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Social Anxiety Disorder – A Christmas Concern

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I referred in my last note to Seasonal Affective Disorder which is commonly referred to as SAD. There is at this time of year another condition which is also referred to by the initials SAD.  This second condition may be less well known but it is particularly common around the festive period and for those affected it can be extremely difficult to bear.

These SAD initials stand for Social Anxiety Disorder. This relates to a reluctance to engage and interact with others especially within a social context.

A very mild form of this type of SAD can be seen in that reluctance to mix with others in a social setting. A common example can be the wish to avoid the annual company event or the family party at the year end. A more extreme form is the complete avoidance of all social or family contact outside of an extremely small circle. The festive period with New Year celebrations and a myriad of Christmas parties can be a very difficult time for SAD sufferers,

There is of course the question of whether SAD really exists as a condition to be remedied or if as therapists we are just pathologising a perfectly normal condition. On a cold wet December evening is there really anything amiss in not wanting to go after work into a noisy crowded pub to have a couple of lukewarm orange juices whilst talking to people with whom you have little in common - as opposed to just going home. Some will argue that it is those who have the need to always go to the pub who may have the issue.

I hold a belief in the importance of choice in a life well lived. I growl inwardly (and sometimes outwardly!) at those who always feel they know what is right for others – and who then proceed to broadcast that opinion. When these individuals assume positions of power and influence my apprehension increases manifold, irrespective of the context, be that political, cultural or intellectual. That may be why as a therapist I retain suspicion of those counselling fundamentalists who preach a rigorous version of CBT or promote certain forms of NLP or hypnotherapy.

If that existential freedom is part of my creed then it follows that I should be careful not to inadvertently pass on these thoughts as any form of imperative.  So long as there is no express harm to others, individuals should be free to be as they wish. Freedom is just that – the freedom to do, to be, to appear, to act and to say as we wish. And if that means that individuals wish to avoid socialising then so be it.

So when does SAD come in as a condition which calls for attention and help?  Perhaps the acknowledgment comes when an individual recognises that they have lost that inner personal freedom to do as they wish. It may be that when the dread at having to attend an event becomes so overwhelming that there may be an issue to be faced. 

If we decide not to go to dinner, or to drinks with others because we do not enjoy the event, the ritual or the company, that seems a reasonable response. The challenge comes when we do not attend because we feel that we just cannot go along because of a nameless dread of being with others.

Sometimes that anxiety can be recognised as having a specific source.  Examples can range from having a long held unease at eating in public or a perceived lack of competence in the art of small talk.  Sometime an individual may feel uncomfortable at his/her appearance compared to others or is overwhelmed by what they may regard as the powerful nature of the other participants.

With those situations there is at least an identified focus for the discomfort which can then be addressed by the individual. That work can be carried out either alone, or in conversation with friends or by sessions with a counsellor or therapist.  Sometimes however there may just be that overwhelming sense of fear. The prospect of having to go to the event gives rise to a devastating sense of an existential threat to one’s whole being – and in those very difficult cases the work may need to be much more open.

Whatever the extent of the distress it is important to acknowledge that Social Anxiety Disorder is real. The impact for those who suffer from SAD can range from a mild discomfort through to outright emotional torment.  The pain comes when sufferers are coerced by friends, lovers or colleagues into agreeing against their wishes to go to social events.  The days, weeks or even months leading up to the event can be desperate and agonising and yet there is often a perceived lack of understanding from others.

The reasons for the anxiety can be manifold but this type of unease may well have origins back in earlier years of life and with those initial interactions with others whether at home or school.  As with all therapy the key tasks are to try to develop an understanding of why the anxiety state has arisen and to then find ways to ameliorate the condition.

Different types of therapy can help in different ways.  Some solution focussed work or cognitive behaviour therapy can be particularly effective in dealing with mild SAD or with conditions where there is that very specific source of concern such as eating in public. 

For more general concerns where there is a deeper or widespread malaise it may be that a more reflective form of therapy can prove to be helpful such as psychodynamic counselling.   

With chronic conditions when SAD is impacting on an ability to function in a work or social environment, an integrative approach can be particularly helpful.  If we can understand more about ‘why’ before moving too quickly off into solution or ‘fixing’ mode, that approach can enable the eventual helpful changes to be built upon firmer emotional and cognitive foundations.

A key time for all with the SAD condition is when the sufferer decides to have that initial conversation with a counsellor. That may not be an easy decision to make particularly if the condition is downplayed by the individual concerned.

In those instances I often encourage potential clients to look across the physical/emotional divide. If a friend was enduring acute debilitating physical pain which arose on a regular basis, we would of course encourage the sufferer to look at taking action to have things checked out. I would suggest applying the same approach to emotional pain and discomfort and to look for effective remedies.

If this form of SAD – Social Anxiety  Disorder - affects you especially around this time of year when the world expects you to be buzzing with anticipation about forthcoming events with friends, family and colleagues, then perhaps the time is right to take some action.

If on reflection that action is no more than finding the right way to say no and stay at home, safe and without social pressures then so be it.

But if we want to resolve this issue and ease the torment there is an alternative. That is to confront the issue and work together with a therapist or counsellor to understand what is happening and why - and to then look reducing those concerns.

And if you do decide to go through that process this may mean that by the end of next year it really could be a festive and merry time for you!!





Geoff Boutle

added on 1st December 2014

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