Kauscher 1

Kaleb Kauscher

Prof Leonard

ENG 1201.2V3

5 Apr 2021

Social Anxiety: What is The Treatment?

Social anxiety, also known as social anxiety disorder or social phobia, is an anxiety

disorder that affects 5-10% of adolescents (Lebowitz, King and Silverman). It is characterized by

a marked avoidance of social situations involving a person’s peers. A major symptom of social

phobia is the affected person creates a negative self-image, along with being extremely self-

critical. I am one of those people that make up the 5-10%. I was born with this mental disorder,

but once I started getting help, I became much better at handling it on my own. There are

multiple treatment options to help adolescents deal with anxiety. The best treatment for social

anxiety in adolescents is a combination of cognitive-behavioral therapy and prescription

medication.

Mayo Clinic, a non-profit organization that has offices located around the world, list

some symptoms of social anxiety as:

 Fear of situations in which you may be judged

 Fear that others will notice that you look anxious

 Avoiding situations where you might be the center of attention

 Having anxiety in anticipation of a feared activity or event

 Expecting the worst possible consequences from a negative experience during a social

situation
 Kauscher 2

They then go on to list some of the more physical symptoms, “… fast heartbeat, trembling,

sweating,… feeling that your mind has gone blank, muscle tension.” People with social anxiety

may not only experience these symptoms, but they may also attempt to avoid common social

situations such as “… going to work or school, starting conversations, making eye contact,

entering a room in which people are already seated, returning items to a store…”(Mayo Clinic)

Social anxiety can easily take control over your life making tasks that seem menial, almost

impossible. So what causes social anxiety?

Social anxiety stems from miscommunication in the brain and certain parts of the brain

not doing their jobs correctly. When a person experiences anxiety, the amygdala, the part of the

brain in charge of the “fight-or-flight” response, sends a message to the prefrontal cortex, whose

job is the rational and calm assessment of the perceived threats received by the amygdala. If the

prefrontal cortex decides there is no threat, it sends a signal back to the amygdala telling it there

are no threats. However, for those who suffer from anxiety, the prefrontal cortex does the

opposite of what it is supposed to do and instead “…amplifies the activity of the amygdala

instead of calming it.” (Causes of Social Anxiety) This, in turn, keeps a person’s fight-or-flight

sense active when it does not need to be. However, there is a way to help re-wire the brain in

order to turn off the fight-or-flight sense when it is not needed and that is something called

cognitive-behavioral therapy.

Cognitive-behavioral therapy, abbreviated as CBT, is a variety of psychotherapy that

shows to be extremely effective at treating social anxiety. CBT combines two kinds of

therapeutic approaches, behavioral therapy, and cognitive therapy. Cognitive therapy is a way to

create a clear idea of your own attitudes, expectations, and thoughts. The goal of this is to help

expose and modify false and distressing beliefs. Behavioral therapy helps to identify specific
 Kauscher 3

behavioral patterns that can create difficulty in your life or exacerbate your problems. Then the

individual works on changing those behavioral patterns. “CBT teaches you different ways of

thinking, behaving, and reacting to situations that help you feel less anxious and fearful. It can

also help you learn and practice social skills.” (More Than Just Shyness). There is ample

scientific evidence that the methods used in CBT produce change. CBT emphasizes teaching

individuals on how to become their own therapists. Then the individual can understand how to

change their own behavior, thinking, and problematic emotions all on their own. The ultimate

goal of CBT is to help people help themselves and cope with their lives again without therapy.

While it may seem like CBT would be developed towards the individuals need, CBT

does work particularly well in group format. One bonus of group oriented CBT is that the cost

can be considerably lower. Group format also allows individuals to not only work with a

therapist, but also with their peers who experience similar problems. The therapist also makes

sure that everyone is active in the conversation to the extent they are comfortable with. Another

benefit to group format is that the individuals can practice these ideas and skills they have been

working on with each other. Which is a major benefit compared to individual work as those

people cannot do this. As Amelia Aldao writes, “This is super important because, quite

frequently, even the most motivated of clients have a hard time translating the skills they practice

in individual therapy to the real world.” Although CBT can work well in group format, it can

also be more beneficial in one-on-one format so the therapist can fine tune their approach and

methodology.

