PTSD & Social Anxiety: Connection & Tips to Overcome

What Is Post-Traumatic Stress Disorder (PTSD)?

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that arises following exposure to an event that is life-threatening. PTSD can also develop by seeing the traumatic event happen to others, or even hearing about tragic events happening to others. Traumatic events can include physical, emotional or sexual abuse, accidents, combat, and natural disasters but can also be any experience that overwhelms the individual’s capacity to cope, leading to lasting emotional and psychological distress.

Not everyone who experiences trauma develops PTSD, as it depends on various factors such as the severity of the trauma, the level of support received afterward, history of traumatic experiences, and an individual’s pre-existing coping mechanisms. PTSD has a lifetime prevalence that is close to 10% and shares neurobiological features with anxiety disorders.³

Symptoms of PTSD include:

• Recurring flashbacks and/or nightmares of the traumatic event
• Inability to experience positive emotions
• Problems with concentration and attentiveness
• Feeling detached from others
• Diminished interest in participating in significant activities
• Avoiding or attempting to avoid reminders associated with traumatic event
• Irritability
• Self-destructive/reckless behaviors
• Negative beliefs or expectations about oneself, others, or the world

What Is Social Anxiety?

Social anxiety disorder is characterized by an intense fear of being scrutinized or judged by others in social situations. It encompasses a range of anxieties, from specific fears of particular social activities to a more pervasive fear in nearly all social interactions. Individuals with social anxiety worry excessively about being perceived as socially awkward or embarrassing themselves, leading to heightened stress and anxiety before social events. This fear of negative evaluation can lead to avoidance behaviors, causing them to alter or cancel plans last-minute.

Social anxiety is relatively common, affecting around 7-13% of the population in the United States. It tends to emerge during adolescence and may persist if left untreated. Women are more likely to be diagnosed with social anxiety disorder than men. However, some research suggests that social anxiety is over-represented among women and that men might be more likely to seek treatment, likely due to social anxiety causing more impairment for men.⁴ Risk factors include a family history of anxiety disorders, childhood shyness, negative social experiences, and a lack of social support. While it’s a treatable condition, social anxiety can significantly impact a person’s daily life, limiting their social interactions and overall quality of life.⁵

Symptoms of social anxiety include:

• Intense fear of interacting with strangers
• Avoiding of social situations
• Fearing that one’s actions will lead to negative evaluation by others leading to rejection
• Fear or anxiety is out of proportion
• Enduring social situations with intense fear or anxiety (pushing through or “white knuckling it”)

The Connection Between PTSD & Social Anxiety

PTSD and social anxiety disorders are significantly similar, particularly in the context of co-morbidity.⁶ Individuals with both conditions often share symptoms such as fear of negative evaluation, avoidance of social situations, and intrusive memories with intense distress.⁷ The connection between the two disorders lies in the shared emotional and cognitive processes involved in heightened arousal, negative self-perception, and avoidance behaviors.²

Despite these similarities, PTSD and social anxiety also differ in fundamental ways. PTSD is characterized by unique symptoms like hypervigilance, emotional numbing, nightmares, and flashbacks, which are not typically observed in social anxiety. This suggests that PTSD may involve distinct or more severe emotional dysregulation, possibly linked to the severity and nature of the traumatic event itself. On the other hand, social anxiety disorder may primarily manifest as fear of social judgment without the same traumatic memories and physiological responses seen in PTSD.⁸

Is It Common to Have Both Social Anxiety & PTSD?

Experiencing social trauma can increase the likelihood of co-occurring PTSD and social anxiety. Recent research suggests that considering them as one interconnected issue rather than separate disorders may be beneficial. Approximately one-third of individuals diagnosed with Social Anxiety meet full PTSD criteria or suffer from clinically significant PTSD symptoms.³

This comorbidity can be attributed to the social withdrawal, hypervigilance, and avoidance behaviors often seen in individuals with PTSD, which can manifest as social anxiety symptoms like fear of judgment and embarrassment. Although the exact percentage varies across studies, it is generally estimated that around 30% to 40% of those with a primary PTSD diagnosis also experience social anxiety symptoms.² In contrast, the percentage of individuals with social anxiety experiencing concurrent PTSD symptoms is lower, emphasizing the need to consider trauma history when addressing social anxiety. This complex relationship underscores the importance of comprehensive assessment and treatment strategies to address both conditions effectively.

