Dear Dr Pene: I can’t face people because I’m worried I’ll say something stupid and embarrass myself

Question |

Dear Dr Pene, 

Lately I just can’t face people. I get really nervous that I’ll say something stupid and embarrass myself. I’ve been avoiding my friends as I’m sure they think I say strange things all the time.

I get so anxious about going to the supermarket because I’m worried I’ll bump into someone I know. When I seen people I know I go as red as a beetroot and can’t think clearly - it’s almost like I’m going to faint or pass out.

The other day I had to sign my name at the bank and I felt all panicked and worried about having to do it in front of bank teller. My hand was trembling so much and she would have thought I was some kind of freak for sure. Do you know what could be going on?

Dr Pene |

Social anxiety is used to describe nervousness or discomfort that occurs in response to social situations. The anxiety might occur before, during, or after the social situations, and in many instances at all three times. Most of us, at some point in our lives have felt a little nervous, or embarrassed in response to social situations. Things like giving a speech. Going to a party. Meeting someone new. Making small talk. Dating. These are all situations that can easily make many of us feel a little anxious. But for some of us, the anxiety can be so intense and distressing that we might avoid social situations all together. When this happens, anxiety can have the effect of holding us hostage, stopping us from living the life that we really want to be living.

Anxiety is something that everyone experiences. It can be helpful to think about is as occurring along a continuum or on a scale that varies in intensity. I think about it like this…at one end of the scale is the “chilled out/ no to low anxiety” zone where we are largely free from anxiety and feel relaxed. Towards the opposite end of the spectrum is the “stressed out/ high anxiety” zone where we experience heightened and often intense anxiety. Just beyond this is where we find the “Panic” zone. When we enter this zone we can’t really think clearly and it can be quite intense and uncomfortable. And somewhere in the middle, is the “neutral” kind of zone. We hope that we spend most of our time here, moving up to the high zone or down to the low anxiety end of the scale, when appropriate. Sometimes we might even go right to either end.  

But if we find that everyday social situations are so anxiety-provoking for us that they are pushing us up into the “high anxiety” zone, it can be quite distressing. While it’s completely normal to experience a certain degree of social anxiety prior to a social interaction, people with a social anxiety disorder (or social phobia) will differ from these normal feelings of nervousness and instead experience an intense and debilitating level of fear. When this occurs it’s likely that we are either interpreting the situations as threatening in some way, or we are predicting that something negative might occur.  There are of course other reasons for why this can happen but for now let’s just focus on these two.

People who are socially anxious often have a strong desire to make a good impression and worry about making a fool of themselves, being embarrassed or humiliated. They can be their own worst critic and quite often might feel that other people will be judging them just as harshly as they judge themselves. They might worry that people will think they’re awkward, uninteresting or “a freak”. Basically, they are worried about not coming across well.

You might be surprised to learn that for people with social anxiety, things like going shopping or going to the bank, are really common types of situations that can trigger anxiety. Even walking down the street in view of other people or sitting opposite people on public transport can be incredibly anxiety-provoking, because if we’re socially anxious we can feel self-conscious and worry about what other people are thinking about us. It’s important to acknowledge that when it comes to social anxiety the types of social situations that people find anxiety provoking will vary, so identifying our own personal triggers is key.

So what is going on? If we are perceiving a “social threat” in a particular situation, or thinking something negative might occur (i.e., perceived social danger is high), our fear response (fight or flight) can get triggered. This usually results in the uncomfortable physical sensations that come with heightened anxiety. Things like a racing heart, blushing, going blank, nausea, tightness in the chest, increased sweating and tension. Or as you experienced at the bank, trembling and shaking. These symptoms can be really unpleasant and can often leave us feeling like we’re losing control or feel like we’re “going crazy”. Naturally, when we experience these symptoms we tend to also worry that other people will notice. So what does this do to our anxiety level? It drives it up of course.

The most common behavioural response for someone with social anxiety is to avoid the social situation completely. It sounds like this may even be a strategy that you have started to use. While this may temporarily reduce your anxiety, in the long term it actually maintains your anxiety and can make it worse. You see, the more you avoid, the more anxious you are likely to feel, and then the more you will continue to avoid. You can see how this cycle continues on a downward spiral. When it comes to social anxiety a useful motto is: AVOID AVOIDING.

Along with Avoidance, there are five other factors that can contribute to the overestimation of social threat. These are our:

• negative thoughts

• avoidance

• safety behaviours

• self- and environment-focused attention

• how you think you appear to others

• and negative core beliefs. 

These factors all work together to maintain your social anxiety. Working with a therapist to start to unpack what’s going on for you could be helpful in discovering some practical strategies to manage each of these factors. The more we can all understand our own anxiety response patterns, the better we are equipped to proactively manage our anxiety when it shows up. Depending on your own features of anxiety there are a range of treatment options including cognitive behavioural therapy (CBT), medications, using exposure techniques to confront your fears, polishing up on your social skills (e.g. learning how to start or keep a conversation going).

From your letter, it seems that you have a number of negative thoughts occurring? Thoughts like “I’ll say something stupid and embarrass myself” “My friends think I say strange things all the time” “I look as red as a beetroot” “She thinks I’m some kind of freak”. These kind of negative thoughts will no doubt be contributing to making you feel anxious about social interactions or situations. Sometimes we can be aware that unhelpful thoughts are contributing to our difficulties, but we don’t know what to do about them. Working with a psychologist or following the principles of cognitive behavioural therapy (CBT) via a book or other resource can offer practical ways of overcoming self- defeating thoughts and behaviour. The aim of CBT is to develop helpful and realistic thought patterns to help us respond better to strong and unsettling emotions.

Learning how to identify and challenge your negative thoughts is a skill that can have a powerful positive impact on your anxiety levels. Specifically, it can help you to recognise when you’re overestimating the level of threat in a social interaction, and to think about the interaction in a more helpful and realistic way. So start by being curious about your anxiety. How long has it been present? Are there any core beliefs that might be contributing to your current experience? What is it that you really fear people might think about you? Whatever it is, it’s helpful to start to understand your anxiety, and perhaps even make room it. By doing this, many people find that they can stop worrying about worrying, and learn to live their life despite anxiety showing up. This is because the more we can understand our own anxiety, the easier it is to learn ways to manage it, and the less we fear it. The less we fear anxiety, the more confident we will be in our ability to reduce it’s negative impact on our life.

Some things you might like to think about…

• Identify how anxiety shows up for you. What do you think, feel and do in social situations? By examining the physical, cognitive and behavioural aspects of your anxiety you will get a greater understanding of your anxiety. 

• Depending on your own features of anxiety there are a range of treatment options including cognitive behavioural therapy (CBT), medications, using exposure techniques to confront your fears, polishing up on your social skills (e.g. learning how to start or keep a conversation going). 

Dear Dr Pene is for informational purposes only, does not constitute medical or psychological advice, and is not a substitute for professional medical or psychological advice, diagnosis, or treatment. Always seek the advice of your physician, psychologist, mental-health professional, or other qualified health provider with any questions you may have regarding a medical or psychological condition.