An invisible struggle is fought by many people suffering from mental illness, and this is perhaps no more evident than with social anxiety. This is a social phobia, where those with the disorder have a fear of people and social interactions. For something so debilitating, this particular disorder seems to fall between the cracks in the provision of widespread treatment options or information availability.
To shine the spotlight on those who want to reach out and connect with others, I spoke with Ali, an 18-year-old with social anxiety, to document her treatment experiences so far. I also hoped to identify mental health treatments for social anxiety that are currently accessible.
A lonely road: living with social anxiety
Ali can’t remember a time in her life when she didn’t have social anxiety, but she was only gradually able to put a name to her condition. It was difficult for her to find the right treatment option.
“I really don’t know when it started, like I feel as if I’ve always had it. When I first went to school, I would get so anxious, and I couldn’t really talk to the other kids. I got bullied pretty badly, name calling and all that. I was always afraid going into school. I got scared looking at the teacher or having to speak in class. I found it hard to remember what people said to me when I was talking to them because of it.
“For ages I thought there was just something wrong with me, or that I would grow out of it. It slowly got worse and worse when I went to secondary school. I hadn’t any friends and I wouldn’t go out. My parents knew something was up, but I couldn’t open up. I think I learned about it from YouTube mostly. I was able to get the right help in the last year or so, but it wasn’t easy to find. My GP referred me to the Anxiety Program in St Patrick’s University Hospital, and I’m going to a therapist regularly”, Ali said.
According to Social Anxiety Ireland, the disorder affects approximately 13.7% of Irish adults at any one time or up to 1 in 8 people. Social Anxiety Ireland is the only Irish charity dedicated to dealing with the condition. They have found that it is more common in women than men and is the last anxiety disorder in terms of public as well as professional awareness/understanding.
Finding the right treatment option
Ali spoke about how she initially wasn’t successful in her first few attempts at seeking treatment and that it left her upset.
“I went to a couple of different counsellors over about 3 years since I was 15. I think a lot of the time I felt unable to open up about anything and stuck to safe topics. I never gave it a name at that stage, I just thought I was socially awkward. Some therapists just had no connection with me too. It felt like I was getting nowhere, just running around in circles really.
“I guess I put my head in the sand and just let things spiral for a bit. I eventually had a breakdown and became depressed. My parents refused to let me give up that time and my GP referred me to St. Pat’s who put me on antidepressants and recommended a therapist whom I’m still seeing”, Ali stated.
Many young people who come to Jigsaw, the youth mental health charity, look for support for social anxiety. Their website has a specific section dedicated to social anxiety, with simple suggestions that may be of use as short-term measures, such as challenging negative thoughts or practising relaxation techniques for managing anxiety.
A return to balance: exploring mental health medication
Ali also told me about her experience of taking mental health medication to help her cope with the depression she had during her worst time of despair.
“I got put on anti-depressants to combat my low periods. It was weird to be honest. The doctor gave me a low dose at first so I could adjust to them. I remember I couldn’t sleep for a few weeks when I first went on them, so it was annoying being tired all the time. Gradually, I think it really upped my mood, but it wasn’t like all of a sudden.
“I transitioned to a stronger dose, it’s in the medium range, I think. I have to take it once daily in the morning. If I don’t take it for a day or two, I get withdrawal symptoms and start to feel woozy, making it hard to concentrate. I had to switch medications from Cymbalta to Venlafaxine because I felt drowsy all the time on Cymbalta. The doctor in Pat’s said I have to take it for the next 2 years, but it’s fine. I’m used to taking it by now.” Ali explained.
Towards recovery: the support of mental health treatment
Ali then went on to describe how she has been supported through her social anxiety and has gotten past the worst period of the disorder. She said she is learning new ways to cope with it through therapy and exposure work:
“The biggest help for me in getting treated for social anxiety was going on the St. Pat’s Anxiety Disorder Programme. They brought me through group therapy, and we got to do lots of exposure work to deal with our anxieties. It was very difficult to get through, facing things that triggered me and there were many days I didn’t want to do it, but I’m glad I kept going. I see my therapist once a month as well, which helps to keep me on track.
“I was also lucky to get into the Social Anxiety Ireland Treatment Group, which meets once a week. It’s less intense than the Pat’s programme, which is 3 days a week for 5 weeks. I really like it though, as it’s more focused on social anxiety, whereas in Pat’s you’re dealing with lots of people with different disorders. I don’t think I’ll ever get rid of my social anxiety, but it’s definitely something I can manage a lot better now, even though there are still dark days,” Ali said.
St Patrick’s Mental Health Services offer the Anxiety Disorders Programme that covers social anxiety. It is a comprehensive and multi-disciplinary assessment, treatment and aftercare service for those with primary anxiety disorders. It is an inpatient and outpatient service, making it very accessible via a referral or enquiry.
Social Anxiety Ireland also offers its Social Anxiety Program, which is a 14 week group therapy program that utilises Cognitive Behavioural Therapy (CBT) and focuses on changing our thoughts as well as emotions. Social Anxiety Ireland is a charity and operates on a donation basis. Applications to the program can be made on their website via email.
Further mental health treatment options for social anxiety sufferers
There are a range of treatments available to those with social anxiety apart from the aforementioned programs. The HSE webpage on social anxiety outlines a number of different therapies that may be of use, such as psychotherapy, which focuses on how our past can influence what happens in the present. The HSE states that the most effective form of therapy is CBT and should be considered first.
There are also self-help methods, such as the book, Overcoming Social Anxiety and Shyness, 2nd Edition: A self-help guide using cognitive behavioural techniques, by the psychologist Dr. Gillian Butler, which has been recommended by Social Anxiety Ireland. Private CBT appointments can also be made.