Friends Wanted

The new year seems to trigger discussions about connections, loneliness and friendships. Perhaps a time for reflection or a reaction to all the expectations of gathering with others around the holidays. This article explores and explains the importance of social connections to our emotional and physical health. New research by psychologists uncovers the health risks of loneliness and the benefits of strong social connections.

By Anna Miller

Monitor Staff

January 2014, Vol 45, No. 1

Print version: page 54

It took a trip to the hospital for Cathryn Jakobson Ramin, 56, to confront a nagging concern she'd had for years: She had no friends. "I didn't have one person who could pick me up," says the journalist in Mill Valley, Calif., who went to the hospital for a small medical procedure.

Ramin does have many friends — those she first met in childhood and in the four cities she's lived in as an adult — but they don't live nearby anymore. She also has a strong marriage, two grown sons and a successful career. But she has few local friends she can call on in a time of need — or for simple companionship.

"I like the sense of sitting in someone's kitchen with a cup of tea and cookies and just shooting the [breeze]," she says, admitting she feels a void. "That to me is a very important part of life."

Psychologists agree. While research on relationships has skirted adult friendships — tending to focus on adolescent friendships and adult romances — the importance of strong social connections throughout life is gaining scientific clout, having been linked with such benefits as a greater pain tolerance, a stronger immune system, and a lower risk of depression and early death.

"For years and years … people speculated that if you felt alone or you lived alone or you were alone a lot, you wouldn't eat good meals, you wouldn't exercise as much, nobody would take you to the doctor," says Laura Carstensen, PhD, who directs Stanford University's Center on Longevity. "But I think what we're learning is that emotions cause physiological processes to activate that are directly bad for your health."

Yet forging platonic relationships isn't always easy. Ramin's situation appears to be increasingly common: According to a meta-analysis with more than 177,000 participants, people's personal and friendship networks have shrunk over the last 35 years (Psychological Bulletin, 2013).

Combine that trend with the United States's rising age of first marriage, a divorce rate nearing 50 percent and a life expectancy that's at an all-time high, and you get "a demographic shift such that there are now [more] people who don't have a marital partner to supply the intimacy they need," says Beverley Fehr, PhD, a social psychologist at the University of Winnipeg and author of the 1996 book "Friendship Processes." "In light of those shifts, I think that friendships are more important today than ever before."

I'm so lonesome I could die

A lack of friends isn't simply an inconvenience when you want a movie partner or a ride to the hospital. A sparse social circle is a significant health risk, research suggests. In one meta-analysis of 148 studies comprising more than 308,000 people, for example, Brigham Young University psychologists found that participants with stronger social relationships were 50 percent more likely to survive over the studies' given periods than those with weaker connections — a risk comparable to smoking up to 15 cigarettes a day and one double that of obesity. And the risks of poor relationships are likely greater, the researchers say, since the studies didn't look at the quality of participants' social connections (PLOS Medicine, 2010).

There's some evidence that more really is merrier. In one recent study tracking 6,500 British men and women ages 52 and older, psychologist Andrew Steptoe, PhD, of the University College London and colleagues found that both feeling lonely and being socially isolated raised the risk of death. However, only social isolation — measured in terms of frequency of contact with family and friends, and participation in organizations outside of work — appeared to be related to increased mortality when the researchers adjusted for demographic factors and baseline health (PNAS, 2013).

But contrary to Steptoe's findings, most research indicates that feeling isolated is more dangerous than being isolated, says psychologist John Cacioppo, PhD, co-author of the 2008 book "Loneliness: Human Nature and the Need for Social Connection." In one 2012 study, he and colleagues looked at data from more than 2,100 adults ages 50 and older and found that feelings of loneliness were associated with increased mortality over a six-year period. The finding was unrelated to marital status and number of relatives and friends nearby, as well as to health behaviors such as smoking and exercise (Social Science and Medicine, 2012).

"It's not being alone or not" that affects your health, Cacioppo says. "You can feel terribly isolated when you're around other people."

