Rabbi Jonathan Schwartz, PsyD

Chaya hates going to simachos. Even when she “has to go,” she shakes violently and cannot talk because she's afraid that everyone is watching her. She knows it isn’t true, but she can’t shake the feeling. She's sure she's making a fool of herself. Her self-consciousness and anxiety rise as she silently prays for her husband to agree to go home...

            Dina just told her mother that she “is stopping shidduchim.”  She told her mother that she ”just needs a break from the first date pressure.” According to Dina, “just thinking about sitting in a hotel lobby or restaurant, introducing yourself to a stranger who will be staring at you and trying to make conversation” makes her feel nauseous. She knows she won't be able to think clearly because her anxiety will be so high, and she is sure she will leave out important details. Her voice might even quiver and she will sound scared and tentative. She is tired of shadchanim reporting back to her that she is “too quiet” or coming off “disinterested” in the boys she is dating. The anxiety is just too much to bear---so she wants to stop dating to avoid the anxiety.

            Dina and Chaya, like so many others, suffer from Social Anxiety Disorder (also called Social Phobia). Social Phobia is the third largest mental health problem in the world. Social anxiety is the fear of social situations that involve interaction with other people. Put another way, social anxiety is the fear and anxiety of being judged and evaluated by other people. If a person usually becomes anxious in social situations, but seems fine when they are alone, then "social anxiety" may be the problem.

            People with social anxiety are many times seen by others as being shy, quiet, backward, withdrawn, inhibited, unfriendly, nervous, aloof, and disinterested.   People with social anxiety wantto be "normal" socially, they want to make friends and they want to be involved and engaged in social interactions. They want to be friendly, open, and sociable.  It is fear (anxiety) that holds them back from participating. 

            People with social anxiety can experience significant distress in a whole host of situations. These include:

·         Being introduced to other people

·         Being teased or criticized

·         Being the center of attention

·         Being watched or observed while doing something

·         Having to say something in a formal, public situation

·         Meeting people in authority ("important people/authority figures/Rabbis/Gedolim")

·         Feeling insecure and out of place in social situations ("I don’t know what to say.")

·         Embarrassing easily (e.g., blushing, shaking)

·         Meeting other peoples’ eyes

The common denominator in these cases is that the person experiences anxiety (intense fear) in social situations. The feelingsthat accompany social anxiety include nervousness, automatic negative thinking cycles, racing heart, blushing, excessive sweating, dry throat and mouth, trembling, and muscle twitches. 

            Sometimes, the social anxiety can affect a person’s ability to engage in normal religious life.

            Shlomo used to enjoy going to shul. He would regularly approach the amud, when asked, in order to lead the minyan. However, recently, Shlomo has gotten very conscious of his Ivrah. He worries that he might not pronounce every word correctly and that he will embarrass himself in front of people in shul. He stopped davening from the amud entirely. During the year of aveilus after he lost his mother, Shlomo would come to shul late in order to miss “getting the amud” and skip the first two Kaddaishim which might open him to scrutiny. He began to feel terrible as he felt he was doing a disservice to his mother’s memory.

            The fear of public scrutiny is so common that many might see it as “normal.” However, Shlomo’s preoccupation with the anxiety, his anticipation of error, and his avoidant behavior are anything but regular. Moreover, like Chaya and Dina and so many other people who suffer from Social Phobia, Shlomo is allowing his anxiety to interfere with his quality of life.

But he doesn’t have to.

Treatment options:

According to the Mayo Clinic, a majority of the cases that present for treatment for Social Phobia are treated successfully. The most often recommended form of treatment for the condition is Cognitive Behavioral Psychotherapy (CBT). In fact, 75% of Social Phobia cases treated with CBT reported a reduction of anxiety symptoms. 

 The goal of CBT is to guide the patient's thoughts in a more rational direction when faced with anxiety. People learn to face their fears instead of avoiding them. Armed with a series of techniques, patients learn to react differently to the situations that trigger their anxiety. These techniques may include role-playing to practice social skills and gain comfort and confidence in relating to others, as well as relaxation and stress management techniques,

CBT will also make use of real-life (in-vivo) and imaginary (in-vitro) exposure exercises whereby people with social anxiety gradually expose themselves to the situation they fear, but with the support of the therapist. This allows them to become better skilled at coping with these anxiety-evoking situations and to develop the confidence to face them alone. By learning to accept the idea that failure is not catastrophic, people learn to handle the anxiety and manage it, instead of it managing them.

For some patients, medication might be used along with CBT. Several types of medications are used to treat social anxiety disorder, such as antidepressants like Paxil or tranquilizers such as Xanax, Librium, Valium, and Ativan. Beta-blockers, which are often used to treat heart conditions, may be used to mitigate some of the physical symptoms of social anxiety, such as rapid heart rate or rising blood pressure.

            The best way to overcome one’s social anxiety is to persist in finding challenges and facing them. While progress is not linear – there are ups and downs – the more exposure, the easier the challenges seem to become. By being persistent in one’s approach to Social Phobia, one can indeed turn a “SAD (Social Anxiety disorder)” story into a happy ending.

Rabbi Jonathon Schwartz, PsyD, is a practicing Rav in NJ and Clinical Director of the Center of Anxiety Relief (www.njanxietyrelief.com).  He has offices in NY and NJ where he specializes in treating adults suffering from anxiety disorders.  He can be reached at [email protected].