wake up feeling wired, your mind is racing, and you’re unable to calm yourself down.

Irrational fears

Some anxiety isn’t generalized at all; on the contrary, it’s attached to a specific situation or thing—like flying, animals, or crowds. If the fear becomes overwhelming, disruptive, and way out of proportion to the actual risk involved, it’s a telltale sign of phobia, a type of anxiety disorder.

Although phobias can be crippling, they’re not obvious at all times. In fact, they may not surface until you confront a specific situation and discover you’re incapable of overcoming your fear. “A person who’s afraid of snakes can go for years without having a problem,” Winston says. “But then suddenly their kid wants to go camping, and they realize they need treatment.”

Muscle tension

Near-constant muscle tension—whether it consists of clenching your jaw, balling your fists, or flexing muscles throughout your body—often accompanies anxiety disorders. This symptom can be so persistent and pervasive that people who have lived with it for a long time may stop noticing it after a while.

Regular exercise can help keep muscle tension under control, but the tension may flare up if an injury or other unforeseen event disrupts a person’s workout habits, Winston says. “Suddenly they’re a wreck, because they can’t handle their anxiety in that way and now they’re incredibly restless and irritable.”

Chronic indigestion

Anxiety may start in the mind, but it often manifests itself in the body through physical symptoms, like chronic digestive problems. Irritable bowel syndrome(IBS), a condition characterized by stomachaches, cramping, bloating, gas, constipation, and/or diarrhea, “is basically an anxiety in the digestive tract,” Winston says.

IBS isn’t always related to anxiety, but the two often occur together and can make each other worse. The gut is very sensitive to psychological stress—and, vice versa, the physical and social discomfort of chronic digestive problems can make a person feel more anxious.

Stage fright

Most people get at least a few butterflies before addressing a group of people or otherwise being in the spotlight. But if the fear is so strong that no amount of coaching or practice will alleviate it, or if you spend a lot of time thinking and worrying about it, you may have a form of social anxiety disorder (also known as social phobia).

People with social anxiety tend to worry for days or weeks leading up to a particular event or situation. And if they do manage to go through with it, they tend to be deeply uncomfortable and may dwell on it for a long time afterward, wondering how they were judged.

Self-consciousness

Social anxiety disorder doesn’t always involve speaking to a crowd or being the center of attention. In most cases, the anxiety is provoked by everyday situations such as making one-on-one conversation at a party, or eating and drinking in front of even a small number of people.

In these situations, people with social anxiety disorder tend to feel like all eyes are on them, and they often experience blushing, trembling, nausea, profuse sweating, or difficulty talking. These symptoms can be so disruptive that they make it hard to meet new people, maintain relationships, and advance at work or in school.

Panic

Panic attacks can be terrifying: Picture a sudden, gripping feeling of fear and helplessness that can last for several minutes, accompanied by scary physical symptoms such as breathing problems, a pounding or racing heart, tingling or numb hands, sweating, weakness or dizziness, chest pain, stomach pain, and feeling hot or cold.

Not everyone who has a panic attack has an anxiety disorder, but people who experience them repeatedly may be diagnosed with panic disorder. People with panic disorder live in fear about when, where, and why their next attack might happen, and they tend to avoid places where attacks have occurred in the past.

Flashbacks

Reliving a disturbing or traumatic event—a violent encounter, the sudden death of a loved one—is a hallmark of post-traumatic stress disorder (PTSD), which shares some features with anxiety disorders. (Until very recently, in fact, PTSD was seen as a type of anxiety disorder rather than a stand-alone condition.)

But flashbacks may occur with other types of anxiety as well. Some research, including a 2006 study in theJournal of Anxiety Disorders, suggests that some people with social anxiety have PTSD-like flashbacks of experiences that might not seem obviously traumatic, such as being publicly ridiculed. These people may even avoid reminders of the experience—another symptom reminiscent of PTSD.

Perfectionism

The finicky and obsessive mind-set known as perfectionism “goes hand in hand with anxiety disorders,” Winston says. “If you are constantly judging yourself or you have a lot of anticipatory anxiety about making mistakes or falling short of your standards, then you probably have an anxiety disorder.”