CBT focuses on what skills the adolescent is lacking; for example, if they do not know

any calming exercises, psychotherapists teach them some, if they do not know redirection

techniques, a process of changing the person’s thought train in order to “redirect” their thoughts
 Kauscher 4

towards ideas that calm them and get rid of the anxiety inducing stimuli, they are taught some. I

was taught both of these things, along with anger management techniques. Whenever my anxiety

got high, I would also get angry and then lash out in anger whenever something pushed me over

the edge. However, whenever that happened it was not alone because of my anxiety, it was the

result of another mental condition I have called sensory processing disorder.

CBT may seem like it only deals with helping those deal with their anxiety, but it does

much more. Since most people who have social anxiety tend to avoid social interactions, they do

not know proper social etiquette. CBT can be used to re-write the brain in order to help make

daily tasks easier to do. Hippocrates describes a person with social phobia as a person who, “…

loves darkness as life and cannot endure the light or to sit in lightsome places….” Social phobia

can make it difficult to go outside and interact with new people or enter new situations. CBT can

also teach people how to stay calm in these situations and to act properly. I did not know how to

act in new situations so I would either stay isolated or get angry and lash out. CBT taught me

how to properly act in certain social situations.

While CBT can help a person control their anxiety on their own, prescription medication

can make that job even easier. The most common anti-anxiety meds are referred to as SSRIs, or

selective serotonin reuptake inhibitors. The most common of these medications include, “…

Prozac (fluoxetine), Celexa (citalopram), Zoloft (sertraline), and Lexapro (escitalopram).”

(Morin) Since a lack of serotonin can cause anxiety, these meds are used to help increase the

levels of serotonin in the brain by blocking the reabsorption of serotonin. These medications can

be prescribed depending on the severity of a person’s anxiety. A person will work with their

doctor in order to figure out which medication will work best, along with what dosage will be

best.
 Kauscher 5

Serotonin is the main cause of social anxiety and a lack of serotonin in the brain can

cause depression, while too much of it can cause anxiety. Serotonin is also a vital chemical in the

body; it can act as both a hormone and a neurotransmitter. Serotonin allows the brain to

communicate with the nervous system. Serotonin also controls several other important bodily

functions including, mood, bowel movements, nausea (to help reduce it), sleep, blood clotting,

and bone health. While lower levels of serotonin tend to affect behavior and emotion, high levels

of serotonin can lead to more devastating effects. Serotonin syndrome can result when the level

of serotonin in the body reaches too high of a level. The symptoms of serotonin syndrome can

range from something as mild as headaches, to something severe such as unconsciousness or

irregular heartbeat. (Serotonin) So how do SSRIs control your levels of serotonin?

 Kauscher 6

SSRIs work by taking advantage of synapse. As the brain is made up of millions of

neurons, messages travel along these neurons. However, when that message reaches the end of a

neuron, it has to jump to the next neuron (synapse). In order for the neuron to jump, it releases a

miniscule amount of neurotransmitters into that gap. Serotonin is one of those neurotransmitters.

After the message is transferred between neurons, serotonin is normally reabsorbed by the nerve

cells. SSRIs block that reuptake which means there is more serotonin to deliver more messages
 Kauscher 7

between neighboring nerve cells.

