As Christmas gets closer many of us are preparing our homes, wrapping gifts and getting excited for the holiday. But for those people who suffer from Social Anxiety Disorder (SAD), this can mean a difficult and, often, traumatic time.
The National Institute for Health and Care Excellence (NICE) has estimated that 10% of the population suffers from SAD. In the US it's closer to 12%.
NICE's guidelines on the subject state that SAD is "persistent fear of or anxiety about one or more social or performance situations that is out of proportion to the actual threat posed by the situation."
Typical situations that might be anxiety-provoking include meeting people, including strangers, talking in meetings or in groups, starting conversations, talking to authority figures, working, eating or drinking while being observed, going to school, going shopping, being seen in public, using public toilets and public performances such as public speaking.
Although worries about some of these situations are common in the general population, people with SAD worry excessively about them at the time, before and afterwards. This can have a great impact on a person's functioning, disrupting normal life, interfering with social relationships and quality of life and impairing performance at work or school.
The Christmas period serves up an array of situations that can trigger an anxiety attack. For many of us, spending time with our extended families can cause an increase in stress which may lead to downing that extra glass of mulled wine to get through the day. For those who suffer SAD however, this time can become debilitating due to the obsessive fear that they will do or say something that they think will be humiliating or embarrassing.
James is a SAD sufferer and he explained to me, "There is an added pressure to attend events and parties over the holidays that for some is just too much to handle. Then there is the guilt of letting our loved ones down and if you don't go, friends and family sometimes don't understand and think you don't care, which of course is not the case!"
I used to suffer debilitating anxiety and found ways of isolating myself from Christmas get-togethers to keep it down to manageable levels. It was the increased pressure to spend time with extended family, the expectation to be 'happy' and mixing with people who were having a great time that was difficult. I felt extra sad that I just couldn't be as happy as everyone else. On the outside I looked like the party girl but inside I was a crying.
The run up to Christmas can be just as difficult with the opportunity for anxiety attacks starting at the office party. My friend Debby buys herself the ticket to pretend that she's going to attend knowing full well she won't be showing up. Another friend Tina makes sure that she buys the best gifts for Secret Santa to paper over any hint of people looking down on her. And Sue used to make sure all her shopping was done by October to avoid the crowds.
SAD does not hold back for celebrities and people who seem extroverted can suffer. Barbara Streisand, Robin Williams, Amanda Seyfried and Jim Carey have spoken out about their battles. Jennifer Lawrence said she had chronic anxiety as a child and 'felt worthless'.
So what's an effective treatment?
NICE recommends two approaches. The first iscognitive behavioural therapy (CBT) based on the premise that symptoms are tackled, rather than the underlying causes of anxiety. However, the guidelines state an 11 week course which isn't long enough for many sufferers. The second is a prescribed anti-depressant medication like Sertraline. These drugs come with a price because the possible side affects are hives, difficulty breathing, and swelling of your face, lips, tongue or throat, mood or behavior changes, increased and trouble sleeping.
My own personal recovery from severe anxiety was the opposite of NICE guidelines. I tackled the underlying causes and I didn't take medication. My anxiety was deeply rooted in my extremely dysfunctional upbringing. The only way I was going to become free of it was to dig deep and excavate it. I suffered very low self esteem and a fear of what others thought of me but when I was able to identify the start of the anxiety trail, I finally recovered. It took much longer than 11 weeks but at least I know I will never relapse.
Some recommendations for self-help treatment:
1. Sign up for the launch of my'Program of Miracles'. A self help program to dig deep, discover the source of anxiety and depression and recover the lost parts of you.
2. Conscious Therapy (CT) might be a more relevant type of 'talking therapy' because of the immediacy of its approach. Jan Day is a regarded therapist in this area and I trialed a session. I think it could work well for SAD because it helps you break down the anxiety issues into manageable chunks and gently challenge each one. I got a new perspective on an old problem in less than 30 minutes. Her website highlights sexual relationship therapy but don't be detracted by that - her approach could work for SAD too.
3. Exercise helps combat anxiety by encouraging the brain to release the mood lifting serotonin and it worked particularly well for me. Aim for 150 minutes of moderate exercise a week and do something that makes both your breath and heart go faster.
4. Staying off the caffeine is a good idea because anything that chemically increases the heart rate also increases anxiety.
5. Try hypnotherapy; there are some brilliant free apps, pod casts and Youtube videos.
6. Acupuncture was an amazing help for me. Find a trained practitioner here: http://www.acupuncture.org.uk/
7. Read 'The Power of Now' by Eckhart Tolle.