In his ongoing Chicago Health Aging and Social Relations Study, funded by the National Institute on Aging, Cacioppo and colleagues have also linked loneliness with depressive symptoms and an increase in blood pressure over time.

Other research indicates positive social connections might accelerate disease recovery. In a study of 200 breast cancer survivors, psychologist Lisa Jaremka, PhD, and colleagues at the Ohio State University found that lonelier women experienced more pain, depression and fatigue than those who had stronger connections to friends and family. The more disconnected women also had elevated levels of a particular antibody associated with the herpes virus — a sign of a weakened immune system (Psychoneuroendocrinology, 2013).

Particular genes may play a role in explaining why our bodies are so attuned to our social lives, says psychologist Steve Cole, PhD, at the University of California, Los Angeles. In one study, he and colleagues including Cacioppo analyzed the gene expression profiles of chronically lonely people and found that genes expressed within two subtypes of white blood cells are uniquely responsive to feelings of loneliness. The cells — plasmacytoid dendritic cells and monocytes — are associated with diseases such as atherosclerosis and cancer, as well as "first line of defense" immune responses (PNAS, 2011).

Cole says the most "biologically toxic" aspect of loneliness is that it can make you feel chronically threatened, an emotion that can wear on the immune system. "It's really that sense of unsafe threat, that vague worry, that's probably what's actually kicking off the fight-or-flight stress responses that affect the immune system most directly," he says.

Friends in adulthood

As researchers work to better understand the link between friendships and health, they're also helping to answer a question familiar to anyone who's ever moved to a new city, lost a spouse or otherwise found themselves feeling alone: How do you make friends as an adult? Here's what the research suggests might work:

• Be a familiar face. The idea that familiarity breeds attraction is long-established by research, and was again supported in a 2011 study led by psychologist Harry Reis, PhD, at the University of Rochester. In the first experiment, same-sex strangers rated how much they liked one another after having several structured conversations. In the other, strangers chatted freely online. In both cases, the amount participants liked their partners increased with each exchange (Journal of Personality and Social Psychology, 2011).

Rachel Bertsche, a writer in Chicago, witnessed this phenomenon outside of the lab when she joined a weekly comedy class a few years ago. At first, she thought her classmates were strange. But she gradually changed her mind — and soon wound up joining the group for drinks after class. "Consistency is so important," she says.

Fehr agrees. She says sticking to a simple routine — whether it's going to the same coffee shop at the same time every day, joining a class like Bertsche or even just going to the office mailroom when it's most crowded — can help turn strangers into friends.

• Divulge a secret. There are ways to make fast friends, too, psychologists say. Research by Stony Brook University professor Arthur Aron, PhD, showed that gradually increasing the depth of questions and answers between strangers can spawn friendships in just 45 minutes (Personality and Social Psychology Bulletin, 1997). Fehr and her team are building on this model by directing a couple of college buddies first to ask each other neutral questions, such as, "When did you last go to the zoo?" and slowly build up to more intimate questions such as, "If you knew someone close to you was going to die tomorrow, what would you tell them today — and why haven't you told them yet?"

So far, she's seeing men's friendships getting stronger. "When they do open up to each other, they feel closer to each other and they feel more satisfaction with the relationship," she says.

• Realize it's in your head. Loneliness is a subjective experience that can often be a self-fulfilling prophecy, says Cacioppo. "When people feel isolated, the brain goes into self-preservation mode," he says, meaning that they become preoccupied with their own — not others' — welfare. While the response is an innate one meant to protect us from threats, over time, it harms physical and mental health and well-being, and makes us more likely to see everything in a negative light. It can also make us seem cold, unfriendly and socially awkward. But recognizing what's in your head can help you get out of it, Cacioppo says.

In a review of interventions to reduce loneliness, he and colleagues found that those that encouraged participants to challenge their own negative thought processes — for example, by sharing a positive part of their day with someone else — were more effective than interventions seeking to improve social skills, enhance social support or increase opportunities for social contact. "It has a surprising effect," Cacioppo says. (Personality and Social Psychology Review, 2010).

