In casual conversation, we tend to speak about the heart in the context of emotions and the brain in the context of thoughts. But everything is processed through the brain, even the fear and anxiety common in social situations. We’ll delve into a neurobiological perspective on social phobia.
These days, when I walk into a room full of people I don’t know, I experience at least some excitement. I might meet some really great people!
But this wasn’t always the case. In fact, for the first two decades or so of my life, all I felt was anxiety – and even fear. My heart pounded at the thought of having to move among the crowd, with a choice between risking embarrassing interactions or feeling humiliated for standing all alone.
If I tried to introduce myself to a group, I’d often sweat and blush, eventually going home believing I’d ruined my reputation among these people forever. If I didn’t speak to anyone, I’d go home to a sense of isolation and worry that everyone there assumed I had no friends.
For me, the physical and emotional responses plagued me more than anything in the moment. Before and after, however, it was my mind that seemed to take the role of antagonist.
People with social anxiety understand that the brain is involved. But what causes it to seemingly work against us? And how does understanding the neurobiological perspective help overcome the symptoms of social anxiety?
Neurobiological Foundations of Fear and Anxiety
Fear and anxiety are deeply rooted in the brain’s structure and function. This makes sense on a pure survival level. When we sense a threat, the brain is driven into action, identifying the risks and problem solving to find a way to safety.
Although socializing at a party may seem to have little to do with survival, humans once needed to belong in tight groups to survive. Isolation can still be catastrophic in the twenty-first century, but we don’t usually have to come together to fight off physical threats these days. Nonetheless, we still instinctively experience acceptance within a group as a high stake necessity.
The same key brain regions involved with primal fear are therefore relevant. These include the amygdala, prefrontal cortex, and hippocampus.
Amygdala: The Fear Center
The amygdala, often referred to as the brain’s fear center, is integral in processing fear and anxiety. It rapidly assesses potential threats and triggers appropriate responses. In social situations, the amygdala is particularly sensitive to perceived social threats, such as negative judgments or unfamiliar environments, which can heighten anxiety.
Prefrontal Cortex: Regulation and Control
The prefrontal cortex is responsible for higher-order functions, including the regulation of emotions and decision-making. It interacts with the amygdala to manage fear responses, helping to moderate and control anxiety. Effective regulation by the prefrontal cortex is crucial in reducing social anxiety, allowing individuals to navigate social situations more comfortably.
Hippocampus: Memory and Context
The hippocampus plays a key role in forming and recalling memories, providing context to fear responses. It helps individuals remember past social interactions and experiences, which can influence current anxiety levels. When past experiences are perceived as negative or threatening, the hippocampus can trigger heightened anxiety in similar present situations.
Neurotransmitters and Social Anxiety
Neurotransmitters such as serotonin, dopamine, and GABA, along with the stress hormone cortisol, also play an important role in regulating anxiety. Serotonin influences mood and anxiety levels, while dopamine affects reward and motivation in social contexts. GABA and cortisol are involved in the body’s stress response and anxiety regulation. Imbalances in these neurochemical systems can contribute to heightened social anxiety, influencing how individuals react to social situations.
Implications for Treatment
Physical Treatments
This may sound a little overwhelming, but it actually has extremely positive implications for treatment. You’ve probably tried to ‘think’ your way out of anxiety countless times. Often, this only makes it worse. Trying to outthink my instinct to blush and sweat not only didn’t work, but even preempted it and prevented it from stopping on its own.
There are certainly ways to change how we think in order to confront anxiety, and we’ll get into them soon, but the role of the brain means that physical measures can make a big difference.
Anti-anxiety medications, such as selective serotonin reuptake inhibitors (SSRIs), work by targeting specific neurobiological pathways to alleviate symptoms. Emerging treatments, like neurostimulation and psychedelics, are revealing new possibilities for addressing the neurobiological aspects of social anxiety, promising more targeted and effective therapies in the future.
If you cannot take medications, or do not wish to, strategies like mindfulness and meditation can help. These approaches focus on changing your body’s reaction to perceived social threats. You experience the emotions differently, and the signals sent to your brain no longer send you into a spiral. Instead of trying to think your way out of anxious thoughts, you circumvent them.
Cognitive Treatments
The above treatments are not usually prescribed in isolation. Rather, they are combined with cognitive treatments, which teach you a different way of thinking.
Cognitive-behavioral therapy (CBT) utilizes the connection between thoughts, feelings, and behaviors to change your reactions. It provides useful measures to take to lessen your anxiety. I started carrying a handkerchief with me, so that I could wipe sweat away if necessary. With some agency over my actions, my anxious thoughts no longer took over.
The most well-known aspect of CBT is the process of challenging thoughts. Instead of trying to frantically solve for the problems they present, you identify each thought and then test it against reality.
In the beginning stages, you do this after the fact, or while thinking about a situation in a safe environment. It becomes habitual, playing out in the background of your mind during social interactions, and eventually eliminating the thought entirely.
Bringing it Together
Different strategies work for different people. Medication is not a plausible solution for everyone, and therapies like CBT can be difficult for some to implement. However, finding the right balance involves working with a professional to identify the best options for you.
The good news? Like millions of others, I can attest to the fact that social anxiety does not have to cause distress for the rest of your life. With help, you can learn to be at ease in social situations, and even learn to enjoy what used to scare you!