Perfectionism is especially common in obsessive-compulsive disorder (OCD), which, like PTSD, has long been viewed as an anxiety disorder. “OCD can happen subtly, like in the case of somebody who can’t get out of the house for three hours because their makeup has to be absolutely just right and they have to keep starting over,” Winston says.

Compulsive behaviors

In order to be diagnosed with obsessive-compulsive disorder, a person’s obsessiveness and intrusive thoughts must be accompanied by compulsive behavior, whether it’s mental (telling yourself It’ll be all right over and over again) or physical (hand-washing, straightening items).

Obsessive thinking and compulsive behavior become a full-blown disorder when the need to complete the behaviors—also known as “rituals”—begins to drive your life, Winston says. “If you like your radio at volume level 3, for example, and it breaks and gets stuck on 4, would you be in a total panic until you could get it fixed?”

Self-doubt

Persistent self-doubt and second-guessing is a common feature of anxiety disorders, including generalized anxiety disorder and OCD. In some cases, the doubt may revolve around a question that’s central to a person’s identity, like “What if I’m gay?” or “Do I love my husband as much as he loves me?”

In OCD, Winston says, these “doubt attacks” are especially common when a question is unanswerable. People with OCD “think, ‘If only I would know 100% for sure whether I was gay or straight, either one would be fine,’ but they have this intolerance for uncertainty that turns the question into an obsession,” she says.

This article originally appeared on Health.com

Anxiety — When You Worry About Worrying

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By Kurt Smith

Anticipation is a funny thing. If you are anticipating something fun it can seem like you can’t focus, you might think about it constantly, you might talk about it to anyone who will listen, all with a big smile on your face. Anticipating something stressful, however, can do all of the same things — just without the smile. In this case rather than being excited you are filled with dread over what you think is about to come.

But what if you feel that sense of dread all of the time, whether there is something good or bad ahead of you? Unfortunately, there are a number of people who live day-to-day in a near state of panic, dreading almost everything about their life, waking up every morning with the sense that something terrible is about to happen, or that everything they have to do or want to do will go badly.

The constant feeling of dread is a symptom of an anxiety disorder and can often go unrecognized. This lack of awareness of a problem can happen because these feelings have either slowly become more frequent and intense or they have always been present so they seem normal.

It is important to note that although they can be linked, there is a difference between anxiety and depression. A person who is suffering with depression can have no feelings at all and believe that no one cares about them. They feel hopeless. Someone living with anxiety on the other hand, cares and worries about everything and may think that everyone cares about them — just not in a positive way. It’s like living in a state of perpetual fear.

Unlike those dealing with severe depression who may find it difficult to get up in the morning or leave the house, people dealing with anxiety can be very high functioning and may even be over-achievers. It’s not uncommon for them to feel the need to control everything around them because they fear if they don’t they may actually lose control themselves. In this way they are able to mask their continual anxiety through activity and work. What people don’t see in these individuals is that they are constantly worried about, well, everything.

Dealing with anxiety can be a constant fight to get past a suffocating feeling of dread. You may worry about things that haven’t happened, aren’t likely to happen, or are flat out impossible. Living in fear even though there’s nothing to be afraid of is the norm. For example, I once treated a woman who had gotten to the point that she needed to take a picture of her oven, hair tools, and front door just so she could look at them and remind herself that they were turned off. Without doing that she would spend the day with a nagging fear that her house would go up in flames before she got home to check everything — again.

These feelings of worry and dread can also have dire consequences on your physical health and relationships. Physical responses in the form of panic attacks, high blood pressure, and nausea or irritable bowel syndrome (IBS), are all common. And unfortunately this can begin a cycle of worsening problems with the physical symptoms that result from the anxiety causing additional anxiety over health concerns, and even worry about death.

So how does someone cope with feelings of dread, worry and fear? Well, that depends a great deal on the severity of those feelings. There are certain things that can be helpful on a day-to-day basis, but some people will need the help of a counselor to learn techniques for managing these feelings. If you recognize that you are suffering from anxiety some of the following can help.