• Log on, with caution. Liz Scherer, a copywriter in Silver Spring, Md., used social media to forge friendships when she moved from New York City to Annapolis, Md., about 10 years ago at age 42. Through Twitter, she connected online with others in her business and met many of them in person at social media conferences. "I've made some really good friends who I talk to … every single day," she says. "They're good social supports and business supports."

Research suggests Scherer's positive experience with social media is most common among people who are already well connected. A review of four studies by psychologist Kennon Sheldon, PhD, of the University of Missouri, and colleagues, for example, found that more time on Facebook was linked to both high and low levels of connectedness. Psychologists posit this may be the case because Facebook supports relationships among those who are already highly socially connected, but might make those who are isolated feel even more so (Journal of Personality and Social Psychology, 2011).

"If you rely on virtual relationships entirely, that's probably bad for you," Carstensen says. "But when you're using email and face time to supplement real relationships, that's a good thing."

• Don't force it. If the pressure to forge new relationships is more external than internal, put away the "friend wanted" ad and focus on what and who does make you happy, says Carstensen. "If people are not very socially active and they aren't necessarily interested in expanding their social networks, and they seem OK emotionally, then you shouldn't feel alarmed," she says.

After all, being highly connected has its downsides, too, says University of Sheffield psychologist Peter Totterdell, PhD, who studies social networks in organizations. He's found that people with large work-based networks tend to be more anxious than those with fewer connections. "Possibly what's going on there is that you get more possibilities, more resources, but at the same time you've got more responsibility as well," he says.

And trying to change who you are can backfire, since people's likelihood to forge connections seems to be relatively constant throughout life, Totterdell says. "People may have a natural inclination, and to try to change that [may] make them uncomfortable with the results," he says.

The bottom line? Whether you're content with two close friends or prefer to surround yourself with 20 loose acquaintances, what matters is that you feel a part of something greater than yourself, Carstensen says.

"We shouldn't judge people who say, ‘I'm not a party goer, I don't want to make friends, I don't want to hang out in the bars or the clubs' — that's fine," she says. "There's a whole bunch of people who feel the same way."

Link to article

Holiday Stress, Parties and Hangovers: Drinking Responsibly This Holiday Season

I was quoted on the negative impact of over drinking at holiday parties. By Rheyanne Weaver HERWriterDecember 4, 2012 - 7:10am

Holiday parties are among the highlights of the winter season, and these parties tend to involve drinking alcohol.

If you’re not careful, you might overindulge in festivities, leading to a hangover the next day. This can become a problem, especially if the next day is a work day.

Caron Treatment Centers recently released survey results from 2,005 adults age 21 and above, suggesting that it is quite common to drink excessively, suffer from a hangover and miss work after a holiday party.

In fact, 64 percent of Americans have either called in sick or know someone who did because of a holiday party hangover.

 74 percent of holiday party attendees drank more than three alcoholic drinks or know someone who has at a holiday party, which is considered above a moderate alcohol limit.

Drinking out of moderation could be a sign of substance abuse or depression, which are major mental health issues.

The workplace can already be filled with stress and competition, so missing work or having impaired functioning in the workplace just adds to a negative workplace atmosphere.

Sometimes alcohol can lead to destructive behavior, which is even worse if the holiday party involves co-workers.

Survey results showed that most people who have attended holiday parties noticed behaviors such as arguing and aggression, excessive use of profanity, drunk driving and inappropriate disclosure of private details.

Dr. Harris B. Stratyner, the vice president of Caron Treatment Centers and New York regional clinical director, said in an email that hangovers can be terrible for mental health because dehydration leads to an “alcoholic migraine.” Serotonin levels also decrease, which leads to depression.

“Drinking too much alcohol can affect your mental health and harm your status in the workplace, because you can come off looking immature and having poor judgment,” Stratyner said.

“Employers and colleagues will start to question your judgment, therefore leading them to question your reliability to meet deadlines and do your job well.”

He suggested only drinking a maximum of two alcoholic drinks at work-related events.