 Kauscher 8

Figure 1 An example of normal synapse versus synapse with an SSRI

While SSRIs seem like they do a great amount of good, they also come with many

adverse side effects. Some of these side effects include, difficulty sleeping, headache, nausea,

dizziness, and several others. While that may not seem like much, in 2004 “The FDA issued a

warning… that antidepressant medications, such as many of the SSRIs… that are often used to

treat adolescent anxiety, may increase suicidal thoughts and behavior in a small number of

children and adolescents.” (Morin). The FDA further went on to add a black box warning on

SSRIs. A black box warning, also known as a boxed warning, is put on prescription drug labels

in order to call attention to their serious or life-threatening risks. Karin Gornick, a film producer

who made a documentary about teens with anxiety says in response to SSRIs that, he feared his

son would become addicted to them and would not be able to function on a normal level again
 Kauscher 9

without them. (Qtd in Graham). While Gornick feared that SSRIs would make their child

addicted to them, antidepressants are not considered to be addictive.

However, Gornick is not the only person to fear SSRIs. Dr. Deborah Serani, a licensed

psychologist in practice for thirty years says that, “Research shows,…, that public opinion about

antidepressants is not consistent with scientific knowledge and clinical experience.” She then

goes on to say that numerous people incorrectly believe that SSRIs are “… addictive, change a

child’s personality or become a ‘crutch’ if prescribed.” One thing that strengthens the fear of

SSRIs is that if a person where to suddenly stop taking them, it could lead to a condition called

Antidepressant Discontinuation Syndrome, a temporary case of flu-like symptoms or it could

lead to a relapse. These two after-effects help to fuel the fear and belief that SSRIs are addictive.

If people fear SSRIs so much, why are they still so common? Well the answer to that

question lies in the results. While SSRIs seem dangerous, they are faster at reducing anxiety than

CBT. The Harvard Medical School writes that, “Overall, CBT and medication are about equally

effective. However, the research suggests that while medication works faster, CBT offers longer

lasting benefits.” So while both CBT and SSRIs do different things to help with anxiety, what

happens when you combine the two? Well, according to The National Institute of Mental Health,

people who have social phobia achieve the best results combining the two common methods of

treatment, CBT and prescription medication. While it might seem redundant to combine two

perfectly good methods of treatment, there is evidence to support the fact that combining an

SSRI with CBT can be more effective at treating social anxiety than either one on their own.

However, this evidence is still rather new.

A post by the Harvard Medical School back in 2010 said that there is no current evidence

to support the theory that combining CBT and a prescription medication is any better than either
 Kauscher 10

on their own. However, in 2016 Malin Gingnell and colleagues conducted an experiment to test

that theory. Their method was to use a randomized placebo trial of ICBT (internet-delivered

CBT) and combine it with either escitalopram (an SSRI) or placebo followed by a 15-month

clinical follow-up. Their conclusions proved this theory. “Adding escitalopram improves the

outcome of ICBT for SAD (Social Anxiety Disorder) and decreased amygdala reactivity is

important for anxiolytic (anxiety reducer) treatment response.” (Gingnell, et al.)

Social anxiety has severely affected the way I live my life. I was always shy and isolated

and preferred to stay alone. When I got comfortable in spaces or areas I am in often, I began to

open up and start being less shy. When I first began seeing my therapist I was as I normally was,

isolated, quiet and shy. But when I started going more often, after a while I began to open up and

that was the first step for me to start getting help. I have always thought about my social anxiety

as my mind trying to control my body. So understanding that idea helped me realize that I

needed a different mindset in order to get help. CBT and SSRIs have helped me take back

control of my life. CBT taught me so many things to help me in life while SSRIs made it easier

for me to control my anxiety. I do not believe that I would be where I am today without the help

my therapist provided me through CBT, my anxiety medication helping to lower my anxiety

levels in order to give control back to me and my mom, for realizing that something was wrong

with me.

It is easy to think that medication alone can help with anxiety, like anti-biotics help when

a person is sick, but in reality, it is the anti-biotics working in tandem with their immune system

to help fight whatever ailment the person is suffering from. SSRIs are similar in that concept.