  • Try to identify the source of your worry. Then ask, is my concern rational or am I over thinking this?
  • Close your eyes and breathe deeply for a minute. Concentrate on controlling your breath and focus on slowing your heart-rate.
  • Take a walk and remove yourself from the situation. Often a change in scenery will allow your thoughts to reset.
  • Steer clear of your known triggers. If reading about someone with a rare form of ear cancer convinces you that you also have it, make a point not to read articles of that nature.

If you are an anxiety sufferer it may always be a part of your life, but it doesn’t need to overtake your day-to-day. Even the most extreme anxiety disorders can be treated so that the symptoms aren’t overwhelming. If you find that your life, relationships, and happiness are being compromised by constant dread and worry it may be time to do something about it.

Social Anxiety in the Digital Age

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By Betty Vine

The Internet has changed our social landscape—especially how we communicate—in both subtle and seismic ways. We text instead of call. We like, share, tweet, post, snap, pin, and swipe. Even when we’re physically together, our eyes remain affixed to our screens.

It only makes sense, then, that social anxiety may also manifest differently in a digital world. Such a change doesn’t necessitate an entirely new diagnostic category. Rather, the same symptoms might find different avenues for expression and different catalysts for their continued existence.

The DSM-5 defines social anxiety disorder as a “persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.” This anxiety interferes with normal functioning and generally persists for six months or more. It’s also one of the more common anxiety disorders: Estimates suggest about 7 percent of American adults will be affected in a given year, and about 12 percent over a lifetime.

Some degree of social anxiety is adaptive: It “serves a very important survival function for humans,” explains Stefan G. Hofmann, director of the Psychotherapy and Emotion Research Laboratory at Boston University’s Center for Anxiety and Related Disorders. “In fact, in the normal progression of children, the natural stages include separation anxiety, stranger anxiety—all forms of social anxiety. These are very important features. If they’re missing, something is seriously wrong with the child.”

But there’s a threshold at which social anxiety exceeds its evolutionary function and becomes maladaptive, even debilitating. The same is essentially true of our social media use. Social networking is ubiquitous because we all share the need to belong, says Hofmann. Social networks enable this connection and facilitate our ability to meet social needs. “The problem arises,” Hofmann continues, “when people aren’t actually living their real life because they spend so much time on social media.”

Might sufferers of social anxiety—many of whom find online communication less threatening than in-person interaction—spend so much time on social media that they aren’t actually living and thriving “IRL”?

Digital technology is a double-edged sword, perhaps especially as it interacts with socially phobic behaviors. “It’s hard to speak in generalities about this,” as though it were universally good or bad, explains Franklin Schneier, co-director of Columbia University’s Anxiety Disorders Clinic. Yes, Internet use can be a maladaptive avoidance behavior for people with social anxiety. On the other hand, he says, “You may have someone who was so shy that they really would have had very little opportunity to socially interact. And for them, being able to be online is not avoidance, but actually improving their opportunity for interaction.”

Some research supports the idea that many individuals with social anxiety prefer communicating online. A 2016 meta-analysis in the journal Computers in Human Behavior showed a correlation “between social anxiety and feelings of comfort online.” Computer mediated communication offers a few key features that may appeal to socially anxious individuals: “text-based communication with reduced audio and visual cues,” “anonymity,” and asynchronicity (i.e., there is no immediate need to respond). In other words, some of the social cues required of face-to-face communication are absent. These cues often present a source of worry and discomfort for the highly socially anxious. “Gestures, facial expressions, eye contact … these are the subtle features of social interactions that people with social anxiety disorder will often have a problem with,” says Hofmann. It makes sense, then, that they might feel more comfortable in a digital environment.

But this preference for online communication does not necessarily confer any mental health benefits. The aforementioned meta-analysis actually found a modest correlation between social anxiety and pathological Internet use (PIU). (In this context, “problematic” refers to impaired impulse controland withdrawal symptoms with regard to internet use.)

“Arguably,” the study authors write, “socially anxious individuals … feel more comfortable online. Consequently, they may begin to rely on [computer-mediated communication] while increasingly avoiding [face-to-face] interactions.” A study in Personality and Individual Differences found that “individuals higher in social anxiety who frequently engage in online communication report lower levels of self-esteem satisfaction and higher levels of depression, suggesting that their attempts to compensate for offline social inadequacies may fail to improve wellbeing.”