And if you can’t drink in moderation, that is a major red flag.

“I would say that having a hangover and missing work after a holiday party is a sign that you have a problem with alcohol,” Stratyner said. “Anytime alcohol interferes in your life, you have a problem with alcohol. You have now interrupted the way you earn your living.”

Many employers have to make cuts as it is, so looking irresponsible and foolish by over-drinking at a holiday party is not a wise choice. Unfortunately, he said it is quite common for people to overindulge in alcohol during the holidays due to holiday stress.

“People tend to self medicate because they want to relax, escape or manage difficult emotions that may come up,” Stratyner said.

However, alcohol tends to cause more problems than it solves. He suggested engaging in healthier ways to relieve holiday stress, such as shopping early and online, planning a potluck holiday dinner so everyone contributes, and avoiding alcohol and drugs (especially while driving). He recommended exercising consistently, and focusing only on positive past holiday memories.

Rosalie Moscoe, a registered nutritional consultant practitioner and author of “Frazzled Hurried Woman! Your Stress Relief Guide to Thriving ... Not Merely Surviving,” said in an email that hangovers can lead to lower self esteem, especially if people are perceived poorly in the workplace because of their lack of control.

Besides a hangover, an excess of sweets and alcohol can also lead to hypoglycemia, which is associated with mood swings.

She said that for people who are already struggling with substance abuse, holiday parties can be a trigger because of the acceptability of profuse amounts of alcohol.

It can be tempting to drink more at holiday parties because of all the additional holiday stress that piles up, including financial stress and dealing potentially with unpleasant family members.

Nerina Garcia-Arcement, a licensed clinical psychologist, said in an email that if holiday parties involve co-workers, sometimes it can be an awkward situation.

People are anxious about how they should be acting.

They might think that drinking alcohol will relieve any tension, stress and anxiety about the situation.

People who do decide to overindulge in alcohol can suffer side effects of hangovers like low energy level, concentration and attention problems and changes in mood.

Garcia-Arcement said that overdrinking one time and suffering the consequences at work might not be a dealbreaker for employers. However, if it’s on a consistent basis, this could be a sign of serious mental health issues and you could lose your credibility at work (or your job).

Sources: Caron Treatment Centers. Hungover at Work During the Holiday Season? Web. Dec. 3, 2012.

http://www.caron.org/hungover-at-work-during-the-holiday-season.html

Stratyner, Harris. Email interview. Dec. 3, 2012.

Moscoe, Rosalie. Email interview. Dec. 3, 2012.

Garcia-Arcement, Nerina. Email interview. Dec. 3, 2012.

Reviewed December 4, 2012 by Michele Blacksberg RN Edited by Jody Smith

Link to article

Can Social Anxiety Be Caused by a Nutritional Deficiency?

I was quoted on the topic of social anxiety and its causes. by Rheyanne Weaver |

If you don’t get the right nutrients, your body won’t function to the best of its ability. Some general health conditions can be linked to nutritional deficiency, but it’s up for debate whether the same applies to specific mental health conditions. Some nutrition experts do claim that unique cases of social anxiety can actually be caused by a nutritional deficiency. In the condition several experts refer to as pyroluria, once the nutritional deficiency is taken care of, the social anxiety is relieved. Other experts are quick to dismiss the validity of this diagnosis.

Trudy Scott, a food-and-mood expert who said in an email that she has suffered from pyroluria, is a certified nutritionist, immediate past president of the National Association of Nutrition Professionals, and author of The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings.

“The person experiences shyness, inner tension, and social anxiety,” Scott said in regard to symptoms of pyroluria. “Symptoms usually start in childhood and are made worse under stressful situations. The wonderful thing is that the symptoms can be completely alleviated with taking these supplements: zinc, vitamin B6, and evening primrose oil. People typically start to feel less anxious, less shy, and more social within a week. The important thing is that if you do have pyroluria, you do need to take the supplements always.”

