Synopsis: Social anxiety disorder is more than just shyness. It can be crippling and keep people completely inside the house. An expert whose daughter was afflicted discusses social anxiety warning signs in children and how the disorder can be treated.

Host: Lynn Holley. Guest: Jennifer Shannon, co-founder of Santa Rosa Center for Cognitive-Behavioral Therapy, Santa Rosa, CA and author of The Shyness and Social Anxiety Workbook for Teens and The Anxiety Survival Guide for Teens.

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Lynn Holley: “Rose” was once an outgoing, happy kid who loved playing with friends. But her behavior changed when she switched schools in fifth grade. Rose became anxious. She hid in the girls bathroom at school, afraid to talk to kids she didn’t know. Headaches and stomachaches frequently landed her in the school nurse’s office, followed by a call home for mom to come get her. Then, Rose refused to go to school altogether.

Jennifer Shannon: It’s challenging as a parent, even one who knows, who’s an expert in the field, of like how do you talk to your child about doing things which is really about facing your fears. And she didn’t want me to be her therapist. So that’s why I wrote the book. I actually went out to get her a book and I was like “hey, there is no book on shyness and adolescence that makes no sense.” So, I wrote the book to help both parents and adolescents understand what is going on and what they need to do in order to overcome the fear.

Holley: That’s rose’s mother, Jennifer Shannon, co-founder of the Santa Rosa Center for Cognitive-Behavioral Therapy in Santa Rosa, California. She’s also author of The Shyness and Social Anxiety Workbook for Teens, and The Anxiety Survival Guide for Teens. Shannon says to understand social anxiety, it’s helpful to know a little bit about anxiety in general.

Shannon: All anxiety is related to survival. So we need to be able to perceive threats so that we can stay safe and stay alive. The real distinction between having anxiety cause we all have anxiety and having an anxiety disorder is how much the anxiety is interfering with the person’s functioning.

Holley: Social anxiety disorder, also known as social phobia, is not the same as shyness. Shy people may be slow to warm up at a party, but eventually they’ll start talking to other guests. Shannon says people with social anxiety disorder will avoid the party altogether.

Shannon: If you’re not leaving the house, then that’s an extreme form of social anxiety where just the thought of maybe going out or being observed by others,walking down a street can cause people with social anxiety a lot of anxiety, because they’re imagining that people are looking at them and judging them in some way. More commonly it would be things where it would interfere functioning, like you don’t participate in classroom discussions and that can affect academics. It can definitely interfere with dating relationships cause you may not start conversations with people you’re attracted to. Still we would consider that a disorder.

Holley: According to the national institute of mental health, about 15 million Americans, or 13 percent of the population, suffer from social anxiety disorder. It’s the most common form of anxiety and the fourth most common mental illness. It affects men and women equally, and its onset usually occurs during adolescence. But if a child can be outgoing one day and full of anxiety the next, what triggers it?

Shannon: It can be traumatic experiences. So for example, if you grew up and you were discriminated against or bullied that can certainly contribute to the development of social anxiety disorder, but genetics probably account for between 30-40% of the incidence of social anxiety. So if you have a first degree relative with any time of anxiety you’re 2-3 times more likely to have social anxiety disorder. So huge genetic component to it.

Holley: Fortunately, social anxiety disorder is completely treatable.

Shannon: Luckily, if you have social anxiety you don’t have to suffer your whole life for it, cause there is effective treatment and the most effective therapy is cognitive behavioral therapy. And cognitive behavioral therapy is based on the relationship between thoughts, feelings, and behaviors. In the therapy what we do is help people to change both the way that they’re thinking, so that over-estimation of threat, and their behavior.

Holley: In cognitive behavioral therapy, Shannon helps her patients move towards the things they’re afraid of by engaging in what she calls target practice.  It’s where her patients figuratively practice hitting just the target, not the bull’s-eye, in social situations.

Shannon: When I have people facing their fears, I really have them set a realistic goal for themselves, because people who have social anxiety have an underlying belief and this leads to those obsessive thoughts, that they need to be socially perfect. That means that there should be no awkward silences, that they should show no signs of anxiety, never trip over their words, never forget peoples names, always sound smart and interesting. And I call that social perfectionism and no one can actually meet that standard. So when they’re approaching somebody it’s like smile say hi ask a question and after you do that say okay did I hit the target, yes because you actually moved towards something and pat yourself on the back instead of giving yourself a hard time for not hitting the bull’s-eye. When I’m working a teen we will go out into the public and go to coffee shops and go to the mall and have different practices where you’re actually around people and doing target practice where you’re facing a fear in an imperfect way and do it over and over again.

Holley: Shannon says parents of overly anxious kids often make one of two mistakes.

Shannon: One is to have no sympathy for the child and just say, “what’s wrong with you, just get out and do it” and they really do need some understanding, but the other problem is allowing them to avoid things. So if they’re not going to school, sometimes what they’ll do is wanna do independent study, and no absolutely not because that’s going to keep them in a avoidance cycle. You need to break that cycle so they need to, however you do it, work with a school system to get them back, even if its partial days, get them back in school and get them interacting with others.

Holley: If you’re a parent, some red flags are obvious–like refusing to go to school or leave the house. But more subtle signs can be things like your child repeatedly turning down invitations to activities they used to enjoy, like going to the mall or the movies with friends.

Shannon: You are looking for a consistent behavior pattern of avoidance. I would say, if it’s going on for three months, definitely that sounds like more than just a bad day and how much school are they missing and how many things are they avoiding.  If there is a consistent pattern then you definitely want to get them help or ask them more about it.

Holley: Shannon says, left untreated, social anxiety disorder usually gets progressively worse. It affects jobs and relationships and can lead to depression and substance abuse. You can learn how to find a therapist and find out more about Jennifer Shannon and her books by visiting our web site at radio health journal dot net.

Our writer/producer this week is Polly Hansen. Our production directors are Sean Waldron and Nick Hofstra. I’m Lynn Holley.

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