According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 21.5 million adults in the U.S. alone have a co-occurring mental health disorder and substance use disorder (SUD). The prevalence of co-occurring SUD and other mental health disorders is due to their shared bidirectional relationship. On one hand, SUD increases your risk of developing or exacerbating a mental health disorder, whereas unaddressed mental health challenges increase your risk of developing SUD. There are several mental health disorders that SUD shares a high prevalence with, like social anxiety.
Some of the other disorders and conditions that co-occur with SUD include:
- Other anxiety disorders
- Major depressive disorder (MDD)
- Post-traumatic stress disorder (PTSD)
The co-occurrence of disorders like PTSD also speaks to the interconnected relationship between co-occurring disorders and trauma. As noted in “How to Manage Trauma” from the National Council for Behavioral Health, 223.4 million (70%) U.S. adults have experienced trauma. Although many recover from trauma, for some when left unaddressed, it can manifest into other challenges like PTSD. Further, a symptom of PTSD is anxiety, which highlights the shared relationship between PTSD and social anxiety. Thus, understanding the complex and intersecting relationships between SUD, social anxiety, and trauma can be vital to long-term recovery.
At The Guest House, we believe carrying trauma can be at the root of numerous self-defeating thinking and behavior patterns. The overwhelming distress of trauma and co-occurring disorders can weigh you down and lead to unhealthy coping strategies that impair multiple domains of life. When you are responding to things from a place of distress, it can impede productivity, healthy relationships, and overall well-being. Therefore, we are committed to helping you uncover your trauma, dismantle self-defeating behaviors, and find meaning and purpose in your life.
Yet, you may have many questions about the co-occurrence of social anxiety, SUD, and trauma. Why do social anxiety and SUD co-occur with each other? How does trauma contribute to social anxiety and SUD? Expanding your understanding of social anxiety can give you insight into how anxiety functions in SUD and trauma.
What Is Social Anxiety Disorder?
People often boil things down to their most basic parts or meanings to concisely share stuff with others. However, in mental health, this boiling down of mental health terms often leads to poor awareness and understanding of those conditions. The generalization of disorders and terminology like social anxiety, PTSD, gaslighting, and triggered has led the public to use serious conditions lightly. The cavalier use of mental health terms and disorders speaks to a lack of mental health literacy (MHL) that can contribute to the stigmatization of the significance of disorders like social anxiety. In particular, social anxiety is often overlooked as a disorder that impairs functioning and quality of life.
Many use the term social anxiety to describe typical anxiety or confuse it with shyness and or being an introvert. An introvert can have social anxiety and shyness can share commonalities with social anxiety. However, it is important to understand that anxiety and social anxiety disorder are not the same. Anxiety and nervousness are typical emotions that most people experience at some point in their life. For example, you may feel anxious before a big exam at school or a presentation at work.
It is not unusual to experience some anxiety as it is your brain’s survival response to stress. In many cases, a little anxiety can be useful to get you to study for that exam to graduate or prep for your presentation to get a promotion. Yet, social anxiety disorder, when left untreated, can be a debilitating condition that disrupts every part of your life.
In general, social anxiety disorder is a persistent and irrational fear of situations where you are scrutinized, evaluated, or judged by others. As noted by the National Institute of Mental Health (NIMH), unlike shyness, social anxiety results in symptoms of anxiety or fear in different situations. You experience social anxiety because you are worried about being humiliated, judged, or rejected by others. Moreover, the situations that leave you feeling scrutinized, evaluated, or judged can vary for each individual. Listed below are some of the social situations that can trigger social anxiety symptoms:
- Speaking in public
- Performing in front of people
- Answering questions in front of people like being called on in class
- Asking questions in front of people like raising your hand in class
- Meeting new people
- Going on dates
- Making small talk
- Eating and or drinking in public
- Going on job interviews
- Taking or making phone calls/texting
- Using public restrooms
- Attending social gatherings
- Talking to or asking for help from people in the service industry like a cashier or waiter
- Being watched while completing a task
Looking at some of the situations that can trigger social anxiety showcases its impact on functioning in daily life. The impact of your social anxiety symptoms can leave you feeling like you have no control. When you are overwhelmed by your symptoms, it becomes difficult to function or think clearly. You may feel desperate to alleviate or bury your symptoms, which impairs your ability to cope effectively. Thus, the distress of social anxiety may lead you to engage in unhealthy avoidance-based coping like self-medicating with substances.
