SHYNESS OR SOCIAL ANXIETY? How do you know what is normal? Dr Emily O’Leary, PhD Director Anxiety House

OVERVIEW How much anxiety is normal? Why talk about social anxiety? Facts about shyness and social anxiety Causes What treatments are there? When to seek help? What can parents do? Question time

Anxiety disorders affect one in eight children WHY TALK ABOUT THIS? Anxiety disorders affect one in eight children Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences (impacting on their social and emotional development). Overall, about half of people with anxiety disorders experience their first symptoms by the AGE OF 11 YEARS and of those diagnosed 75% OF THOSE DO NOT GET HELP

WHAT IS NORMAL? AGE FEAR 0-6 months Loss of support, loud noises, sudden movement 7-12 months Strangers, sudden appearance of large objects, loud noises 1 year Separation from parent, strangers, injury, toilet 2 years Large animals, dark rooms, large objects and machines, loud noises 3 years Masks, large animals, snakes, separation from parents 4 years Dark rooms, -noises at nights, large animals 5 years Wild animals, bodily injury, dark, bad people

STAGES OF FEAR (cont’d) 6-7 years Monsters, storms, lightening, being alone 8-9 years Dark, people (kidnapper, robber, mugger), guns, weapons 10-11 years Dark, people, bad dreams punishment, tests grades, being sick 12 years Being in trouble, being hurt, tests, grades, peers 13 years Crime, being hurt, war, nuclear war, grades, peers, family

IS ANXIETY GOOD OR BAD? When is it a problem ANXIETY IS NORMAL AND ADAPTIVE ALERTS US TO DANGER & SERVES AS A NATURAL ALARM SYSTEM TO KEEP US ALIVE When is it a problem When it significantly interferes with your day and you experience distress above same aged peers

Most common anxiety disorder is SOCIAL ANXIETY DISORDER

SOCIAL ANXIETY DISORDER (SAD) Criteria MARKED FEAR OF ONE OR MORE SOCIAL OR PERFORMANCE SITUATIONS IN WHICH THE PERSON IS EXPOSED TO THE POSSIBLE SCRUTINY OF OTHERS AND FEARS HE WILL ACT IN A WAY THAT WILL BE HUMILIATING Exposure to the feared situation almost invariably provokes anxiety Anxiety is out of proportion to the actual threat posed by the situation The anxiety lasts more than 6 months The feared situation is avoided or endured with distress The avoidance, fear or distress significantly interferes with their routine or function

SOCIAL ANXIETY DISORDER – THE FACTS! Research suggests that 10 per cent of the Australian population experiences social phobia in a lifetime, with 4.7 per cent experiencing social phobia in a 12-month period. More women than men appear to develop the disorder. Develops early childhood/adolescence (13 years), only 25% seek help Depression is frequently comorbid and most patients describe an insidious onset 36 % of people with SAD report symptoms for 10 or more years before seeking help Social anxiety disorder is sometimes called a silent disorder because it can affect children for years before it is diagnosed. As children grow and mature, they learn how to avoid being the focus of attention at school or home; as a result, their extreme discomfort in social situations can go unnoticed

SPECIFIC AND GENERALIZED SOCIAL ANXIETIES A specific social anxiety would be the fear of speaking in front of groups (only) whereas people with generalized social anxiety are anxious, nervous, and uncomfortable in almost all social situations. It is much more common for people with social anxiety to have a generalized type of this disorder.   is an anxiety disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people. Selective Mutism usually co-exists with shyness or social anxiety Selective Mutism (SM)

What are the SIGNS? Avoiding situations where they may be the centre of attention Children with possible social anxiety disorder tend to be worried about being embarrassed in front of peers, but not generally in front of adults Fear of being in situations with strangers (people the sufferer does not know) Dread over how they will be presented to others Excessive fear of being teased or criticized Excessive fear that other people may notice that the sufferer looks anxious Excessive worry about being anxious, which makes the anxiety worse Fear of meeting people in authority Avoiding talking to people because of a fear of embarrassment The individual worries excessively about being in situations where he/she may be judged When in a situation that causes anxiety the sufferer's mind may go blank.

Q A Is shyness part of SOCIAL anxiety? No, Shyness and social anxiety disorder are two different things. Shyness is considered a normal personality trait that combines the experience of social anxiety. Many people who are shy do not have the negative emotions and feelings that accompany social anxiety disorder.  They live a normal life, and do not view shyness as a negative trait. While some people with social anxiety disorder are shy, shyness is not a pre- requisite for social anxiety disorder. In fact some people with social anxiety may not be shy at all. They can be completely at ease with people most of the time, but particular situations, such as walking down an aisle in public or making a speech, can give them intense anxiety.