Coping Skills for PTSD & Social Anxiety

Neuroscience research has demonstrated that one of the most effective ways we can change the way we feel is by becoming cognizant of our inner experiences. By pausing, and being curious about what we are experiencing, we can start to understand our reactions and what they are trying to tell us. Once we have some sort of understanding, we can evaluate our reactions and decide to what extent they are appropriate or simply messages from the past. Instead of pushing away, fighting or denying uncomfortable feelings, try accepting them. By allowing and even welcoming those feelings, we are creating a space for them to naturally work their way through our body.

 Relieving PTSD & Social Anxiety Symptoms In The Moment

While it is important to explore the original pain of your PTSD and social anxiety and heal it at the root, there are things you can do in the moment to alleviate or tolerate the intense feelings associated with these diagnoses. Healing from PTSD and Social anxiety does not mean you never experience discomfort or symptoms, it means you shift your relationship with those reactions so they do not get absorbed.

Tips for relieving PTSD and social anxiety symptoms as they occur include:

• Name the feelings: Get curious about what you’re experiencing without judgment! Simply notice, observe and label the sensations. For example, “I’m noticing my stomach is churning as a result of feeling anxious.”
• Practice breathing techniques: Take a deep breath in, hold, and extend your exhale. Prolonged exhaling has been shown to activate our parasympathetic nervous system, which is responsible for relaxation, and rest.
• Temperature change: Dramatically changing the temperature of your body, can shift the sensations and emotions you are experiencing. Next time you are feeling a rush of emotions, grab an ice cube and hold it in the palm of your hand. The coldness will mandate your brain to focus attention away from your emotions and onto the ice cube.
• Use your imagination: Close your eyes and picture your safe space while describing what you see, hear, smell, feel and taste. For example, “I am picturing a forest and I see shrubs, hear a bird chirping and feel the wind on my skin”.
• Practice WISE mind: Recognize and validate your feelings while also reminding yourself of the actions you can to stay consistent with your values.Try telling yourself “I can feel anxious AND I can spend time with my friend”.
• Self-Compassion: Show yourself the kindness and patience that you need from others. It’s okay not to be okay.

 Lifestyle Changes

Developing a lifestyle that incorporates healthy habits and routines can mitigate the intensity of some of your PTSD and social anxiety symptoms. Having healthy habits in place can serve as a safety net for when your symptoms increase and you lose your sense of control. Because our mental health is intertwined in so many different parts of our lives, we can make small changes to everyday tasks that can have a big impact.

The following lifestyle changes can improve symptoms of PTSD and social anxiety:

• Getting regular exercise
• Eating a healthy diet
• Getting enough sleep
• Spending time in nature
• Drinking enough water
• Increasing your social connections
• Adopting a pet
• Having fun
• Educating yourself on your symptoms and diagnoses

Practice Mindfulness

Trauma often leads to a hyperactive mind, creating a cycle of being stuck in past traumatic memories or future worries. Mindfulness for anxiety, including meditation, encourage individuals to stay in the present moment and release judgment. This practice helps break the cycle of rumination and anxiety by redirecting focus towards the here and now.

Engaging in activities to connect with our 5 senses, allows us to switch our attention away from the pain inside our minds and into the beauty of the world. Individuals can regain a sense of control over their thoughts and emotions, leading to reduced symptoms of PTSD and social anxiety. Regular mindfulness practice can be discreetly incorporated into daily life, making it a valuable tool for managing symptoms of PTSD and social anxiety.

Treatment Options for PTSD & Social Anxiety

PTSD and social anxiety can cause debilitating symptoms, often necessitating intervention. Engaging in therapy can provide relief of symptoms through psychoeducation, coping skill enhancement, and the strengthening of a support system.

In some cases, medication management may be recommended, especially if symptoms are severe or significantly impacting daily functioning. Medications can help alleviate the distress associated with both PTSD and social anxiety. The combination of therapy and medication can provide a comprehensive approach to addressing these intertwined conditions, offering individuals the best chance for symptom relief and improved quality of life.

 Therapy

Therapy is an effective form of treatment for PTSD and Social Anxiety as it provides a safe space for you to learn about your symptoms, gain support, and be presented with new perspectives that can offer relief. While there are many different approaches to therapy, having a safe and trusting relationship with your therapist is the key to effective therapy. There is no size fits all in therapy and it is important to figure out what approach resonates with you.