Generally only zinc and Vitamin B6 are recommended for pyroluria, but “gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, is also beneficial for those with pyroluria because its levels are often low, and supplementing with GLA improves zinc absorption,” she added. In her book about anxiety, mood, and food, she wrote a whole chapter about pyroluria.

“I am … very passionate about the subject because I have pyroluria myself and used to suffer terribly from social phobia and shyness, anxiety, unexplained fears, waking with a sense of doom and even panic attacks,” Scott said. “I have used the amazing healing powers of foods and nutrients to completely heal. I now help women find natural solutions for anxiety and other mood disorders.”

She has posted a questionnaire on her website for pyroluria. It includes a long list of symptoms, and if 15 or more items are checked on the list, it is likely a person has pyroluria: http://www.everywomanover29.com/blog/pyroluria-questionnaire-from-the-antianxiety-food-solution/

She said that in research studies, pyroluria is also called “the mauve factor.” “Much of what we know about pyroluria is based on the work of Humphrey Osmond, Abram Hoffer, and Carl Pfeiffer,” Scott said. “Much of the original work was done with schizophrenic patients in psychiatric hospital settings. Although pyroluria was first identified in the 1960s, the medical and mental health communities have been slow to recognize it, and many mental health practitioners and physicians remain unfamiliar with this condition.”

She said she learned about the condition mainly from reading the following books: The Mood Cure by Julia Ross Depression-Free Naturally by Joan Mathews-Larson Nutrition and Mental Illness (1988) by Carl Pfeiffer

Her own book goes into the specific details and biological/chemical/genetic aspects of pyroluria. In her book, she cites research prevalence rates from Joan Mathews-Larson, the author of Depression-Free Naturally. Pyroluria is thought to exist in “11 percent of the healthy population” and “40 percent of adults with psychiatric disorders,” according to Scott’s book. For people with alcohol addiction, pyroluria is thought to have a 40% prevalence rate. However, the prevalence rates do depend on the source. In her own experience as a nutritionist, Scott said about 80% of her clients who have moderate to severe anxiety have symptoms associated with pyroluria.

She added that stress can be a major factor for what age pyroluria develops and that it is a genetic condition that seems to affect more women than men. In addition, people who have pyroluria tend to also have gluten sensitivity, especially if they also are dealing with other issues like depression, anxiety, autism, alcoholism, bipolar disorder, and schizophrenia, according to the book. People with pyroluria may also have digestive problems, and they need to make sure to balance out an increased Vitamin B intake with a higher intake of magnesium.

In the book The Mood Cure by Julia Ross, the author includes a discussion of the prevalence, testing, and treatment of pyroluria, as well as a checklist similar to that offered by Trudy Scott. Ross states that the questionnaire was developed by Dr. Carl Pfeiffer, a clinician and researcher. He wrote the book Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry in 1988.

Ross states in her book that pyroluria is fairly uncommon in the general public, but in certain groups of people (like those who have experienced alcohol addiction), it is more common. “I am just getting familiar with this condition, but I can see that it is an important one for certain people, affecting stress levels and mood generally and preventing full response to nutrient therapy until it is addressed,” Ross wrote in her book.

There are a plethora of articles dedicated to nutrition, diet, and mental health in general, as well as multiple research studies suggesting that certain mental health issues can be improved through natural supplements and a healthy overall diet. “Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries and are exceptionally deficient in patients suffering from mental disorders,” according to an abstract from a research study in Nutrition Journal. “Studies have shown that daily supplements of vital nutrients often effectively reduce patients’ symptoms.”

Another abstract from a research article in the journal Alternative Therapies in Health and Medicine concludes the following: “Many patients will benefit from the use of specific dietary supplements, such as a multivitamin-mineral high in B vitamins and omega-3 fatty acid,” according to the abstract. “And no matter what the underlying cause of the mood disorder, patients should be counseled about the relationship between food and mood, for the evidence now substantiates what laypeople and medical professionals have long known intuitively: the way we eat affects the way we feel.”