WHAT ARE THE DIFFERENCES BETWEEN SOCIAL ANXIETY DISORDER AND SHYNESS? People with social anxiety disorder endure high levels of anxiety in daily activities, and this high level of anxiety makes them avoid situations in which they would like to participate. social anxiety disorder is not considered a “normal” facet of personality, or a personality characteristic, whereas shyness is. In fact, people who are shy may view this condition as a positive quality, whereas a person with social anxiety disorder would not describe their condition positively. Only about one half of those diagnosed with social anxiety disorder report having been shy. Looked at another way, being shy can complicate your life. Having social phobia STOPS YOU, BEING shy IS A TRAIT.

WHAT ARE THE DIFFERENCES BETWEEN SOCIAL ANXIETY DISORDER AND SHYNESS? People with SAD report a significantly greater number of social fears, avoidance of social situations, negative thoughts, and somatic symptoms than the shy people. A shy child may take longer to warm up to a situation, but they eventually do. Also, a shy child engages with other kids, just at a different level of intensity than their peers. In contrast, children with social phobia will get very upset when they have to interact with people. It is a frightening situation for them, and one they would rather avoid altogether

WHAT TYPES OF SAD THOUGHTS? They will reject me I will be found out as incompetent They will think I’m weird I can’t even do the simplest things I had better not blow it again I can’t (don’t know how to) do this I will tremble and people will judge me If they see how anxious I am, they will think I’m crazy I will stumble over my words and be unable to continue What if the teacher calls on me? I always get the answer wrong!

WHAT ARE THE CAUSES? Scientists currently think that, like heart disease and type 1 diabetes, mental illnesses are complex and probably result from a combination of genetic, environmental, psychological, and developmental factors.  There are a number of causes of social phobia, including: If you have a first degree relative with SAD, you may be 2 to 3 times more likely to develop the disorder. The genetic component of SAD, also known as the “heritability” of the disorder has been estimated at around 30% to 40%, meaning that roughly one-third of the underlying causes of SAD come from your genetics. Attachment and temperament Genetics

WHAT ARE THE CAUSES? Scientists currently think that, like heart disease and type 1 diabetes, mental illnesses are complex and probably result from a combination of genetic and environmental factors.  There are a number of environmental causes of social phobia: Environmental Parenting and the family environment - connection between parental over control and parental psychopathology with childhood SAD. Adverse life events such as sexual abuse, negative peer relationships, bullying and marital discord are also found to contribute to SAD development Consistently higher rates of female versus male SAD have been traced to the concept of gender roles and to gender differences in child-parent interactions. Caution practiced in the interpretation of these results, given the limited research in most areas except for parenting. Multifaceted developmental pathway to social anxiety disorder.

What are the Treatments?

COGNITIVE BEHAVIOURAL TREATMENTS CBT is an effective treatment for social phobia It involves teaching people to recognize their anxiety and provides tools to control the anxiety.

COGNITIVE BEHAVIOURAL TREATMENTS KEY CONCEPTS: People learn effective skills through relaxation and mindfulness training, role-playing, and social skills training. Greatest evidence for efficacy of exposure + cognitive restructuring Cognitive-behavioral therapy is the recommended therapeutic treatment, particularly for mild to moderate cases of SAD.  In severe cases, SAD can be treated with a combination of CBT and medication with the goal of eventually discontinuing medication over time.

WHAT CAN PARENTS LOOK FOR PARENTS CAN HELP PREVENT SOCIAL PHOBIA FROM TAKING HOLD BY BEING ATTUNED TO WARNING SIGNS AND SYMPTOMS.

Questions to ask yourself Are they unusually uncomfortable speaking to teachers or peers? Does he or she avoid eye contact, mumble or speak quietly when addressed by other people? Does a child blush or tremble around other people? Does a young child cry or throw a tantrum when confronted with new people? Does a child express worry excessively about doing or saying something “stupid”? Does a child or teen complain of stomach aches and want to stay home from school, field trips or parties? Is he or she withdrawing from activities and wanting to spend more time at home?

What Can Parents Do?

WHAT CAN PARENTS DO Reinforce that anxiety is a normal feeling and lots of other kids have the same difficulties (normalize, normalize, normalize!) Reward Brave, Non-anxious Behavior. Whenever you see the child doing something brave, make a big fuss. Empathize and Understand. Ensure the child knows that you understand their anxiety (you’ve felt anxiety before!) and how hard facing your fear can be (provide an example from your own life). Encourage Constructive Coping. (Skill Building Opportunity) Encourage the child to come up with their own helpful coping options in a scary situation (rather than telling them how to cope) is a great way to foster self-esteem in your child. Model Non-Anxious Behavior. Your child watches you face challenging situations. Ensure you are modeling brave coping whenever you enter a situations that scary for you. Talk to a professional

Shyness vs. Social Anxiety? Q U E S T I O N Shyness vs. Social Anxiety?

CONTACT DETAILS Anxiety House Hawthorne Medical Centre Suite 2, 171 Riding Road Hawthorne, QLD 4171 PO Box 297 Morningside, QLD 4171 www.anxietyhouse.com.au 07 3041 1164 07 3399 9481 admin@anxietyhouse.com.au