23 August 2021
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As the COVID-19 pandemic and measures to contain its spread evolve, societal norms and responsibilities also remain in flux, which can add an extra burden to people with social anxiety disorder.
Research has begun to outline the impact of the pandemic on social anxiety in general and on people with social anxiety disorder. A study published in Psychiatry Research showed that pre-pandemic social anxiety serves as a statistically significant predictor of anxiety and depression during lockout orders, as well as a robust relationship between social anxiety and COVID-19-related worry and impairment. The authors of an article published in Cognitive and Behavioral Practice found that the combination of increased anxiety and decreased social opportunity has created challenges in managing social anxiety in adolescents.
Franklin Schneier
Healio Psychiatry spoke to Franklin Schneier, MD, Co-Director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute, on the impact of the pandemic on people with social anxiety disorder, how doctors can better serve them, and the opportunities and challenges the pandemic presents for this patient population and their doctors.
Healio: How is social anxiety expressed during the pandemic?
Schneier: My impressions are based on some published research and on my personal dealings with patients in my practice and during my research. Some studies have looked at social anxiety as a predictor of how people are doing during the pandemic. By and large, they tend to show that people with significant social anxiety or social anxiety disorder did not fare well during the pandemic. Socially anxious students have higher levels of persistent anxiety, which usually diminishes over the course of a normal school year. Another study showed that social anxiety about the pandemic predicted greater anxiety, depression, and COVID-19-related worries during the pandemic.
These results are not surprising as people with social anxiety tend to have smaller networks of support. Even though you may think that people with social anxiety don’t mind being isolated, they still want social contacts and connections. The barriers associated with COVID-19 have made this difficult for people starting out with social challenges. I have seen exceptions to this, however, with some socially fearful people enjoying the great relief from social obligations that the pandemic has brought with it. This subgroup of people with social anxiety disorder is happy not to have the same demands of being around people, speaking in meetings, etc. Wearing masks can also temporarily reduce the anxiety of people who are worried like them other people might appear.
The downside is that people who were happy to have avoided these interactions will find it doubly difficult to adjust to social demands again as the restrictions eventually wear off and we revert to some form of normal social and professional interactions.
Healio: Does pandemic-related social insecurities play a role in social anxiety?
Schneier: For many people there is a great deal of uncertainty about how to properly deal with people – whether to mask yourself, what to do if the other person is not masking, questions about the possible imposition of a person when you ask them to wear a mask wear, etc. These are the types of social insecurities that people with social anxiety disorder find very difficult and very anxiolytic.
The term social distancing has also become a mantra referring to the physical space between people, but for many people it has also been associated with a certain fear of the other and some discomfort around other people, resulting in a Another level of complexity can lead to the challenge of interacting with people, especially those with a social anxiety disorder.
Healio: what can doctors do for their patients?it social anxiety during the pandemic and after?
Schneier: While some patients have welcomed the pandemic avoidance options, we need to encourage our patients to remain committed and work to put themselves in situations where they may be uncomfortable but want to function well. They should try to limit their social avoidance to what is necessary for safety reasons related to COVID-19. It is important to help patients realize that the world will return to some kind of normal and that social situations will not go away. Hence, it will be important to maintain social skills and stay socially engaged. Social anxiety disorder behavior therapy focuses on using novel coping techniques to help patients enter their dreaded social situations, and this type of work should continue even if the pandemic has limited opportunities to engage in some social situations could. It is important that doctors remind patients with social anxiety disorder and all of our patients to make extra efforts to keep in touch with the people who matter to us. Even if interactions have to be distant, they can still help alleviate the loneliness and feelings of isolation that the pandemic can bring.
Healio: Do you think the pandemic will have some long-term social anxiety impact in the years to come?
Schneier: There is general evidence that this pandemic will have lasting effects in terms of increased rates of anxiety and depression, and possibly PTSD. For some, these conditions can persist. It’s hard to say how long this could go on and whether people will recover quickly from it. There will likely be a range of responses as the pandemic subsides, with some people going back to their daily lives seamlessly and others who will find it a big change.
Healio: Are there macro / systemic interventions that can help people with social anxiety disorder during the pandemic?
Schneier: One thing that was life saving during the pandemic was the ability to see patients from a distance. Many of our patients like it a lot because they don’t have to commute and it can be very effective, even if it’s not quite the same as a face-to-face meeting. For some people with social anxiety disorder, that little bit of distance that comes from remote visits can make therapy or treatment more practical and more emotionally accessible to them. The ability to continue remote call support and insurance coverage will be an important change that could have lasting benefits to our healthcare system.
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