Of course, digital technology also offers new therapeutic avenues. For instance, cognitive behavioral therapy can be delivered via the Internet. As Schneier points out, “Given that most people with social anxiety and other psychiatric conditions actually don’t get treatment at all, if you could make this kind of treatment more widely accessible with a low bar of cost and a low risk of stigma, that could have a positive effect.” Furthermore, he says, researchers have developed “computer-based tasks that might help different aspects of anxiety, like helping people to train their attention away from negative stimuli,” as well as virtual reality exposure therapy that can simulate “public speaking environments and social gathering environments.” And while “most of these things can be done without virtual reality,” it can serve as a kind of “stepping stone to the more critical real-life exposures.”

“Real-life” (in vivo) exposures are still the gold standard for treating social anxiety, because “real life” interactions—not VR simulations—are ultimately the source of one’s fear. As a therapeutic tool, it forces patients to directly confront and engage with reality, to gather evidence that the catastrophic outcomes they imagine are unlikely, and to build trust in their own ability to cope.

Beyond its use in treatment, though, face-to-face communication more generally is our natural preference, despite the ease of online interaction. Why else do people travel thousands of miles for conferences when they could just have a webinar, asks Hofmann. Why do we show up to weddings and births when we could just Skype in?

In part, it’s because “we’re evolutionarily programmed to be with somebody in real life,” Hofmann argues. “Physical proximity is directly related to connectedness, to how you actually feel with somebody. A person’s smell, eye contact, little facial cues that suggest emotionality, a person’s oddities, all of that. You can never recreate it in an electronic form.”

Like a diet deficient in key vitamins, unfit to meet our evolved needs, an online-only social diet lacks essential nutrients, allowing us to keep sucking air but not to flourish. This idea may hold true for all of us, but it’s perhaps especially concerning for socially anxious people who rely on the Internet to meet their social needs because of the synchronicity and anonymity it affords.

Betty Vine is a former PT Editorial Intern.

How to Reduce Anxiety in Our Nervous World

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By Monica N. Starkman M.D.

Someone with severe anxiety—particularly if they have recurrent panic attacks—is like the proverbial canary in the coal mine.  Because of increased sensitivity, such a person can be a sensor that more easily detects changes in the environment that are toxic for everyone.

Matt Haig is such a person. He learned to deal with recurrent panic attacks and thrive despite them.  As a survival mechanism, he identified the specific stressors lurking in our current hyped-up environment. Then, he developed strategies to decrease their power so they don’t set off anxiety.

You may think you know what many of these are, and likely you do. Examples are: social media; the 24-hour news cycle that keeps hitting us with one catastrophe after another; being glued to our cell phones, and more. However, when we read about these, we usually say: ‘Yup, that’s right” and then keep on doing what we usually do.

But not so after one reads, as I did, Matt Haig’s latest book:  Notes on a Nervous Planet. In a charming, easy-to-read but serious fashion, he presents the evidence so persuasively that it makes one realize how toxic our environment truly is. Then, he shares the changes in thinking and behavior he himself implemented, in order to aid us in making these changes for ourselves.

Here are some of the key recommendations Matt Haig makes.

Increase your Awareness

  • Our technologies keep changing, at a pace that is stressful for us to adapt to.
  • Realize how cluttered our lives are with pop-up consumer ads, news overload, and information overload. And how unmanageable that feels.
  • See the collective madness around us and realize how much of the stress we feel is from the culture in which we live. This collective stress magnifies our personal anxieties.
  • Realize how commerce and technology keep pressuring us to change our goals and behaviors.  Instead, we can make our own decisions and choices, and tune out the rest.
  • Consider how many times a day you look at your cell phone. What catastrophe could happen if you looked at it just five or ten times a day.

Inoculate yourself for self-protection

  • Resist being conditioned to want more.
  • You cannot use all the apps that are out there.
  • You can’t be up to speed on all the news.
  • You can’t watch every must-see show. You can’t keep up with each latest ‘buzz’ thing.
  • Accept that negative comments about you or your ideas will appear with people you engage with on social media.
  • Don’t let yourself feel inadequate in the midst of the self-promotion by others who seemingly are more productive, more beautified, etc.

