Do I Have Social Anxiety or Something Else?

As America slowly reopens from the COVID-19 pandemic, social anxiety is on the rise. Nearly half of Americans are anxious about adjusting to in-person interactions again once the pandemic ends, according to the Stress in America survey conducted by the American Psychological Association.

"Anxiety issues hit an all-time high during the pandemic and severely impacted people's lives," says Dr. Debra Kissen, head of Light on Anxiety CBT Treatment Centers, which uses cognitive behavioral therapy to identify irrational thoughts and replace them with realistic ones. "COVID-19 gave those with social anxiety a good excuse to avoid social situations, but with things opening up again there's public pressure for people to start re-engaging in society, and that's made it especially hard for those facing anxiety issues."

Social anxiety affects an estimated 15 million Americans at some point in their lives, according to the Anxiety and Depression Association of America. Social anxiety runs in families, similar to other mental health conditions. Anxiety can also be caused by situations such as natural disasters, traumatic events and global crises like the COVID-19 pandemic.

[Read: Foods and Drinks Linked to Anxiety.]

What Is Social Anxiety?

Everyone lives with a certain level of anxiety. Maybe it's apprehension around speaking up at work, participating in clubs or sports teams because you won't feel welcome or joining neighborhood parties where you don't know a lot of people. One of the most common forms of social anxiety is public speaking -- something almost everyone can relate to.

Moderate levels of anxiety are healthy to avoid harm, act quickly and improve performance. "Some anxiety can be beneficial and help us perform better, like motivating us to prepare for speeches," says social worker Ken Goodman, author of "The Anxiety Solution Series," a 12-hour self-help audio program. "The coronavirus caused a lot of anxiety that reminded us to stay safe, but unfortunately will have a lasting impact for some people long after the pandemic is over."

The defining aspect of social anxiety is an intense fear of being judged, negatively evaluated or rejected in a social or performance situation. "Social anxiety is often marked by excessive shyness, as well as shame and embarrassment around social situations when there is excessive concern or apprehension about what people are going to think about you," says Dr. David H. Rosmarin, associate professor at Harvard Medical School and founder and director of the Center for Anxiety in New York.

Rosmarin continues: "All of us have different personalities -- some of us are extroverted or introverted -- and neither of those are disorders by themselves. It becomes a problem when anxious feelings get in the way of living life and lead to significant distress."

Social Anxiety Symptoms

Those living with social anxiety may experience not only strong emotional feelings, but also physical symptoms as well. When facing a social situation, those symptoms may include:

-- Rapid heart rate.

-- Nausea.

-- Sweating.

-- Full-blown panic attacks.

Although they recognize that their fear is excessive and unreasonable, people with social anxiety disorder often feel powerless against their anxiety.

What are examples of excessive shyness? A person with social anxiety shops at a store and leaves realizing that they forgot an item but would not return to the store because they would worry what the cashier would think of them for coming back. People avoid going to the gym because they are worried what other people will think of their exercise routine. Maybe the person avoids driving a car because they fear getting in a car accident and will have to interact with another driver.

[See: 8 Unexpected Signs You're Stressed.]

Consequences of Social Anxiety

When social anxiety persists, it can lead to multiple consequences such as:

-- Isolation.

-- Loneliness.

-- Depression.

-- Low self-esteem.

-- Lower academic and athletic achievements.

-- Substance abuse.

One of the main ways that social anxiety affects adults is at work, which can hinder advancement at their jobs. "When someone is too quiet during meetings or calls because they are nervous to say something, it's possible that their boss or co-workers may view them as not being interested, and so they get passed over for promotions or other career opportunities," Rosmarin says.

Developing relationships with friends or romantic partners can be challenging for those with social anxiety, too. It's common that people with social anxiety avoid dating because of the distress and fear of what others might think of them during a date. Online dating is often a helpful way for people with social anxiety to overcome their fears and get to know other people through texting or FaceTime before meeting in person.

How to Overcome Social Anxiety

To minimize anxious thoughts, doctors and therapists recommend addressing anxious behaviors first. "Anxious behaviors maintain anxiety and make it hard to break the cycle. You can't overcome a fear of elevators if you don't get into an elevator," Goodman says.

To start freeing yourself from anxiety, identifying the situations that you are avoiding is the first step. "It's about tolerating uncertainty and distress on a frequent basis and that helps reduce fear and anxiety," Goodman explains. Some examples of taking a first step include: wearing one mask instead of double masking, returning to the office one or two days a week, attending a party for an hour or going to the mall to get used to being around people again.

Kissen works with her patients through imaginal exposures. "The goal of this work is to train the brain to face scary scenarios head on and tolerate and cope with the anxiety rather than run from it," she says. This may be imagining what it would be like to go to the party and stay with that image until there's a reduction in anxiety. Another strategy is called response prevention, which means not giving into compulsions such as sanitizing groceries that are delivered to your home.

[Read: How to Help Kids With Anxiety.]

Can Social Anxiety Be Cured?

Kissen is often asked by her patients whether they can be cured of social anxiety. "My short is answer is usually no. But the longer and more helpful answer is that social anxiety can become less of an issue until it's a shadow of its former self," adds Kissen, who's also co-chair of the Anxiety and Depression Association of America public education committee.

With the help of doctors and therapists, social anxiety can be addressed through cognitive behavioral therapy, or CBT, that helps replace irrational thoughts with realistic ideas and helps people understand different coping strategies to manage situations. Specific anxiety-causing situations are addressed to understand the root cause with clear actions on how to adopt healthier thinking for the future.

Doctors may also recommend medications such as antidepressants, which have been proven to be helpful in managing anxiety. Selective serotonin reuptake inhibitors, or SSRIs, and the serotonin-norepinephrine reuptake inhibitor, or SNRI, venlafaxine are commonly prescribed. Other medications include anti-anxiety agents called benzodiazepines and beta-blockers.

"You'll be better off if you take action sooner and don't sit at home and think about your worries," Kissen says. "Facing fears is never easy, but there are small steps that can be taken to get your life back."

Paul Wynn is an award-winning health journalist and contributor to U.S. News. He is the author of hundreds of articles covering a wide variety of scientific, health care policy and technology trends.

Mr. Wynn has contributed feature and news stories to more than 60 consumer and trade magazines throughout his career. These publications include Diabetes Self-Management, Diversion, Health, Medscape, Pain-Free Living, POZ and Prevention.

After graduating from Ithaca College's Park School of Communications, Mr. Wynn started his journalism career covering the drug industry for Med Ad News. He is a regular contributor to the American Academy of Neurology's Brain & Life magazine and the American Medical Student Association's The New Physician magazine.