They help a person deal with their anxiety, but alone it may not be enough to help. Therapy is the

same way, it can help, but it may not be enough. When I stopped going to therapy and was only
 Kauscher 11

on anxiety medication, my anxiety could easily flare out of control if I were not in a good mood

or having a bad day. Due to the COVID-19 outbreak I recently started going to therapy again and

with therapy and medications, I am able to control my anxiety much better than I was before. An

answer to the question could easily be that there is no single treatment that can help on its own

depending on the severity of anxiety, but when two common methods are combined, their

usefulness increases drastically.

Works Cited
 Kauscher 12

Aldao, Amelia “How Does Group Therapy Work?” TogetherCBT,

https://www.togethercbt.com/blog/how-does-group-therapy-work. Accessed 31 Mar

2021.

“Causes of Social Anxiety.” Bridges to Recovery, Bridges to Recovery,

www.bridgestorecovery.com/social-anxiety/causes-social-anxiety/?scrlybrkr=23eccd5d.

Accessed 24 Mar 2021.

Gingnell, Malin et al. “Combining Escitalopram and Cognitive-Behavioural Therapy for Social

Anxiety Disorder: Randomised Controlled FMRI Trial.” The British Journal of

Psychiatry : the Journal of Mental Science, U.S. National Library of Medicine, 23 June

2016, pubmed.ncbi.nlm.nih.gov/27340112/. Accessed 5 Apr 2021.

Graham, Jennifer. “Will Pills Cure Your Teen's Anxiety? What to Know before Putting Your

Child on Anxiety Drugs.” Deseret News, Deseret News, 3 Aug. 2018,

www.deseret.com/2018/8/3/20650152/will-pills-cure-your-teen-s-anxiety-what-to-know-

before-putting-your-child-on-anxiety-drugs. Accessed 4 Mar 2021.

“Hippocrates on Social Anxiety Disorder.” PsychotherapySphere, 3 May 2013,

psychotherapysphere.com/2013/05/02/hippocrates-on-social-anxiety-disorder/. Accessed

30 Mar 2021.

Lebowitz, King and Silverman “Anxiety Disorders for Children and Adolescents.” Current

Diagnosis & Treatment: Psychiatry, 3e. Ch. 40. E-book, McGraw-Hill Education, 2018.

Accessed 3 Mar 2021.

Morin, Amy, LCSW. “Should Your Teen's Anxiety Be Treated With Medication?” Verywell

Mind, 20 Mar. 2020, www.verywellmind.com/is-anxiety-medication-safe-for-teens-

 Kauscher 13

4140381#:~:text=Selective%20serotonin%20reuptake%20inhibitors%2C%20also,%2C

%20and%20Lexapro%20(escitalopram). Accessed 3 Mar 2021.

Publishing, Harvard Health. “Treating Social Anxiety Disorder.” Harvard Health, Harvard

Medical School, Mar. 2010, www.health.harvard.edu/newsletter_article/treating-social-

anxiety-disorder. Accessed 4 Mar 2021.

“Social Anxiety Disorder: More Than Just Shyness.” National Institute of Mental Health, U.S.

Department of Health and Human Services, www.nimh.nih.gov/health/publications/social-

anxiety-disorder-more-than-just-shyness/index.shtml?scrlybrkr=d3f01125. Accessed 29

Mar 2021.

“Social Anxiety Disorder (Social Phobia).” Mayo Clinic, Mayo Foundation for Medical Education

and Research, 29 Aug. 2017, www.mayoclinic.org/diseases-conditions/social-anxiety-

disorder/symptoms-causes/syc-20353561. Accessed 17 Mar 2021.

Serani, Deborah. “Children and Antidepressants.” Psychology Today, Sussex Publishers, 1 Mar.

2017, www.psychologytoday.com/us/blog/two-takes-depression/201703/children-and-

antidepressants. Accessed Apr 3 2021.

“Serotonin.” Serotonin | Hormone Health Network, The Hormone Health Network,

www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-

z/hormones/serotonin#:~:text=Serotonin%20is%20the%20key%20hormone,sleeping%2C

%20eating%2C%20and%20digestion. Accessed 3 Apr 2021.