How to Help a Teen With Extreme Social Anxiety

We recently posed a question on social media:

“Hey Parents of Teens! What Do You Want to Know? What topic would be the most helpful for you? If you’ve ever thought, ‘I wish I had a guide to deal with this problem!’ Now is your chance to ask for that guide.”

Members of our community replied with their most pressing questions. One concerned mother commented,

“Following. I have a 17-year-old son. His social anxiety is debilitating.”

This post is for her, her son, and any parent with a teen struggling with social anxiety. The first thing we want you to know is this:

You are not alone.

The most recent information from the National Institute of Mental Health (NIMH) shows that in the U.S. as of 2014, 9.1% of adolescents had Social Anxiety Disorder (SAD – not to be confused with Seasonal Affective Disorder) and about 1.3% had severe impairment as a result. In raw numbers, that’s about 2.5 million teens with SAD and about 250,000 with SAD symptoms that cause severe problems in their daily functioning. Which means there are literally thousands, if not millions, of families out there who can relate to what you’re going through. Many of the links in this article will take you to websites with a wealth of resources for you and your child.

The second thing we want you to know is possibly the most important thing:

Anxiety – even debilitating social anxiety – is treatable.

Before we discuss the best practices for treating SAD, we want to make sure we’re on the same page about exactly what it is and what the symptoms are.

Anxiety Disorders: Know the Symptoms

According the National Association on Mental Illness (NAMI), all anxiety disorders share this common trait:

“Persistent, excessive fear or worry in situations that are not threatening.”

NAMI advises parents to keep an eye out for the following symptoms:

Emotional:

  • Heightened fear of regular daily situations
  • Extreme irritability and/or restlessness
  • Always assuming the most negative outcome for any future event
  • Extreme agitation or nervousness

Physical:

  • Increased heart rate and/or hyperventilating
  • Insomnia, fatigue, headaches
  • Twitching, sweating, or tremors
  • Nausea
  • Frequent trips to the bathroom

Those are the symptoms common to all anxiety disorders. But what about the symptoms specific to SAD? The Social Anxiety Institute (SAI) streamline the clinical definition of SAD, based on The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the reference manual mental health professionals use to diagnose mental health disorders.

DSM-5/SAI Diagnostic Criteria for SAD

  1. A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating. In children, there must be evidence of the capacity for age-appropriate social relationships and the anxiety must appear in peer settings, not just interactions with adults.
  2. Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.  
  3. The person recognizes that this fear is unreasonable or excessive.
  4. The feared situations are avoided or else are endured with intense anxiety and distress.
  5. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
  6. The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.
  7. The fear or avoidance is not due to direct physiological effects of drugs, medications, or a general medical condition not better accounted for by another mental disorder.

If your teen meets these criteria, you can do an informal check. Ask your teen to take one of these online questionnaires, which were developed by mental health professionals:

Please understand that while professionals created these tests, they cannot replace an in-person assessment conducted by a fully licensed and certified mental health provider. So, if your teen meets these criteria, what next?

Steps You Can Take

Your next step is to consider seeking professional help. There are many resources you can utilize. Start with the three sites above: The Social Anxiety Institute, Psychology Today, and the Anxiety and Depression Association of America. To find a psychiatrist near you, you can use this Online Child and Adolescent Psychiatrist Finder maintained by the American Academy of Child and Adolescent Psychiatry.

If you seek professional help, make an appointment, and the psychiatrist advises a course of treatment for your teen, then you should take their advice. Because, as we mentioned above, anxiety is treatable and even people with extreme anxiety can successfully manage their symptoms.

What Kind of Treatment Should I Expect?

Research shows the best way to treat SAD is through a combination of medication and therapy:

  • Medications typically include:
    • Anxiolytics, a.k.a. anti-anxiety medications
    • Anti-depressants
  • Common therapeutic approaches to SAD include:
    • Cognitive-Behavioral Therapy (CBT)
    • Dialectical Behavioral Therapy (DBT)
    • Exposure Response Prevention Therapy.

In addition to traditional therapy and medication, many complementary therapies are effective approaches manage anxiety. Note: in this context, complementary means in addition to and not in place of. While the following approaches may help on their own, our best advice is to use them under the guidance of a mental health professional, in conjunction with their recommended course of treatment:

  • Mindfulness-Based Stress Reduction (MBSR) techniques
    • Breathing exercises
    • Self-relaxation
  • Meditation
    • Walking meditation
    • Seated meditation
  • Yoga
    • Power Yoga
    • Hatha Yoga
    • Hot Yoga
  • General Exercise
    • Running
    • Cycling
    • Walking
    • Group exercise: aerobics, etc.
    • Weight training
    • Sports

Your Teen Can Heal

Sometimes anxiety is its own worst enemy. It creates a vicious cycle that’s hard to break. Your teen may worry about an upcoming social situation, then try the coping mechanisms they have at hand to deal with their anxiety. Then, if they don’t work, that failure to manage their anxiety causes more anxiety – and this situation can repeat itself over and over again, gaining energy all the while, and like a snowball rolling down a hill, increase in size and scope until it’s out-of-control and virtually unmanageable.

You can help your teen avoid this – with the professional interventions we discuss above – but also with your compassion and understanding.

The best thing you can do, before you get professional help, is to validate their feelings and let them know you’re there for them, you love them, you support them, and you’ll help them get through this difficult period. With a caring support system behind them, the chances of successful treatment increase dramatically. Your teen can turn their symptoms from debilitating to manageable, which can make all the difference and lead to a balanced life and improved sense of happiness and overall well-being.