Therapy options for PTSD and social anxiety include:

• Cognitive behavior therapy (CBT): The idea of CBT is that our thoughts, feelings and actions are interconnected and impact one another. As a result of trauma, our perceptions of the world, ourselves and others become skewed. CBT provides tools to evaluate the accuracy and usefulness of our thoughts and to reframe them to be more balanced. CBT for PTSD and CBT for social anxiety are helpful options.
• Cognitive processing therapy (CPT): CPT is a more trauma-aware form of CBT as its focus is on specifically understanding how trauma impacts thoughts, feelings, and actions. Cognitive techniques that help you challenge and change rigid beliefs are taught.
• Exposure therapy: Trauma causes us to avoid things that remind us of the experience as a way to protect us from additional pain. Exposure therapy teaches us that we can tolerate distress and increase comfort in areas we previously avoided. 
• Eye movement desensitization and reprocessing (EMDR): EMDR for PTSD works by desensitizing past traumatic memories so that they no longer trigger a fight, flight, freeze, or fawn emergency response in the body. EMDR focuses on the memory centers of the brain, particular events or triggers, and any neurological associations. 
• Internal family systems therapy (IFS): IFS views the mind as consisting of different “parts” that take on a variety of roles, such as an inner critic or inner child. IFS aims to help clients recognize the usefulness of each role or feeling, without judgment. The goal is to uncover and access the “Self” in order to reach more balance within the mind.
• Interpersonal therapy: The basic assumption of IPT is that in order to heal, we must address the ruptures in past relationships or social attachments as they are at the root of our emotional distress.
• Dialectical behavior therapy (DBT): The primary focus of DBT is skills training in areas such as mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. These skills are aimed at helping people manage and tolerate emotional distress while learning how to identify and replace extreme or maladaptive behaviors with more effective ones.
• Acceptance and commitment therapy (ACT): The main idea of ACT is that pain and suffering are inevitable parts of life and by developing psychological flexibility we can reach a state of openness that allows us to live life in the present moment.
• Relational therapy (RT): The focus of Relational Therapy is on the therapeutic relationship between the therapist and the client. Therapy provides a safe space for you to practice being in relation to another person and can give you an opportunity to create a new narrative about social relationships that is healthier and more balanced.

Medication

Medication for PTSD and social anxiety may be considered when symptoms are severe, and/or significantly impair daily functioning. While medication can be a helpful component of treatment, it is often more commonly prescribed for managing symptoms of anxiety disorders, including social anxiety, than for PTSD. However, because anxiety, or hypervigilance, can be a symptom of PTSD, these medications may also be helpful for PTSD. However, the decision to use medication should always be made in consultation with a healthcare provider, taking into account the individual’s unique circumstances, treatment needs, and personal comfort.

Common medications used to treat anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Tricyclics
• Benzodiazepines

Common medications used to treat both PTSD symptoms and anxiety include:

• SSRIs – most commonly Sertraline (Zoloft)
• Serotonin norepinephrine reuptake inhibitors (SNRIs)
• Benzodiazepines

When to Seek Professional Help for PTSD & Social Anxiety

If your symptoms of PTSD or social anxiety are significantly disrupting your daily life, relationships, or overall well-being, seeking professional help is advisable. Online therapy directories can create access to finding a therapist that fits your needs. Experiencing symptoms of PTSD and Social anxiety can become overwhelming and alienating, especially if you don’t have a consistent and safe support system with whom you can be vulnerable and transparent. A therapist may also aid in recommending a consultation with a psychiatrist, and online psychiatry options can also be a viable choice for individuals seeking medication management for PTSD or anxiety.

In My Experience

Addressing both PTSD and social anxiety requires a comprehensive approach that combines therapy, mindfulness practices, and, in some cases, medication. PTSD and social anxiety are related in the sense that the trauma in PTSD can have social roots like humiliation or exclusion. In my experience, individuals presenting with anxiety, worries, and hesitancy to engage in social situations are typically able to identify a prior adverse experience in the context of a social situation or relationship. It is important not just to treat the anxiety around socializing but to do the original pain work to identify where that anxiety may have originated from. Our emotional pain is often caused by other people, therefore, our nervous systems learn to associate people as a threat or danger. Our brains struggle to identify the nuances of a situation and, instead, generalize the associations that have been made in the past. If our brains could talk, they would say, “Hey, last time you were around people, you were hurt. We want to prevent more pain, therefore, we will send signals to you to make you more skeptical as a way to protect you from further pain.”

In conclusion, by acknowledging the interconnectedness of these conditions and delving into their roots, individuals can find the support and tools needed to heal, regain control over their lives, and build healthier relationships. Engaging in therapy allows you to form a safe and therapeutic relationship allowing your nervous system and mind to have an experience that challenges the narrative that, “all people are threatening/dangerous”. Even though people are often the cause of trauma, they are also the healing of it.