Use the Internet well

  • Use the clock on the computer to keep track of how long you are spending time on it.
  • Download a user app to help limit social media use.
  • Arguing with strangers online to try and change their mind is usually both ineffective and stressful.
  • Be more considerate to strangers online, which is beneficial to you and them.
  • Don’t use social media when you are not enjoying it.
  • Find internet communities and support groups. These will be people like yourself with similar interests and concerns that will understand you better and be less judgmental.  (As a psychiatrist and novelist with a focus on the psychological wounds resulting from infertility and miscarriage, I can vouch for the positive benefits I see for people in the support groups specifically for those with these traumas.)

Choose your subjective world

  •  You can’t change most of the world, but you can find the version of the world that suits you best. You can change your perspective on it. You can select the parts of the world you let get in.
  • This might include looking at the news less, engaging with social media less, and adding activities that increase you sense of well-being and resilience.
  • Some ways to do this are described in the next few sections.

Seek out Nature

  • There is a calming feeling from being in nature and sensing you are part of a great natural order.
  • Seek out the ‘blue and green’ colors of nature. (Even in a city when not near parks, there are often shrubs around buildings and trees planted along sidewalks. Looking up and watching tree  branches swaying in the breeze can provide a minute of relaxation and mind-clearing.)

Make moments when you are set to ‘neutral’

  •  Just breathe. Don’t crave anything except what you already have: life itself.

Reading fiction is freedom

  • “It gives you the room to exist beyond the reality you’re given.” In addition, there is always some kind of truth in fiction, and it is a connection to the imagination of another person.
  • Matt Haig is also a novelist – (How To Stop Time, for example), as am I (The End of Miracles). As authors, we are well aware that there are about two hundred million print books alone that are also vying for readers’ attention, many of them fiction.  But as readers, we realize we are all drowning in books, as we are drowning in TV shows.  So we need to ignore the feeling that we may miss some good ones, and instead concentrate on the pleasures of the ones we choose.

Life Sucks When You Are Too Anxious To Socialize

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By Holly Riordan

When you are too anxious to socialize, you sit around waiting for a text message to come through your screen because you are too nervous to send the first text yourself. When no one reaches out to you, you feel isolated. Alone. Abandoned. While staring at a blank screen, the little voice in the back of your head mocks you. It convinces you no one likes you, no one cares, no one notices when you are not around. The longer you spend on the own, the more you convince yourself you are always going to be alone.

Of course, if someone does happen to text you, you are going to be smacked with stress. You are going to waste time trying to come up with the perfect reply, trying to find the right emoji, trying to figure out how to strike a balance between being friendly and clingy. Since you only have a scattering of social interactions throughout the week, each one seems like a big deal. If one goes wrong, you won’t be able to stop thinking about it. You won’t be able to handle the embarrassment.

When you are too anxious to socialize, the idea of being invited to a party is as horrifying as the idea of being the only one not invited. You are never satisfied. You are either alone in your bedroom, wishing you were out with friends. Or you are surrounded by people, wishing you could crawl back underneath your covers.

You are a living contradiction. You cannot stand the boredom of being alone — but you cannot stand the stress of being around other people either. You do not want to spend the weekend all by yourself — but you do not want to spend it at a crowded bar or a noisy party either.

When you are too anxious to socialize, you become your own best friend. You spend most of your time finding new ways to keep yourself occupied. You distract yourself with books and movies. You try to ignore your growing loneliness. You tell yourself you are better off on your own as a way to protect yourself, as a way to stop feeling so miserable about having no one to invite over on weekends or text after work hours.

When you’re too anxious to socialize, it’s easy to start thinking less of yourself. It’s easy to start wondering whether you are worthy of love or friendship. It’s easy to allow your insecurities to get the best of you. However, you have to remember no one is judging you as harshly as you have been judging yourself. No one is going to examine the words you type in a text or the facial expressions you make in a conversation as deeply as you have been. No one is going to care about your ‘mistakes’ as much as you think. Most people will not even notice them.

When you’re too anxious to socialize, you need to break out of your comfort zone in order to achieve happiness — otherwise you are going to stay stuck in your routine forever, wishing you had the courage to make a change.