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Social Anxiety Disorder (SAD)

- mild tw: rape -

Definition of SAD

  • A mental health issue

  • Fear of speaking or performing in front of others

  • Terrified of being humiliated and judged by saying the wrong things

SAD vs shyness


  • Extremely concerned + worried about how other people think of them

  • Physical symptoms: nausea, rapid heart rate, shaking etc.


  • Just a type of nervousness when facing a crowd

  • Excessive sweating

  • Timid voice

  • Has no serious physical symptoms



  • One-third of the people suffer from SAD due to pass generations

  • (Not exclusive and not all will pass SAD to their offspring)

  • Researchers and scientists have not found any genetic makeup related to SAD yet.


Example: Taijin Kyofusho

  • Japanese form of social phobia

  • Emphasizes group formity instead of individuals to reflect on how you “fit in”.

  • Stems from judging people based on appearance and body shape etc.

  • More women get Taijin Kyofusho than men.


  • Direct conditioning: a child might develop SAD at school by classmates. Making fun and laughing at the child for tripping over a stone, or forgetting something, or being scolded by teachers etc, making them feel uneasy to do everything

  • Observational learning: when the child saw someone or something in an unpleasant situation, they most likely will not do those kind of activities, making them scared to try out new things

  • Transferring information (indirectly): parents might indirectly tell their children the darker side of society (such as kidnap and rape) during social gatherings etc.

  • Overprotective parents



  • Chest tension

  • Diarrhea

  • Dizziness

  • Derealization

  • Headaches

  • Muscle tension

  • Shortness of breath


  1. Having negative beliefs: being stubborn, holding strong beliefs on how they deal with certain social situations

  2. Being negatively biased: depreciating your social abilities

  3. Having negative thoughts: thinking you can’t socialize well with others and automatically think about negative outcomes and consequences.


  1. Avoiding social activities to reduce the anxiety of facing the crowd

  2. Being “safe”: excessive actions/preparation to control experiences of social situations

  3. Escaping social situations



  • The anxiety has continued for 6 months or longer

  • Meeting new people and giving speeches makes them anxious

  • Feeling embarrassed if someone rejects them

  • Being terrified of people who judge their appearance or acts

  • Constantly experiencing fear before and during social situations

  • They cause distress and affect their daily living such as sleeping routines


Prescription medication

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • first-line pharmacotherapy treatment

  • potential of having withdrawal effects, including dizziness and nausea

  • E.g paroxetine, fluvoxamine etc.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): antidepressants that act on neurotransmitters serotonin and norepinephrine, e.g venlafaxine, duloxetine

Monoamine Oxidase Inhibitors (MAOIs): although effective, they’re not the first medicines given due to severe side effects

Psychological therapy

Cognitive-behavioural therapy

  • Exposure: imagining/experiencing social situations in real life, to make patients feel more comfortable to go to social activities

  • Cognitive restructuring: focusing on patients’ negative beliefs, biases and thoughts, identifying and evaluating them, as well as using alternative thoughts to replace the original thoughts

  • Social skills training: rehearsing and role-playing, to decrease anxiety when facing the public in real life

Acceptance and commitment therapy

  • Learning to accept negative thoughts instead of throwing them away

  • Learning skills for practicing mindfulness


  • Helps you understand some issues in childhood that leads to social anxiety

  • Useful for people who has deep unresolved conflicts



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