The research, authored by Tieraona Low Dog, director of the fellowship at Arizona Center for Integrative Medicine at University of Arizona, added in the research abstract that the healthiest diet for improving mental health is a “low-glycemic, modified Mediterranean diet rich in fruits, vegetables, whole grains, and seafood (if not vegetarian) and low in processed, refined foods.”

Other experts remain unaware of the condition and are skeptical of its legitimacy. Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said in an email that he is not accustomed to pyroluria and had to look it up on Google to find out what it was.

“Once I saw that it is connected to orthomolecular psychiatry, which I have heard of, I knew it was in the pseudoscience realm,” said Carroll, who is also an assistant professor at the University of New Mexico School of Medicine. “Not surprisingly, it claims to be the cause of a number of unrelated psychiatric disorders, which is typical of pseudoscience disorders. Like so many ‘cure-alls,’ it sounds plausible, but there is no scientific basis to it, and it allows dubious practitioners to prey on desperate, suffering people.”

He said there are certain cases where nutrition can play a part in mood and mental disorders. “Inadequate amounts of Omega 3 fatty acids, especially from fish or krill oil, have been shown to affect mood and anxiety in a broad way of which social anxiety can be a part,” Carroll said. “Also, low folate, low Vitamin D, and low B12 have all been associated with negative effects on mood and anxiety.”

“However, in people with low folate, it is more often a case of a genetic inability to transport the folate molecule into the brain rather than a low blood level,” he added. “In those cases, which often present with chronic depression and anxiety that has never responded to antidepressants, there are folate precursors that are more lipophilic and can diffuse into the brain without use of a transport mechanism.”

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at the NYU School of Medicine, said in an email that she didn’t study pyroluria in school and hasn’t read about it in any research studies after graduating from her doctorate program.

“Based on current knowledge it does not appear to be a legitimate health condition,” Garcia-Arcement said. “Further research is required to further explore and understand whether social anxiety or any other mental health condition could be related to improper synthesis in the blood.  Although this theory seems appealing, being able to ‘cure’ a mental disorder with vitamins or supplements … is unlikely.”

“Causes of social anxiety that have been substantiated by research include chemical imbalances in the brain (i.e., serotonin, a neurotransmitter), inherited traits (genetic and through observing anxious family members), negative life events or experiences, and an overactive amygdala (a part of the brain that controls emotions, including fear response),” she added.

She said that good nutrition is important for overall health, but it’s not necessarily linked to mental disorders. “In my experience, the social anxiety could be traced to other causes, not nutritional deficiencies,” Garcia-Arcement said. “Having a healthy and balanced diet is overall beneficial, but it won’t cure social anxiety or a mood disorder. I am more likely to recommend my clients get enough sun exposure to improve their moods (seasonal affective disorder) than recommend diet changes.”

Link to article

Social Anxiety Can Be a Hidden Problem in College

I was quoted on the topic of social anxiety, its causes and how to cope or treat the symptoms. by Rheyanne Weaver |

Public speaking is generally not a favorite activity of most people—in fact many people seem to fear public speaking or at least avoid it when they can. But most people are also not crippled with embarrassment or anxiety when they have to present in front of a class or when they are called on to answer a question. For students with social anxiety, being put into the spotlight occasionally during class presentations or participation is enough to make them avoid those classes altogether.

New research from the University of Plymouth and University of the West of England (UWE) Bristol looked at the impact of social anxiety in higher education, and psychologist Phil Topham estimates that “10 percent of university students experience significant social anxiety,” according to a news release from UWE Bristol.

Social anxiety disorder or social phobia is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as “a marked and persistent fear of social or performance situations in which embarrassment may occur.” There are several other diagnostic criteria, including that “the social or performance situation is avoided, although it is sometimes endured with dread.” People are only diagnosed with the disorder if their life is significantly negatively impacted.

Out of over 1,500 students who were surveyed, some students experienced “frequent anxiety in learning situations that involved interacting with students and staff.” To cope with this anxiety, students would not participate in lectures and presentations or would even skip class. Other students wouldn’t take any classes that involved presenting at some point, according to the news release.

The researchers conclude that students who experience social anxiety “could be missing out on learning opportunities and may be distracted from attending to academic information by excessively focusing on their anxieties.”

Although the researchers don’t believe students should be treated as potentially fragile and coddled, there needs to be more support available for students with social anxiety without further stigmatizing these students or making them feel like their “flaws” are exposed. The researchers even give some suggestions for support in the university, including “not singling out students for questioning in lectures or setting assessed presentations in their first term,” and “sensitive appreciation of the shame and conflict caused in students by the desire to succeed and the fear of failure.”

Basically, college professors need to take into consideration the styles of all college students—some love the spotlight, others have social anxiety, so it’s best to ease students into participating and presenting during class.

Mental health experts have some tips on how to succeed in high school and college despite having social anxiety.

Nerina Garcia-Arcement, a clinical assistant professor at NYU School of Medicine and a licensed clinical psychologist, gave one major suggestion in an email to help students who are experiencing social anxiety.

“Do not avoid what you fear,” Garcia-Arcement said. “The more you avoid, you are creating evidence that it is more comfortable to not do something. Instead, if you face what you fear you can slowly prove that your worst fears will not be realized.”

She also suggests that students follow these four steps to take control of their anxiety:

1. Stop and evaluate what you are feeling (i.e., butterflies in your stomach, sweating, trouble breathing, heart racing).
2. Stop and evaluate what are you thinking (i.e., “people will laugh at me,” “I will fail,” “I will look ridiculous.”)
3. Practice activities that will reduce the physical symptoms, such as deep breathing, muscle relaxation exercises and imagining yourself in a safe place.
4. Challenge your negative thoughts by stopping the critical belief and instead replace it with a positive thought such as “people have never laughed before,” “I can do this,” “looking silly is the point of this activity, and if I do look silly so what.”

There are effective treatment options for students who have access to a mental health professional.

“Talk therapy is extremely effective for social anxiety, especially cognitive behavioral therapy. Medication can be taken in severe cases, Garcia-Arcement said. “Learning to manage the physical anxiety symptoms and stopping and controlling the negative thoughts is essential to controlling social anxiety. Sometimes people can do it on their own, sometimes they need help with monitoring thoughts and feelings and figuring out what gets in the way of using these new skills.”

She has three other tips for students who are trying to decrease their social anxiety:

1. Practice deep breathing, meditation, yoga, and exercise. These help manage and control anxiety.
2. Ease into social activities, first with smaller groups and eventually, as you feel comfortable, with larger groups.
3. Practice what you fear in a controlled environment. First practice the presentation or talking to a stranger in front of a mirror, later practice in front of someone you trust such as a friend or parent, then go into the real situation.

Scott Carroll, a child psychiatrist who works at the University of New Mexico, said that part of the problem can be that some students don’t realize they have an issue that needs to be worked on.

“Many people with social phobia … often just think they are shy and don’t realize they may have a treatable condition,” Carroll said. “Also, if someone has been anxious their whole life, they may not realize they are significantly more anxious than other people.”

Once students do realize they have a disorder, they have a variety of treatment options available to them, including individual psychotherapy (such as cognitive behavioral therapy), social skills therapy groups, and multiple types of medications.

Carroll has two other coping methods for college students who have social anxiety disorder: positive self-talk, in which you reassure yourself that it’s okay to talk or say hello, can be helpful with milder forms; and repeated exposure, which leads to decreased anxiety, like joining Toastmasters to get comfortable with public speaking.

Jeffrey Gardere, a contributing psychologist at Healthguru.com, said in an email that it’s beneficial for students with social anxiety to have friends they can rely on to come along with them in situations that could cause more anxiety.  Sometimes self-help books can be useful as well.

“The young person with social anxiety may also want to stay away from stimulants such as energy drinks and caffeine in order to avoid becoming even more nervous,” Gardere said. “And certainly [try] to avoid liquor, marijuana or any other chemical that is a self medication in order to feel relaxed, simply because they may be more at risk for possible addiction.”

Link to article