Co-Occurrence of SUD and Social Anxiety
According to Psychiatric Times, SUD and anxiety disorders co-occur at greater rates compared to other co-occurring mental health disorders. Additionally, anxiety disorders like social anxiety and SUD can be risk factors for each other. Therefore, social anxiety and SUD play a significant role in your ability to effectively recover from SUD and or social anxiety. Yet, why do SUD and social anxiety co-occur so frequently? Several risk factors can contribute to the co-occurrence of SUD and social anxiety. However, several different risk factors can occur:
- Genetics influence how different parts of the brain functions
- Greater sensitivity to anxiety
- A family history of social anxiety
- Environmental factors
- Stressful life events and trauma
- Adverse childhood experiences (ACEs)
- Stressful life events and trauma
- Substance-induced
- Chronic substance use can change brain functioning
- Self-medication
- Difficulty regulating social anxiety
When you lack the tools to respond to your distress in healthy ways, maladaptive coping strategies can grow. Self-medicating with substances like alcohol is a common maladaptive coping mechanism for dealing with social anxiety and related trauma. Through self-medicating, you attempt to be more sociable, suppress ruminating thoughts, and find comfort in distressing situations. Therefore, the risk factors for co-occurring SUD and anxiety showcase the bidirectional relationship these disorders share with trauma.
Understanding the Impact of Trauma on Co-Occurring Disorders
Much like self-medicating in social anxiety, when trauma is left unaddressed, you are more likely to try to alleviate or suppress your distress with substances. Trauma itself leads to psychological distress, which increases your risk for co-occurring SUD and other mental health disorders. Concerning anxiety, trauma has a significant impact on how you see yourself and the world. Trauma much like SUD, changes the brain, creating similar changes in thinking patterns found in social anxiety disorder. Through trauma and social anxiety, you develop negative beliefs about who you are, the world, and your abilities.
Trauma erodes your trust in yourself and others, leaving you feeling unsafe in the world. Without a sense of safety, it is easier for an intense fear of embarrassment, humiliation, and negative evaluation from others to manifest. Therefore, together, trauma, SUD, and social anxiety create a painful cycle of distress and impairment in your life. Listed below are some of the ways comorbid trauma, SUD, and anxiety impede your relationships and thus other domains of your life:
- You have difficulty interacting with your peers in work and school settings
- Impedes employment opportunities
- Burnout
- Decrease productivity
- Increase job insecurity
- Unemployment
- Impairs educational opportunities
- Decrease academic performance
- School avoidance
- Increase dropout rates
- Impedes employment opportunities
- Greater difficulty advocating for yourself in situations with clear power dynamics
- Healthcare professionals
- Teachers and professors
- Challenge managing responsibilities and obligations, especially when they require in-person or remote social interactions
- Making doctor appointments
- Paying bills
- Calling contractors for household tasks like a plumber
- Making important calls like your bank or social service resources
- Paying bills
- Difficulty voicing your thoughts and feelings with family and friends
Yet, how do you overcome the overlapping impediment of trauma and co-occurring disorders? The thought of trying to overcome a complex and intersecting cycle of harm in trauma, SUD, and social anxiety is understandably daunting. However, healing and lasting recovery from co-occurring conditions and experiences is possible. You can find healing from comorbid challenges through a trauma-specific approach to care.
Benefits of Trauma-Specific Approaches to Social Anxiety and SUD
A trauma-specific approach to treatment services is an essential component of a holistic and lasting recovery. Yet, what exactly are trauma-specific services? How do trauma-specific approaches to care support dismantling self-defeating thinking and behaviors for long-term recovery? According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma-specific services are designed to treat trauma-related symptoms, trauma-related disorders, and specific disorders of traumatic stress. Thus, the main goal of a trauma-specific approach is to recognize that traumatic experiences are closely tied to behavioral health challenges.
Moreover, trauma-specific approaches do three main things:
- Recognizes that trauma impacts individuals and communities
- Are committed to supporting your resilience and the resilience of the community
- Proactively uses evidence-based practices
At its core, the benefit of trauma-specific care is giving you the space to find empowerment, choice, collaboration, safety, and trustworthiness in your treatment program. Through trauma-specific approaches to care, you can work in tandem with your clinician to address and dismantle the harm of trauma and co-occurring disorders in your life. Within trauma-specific care, there are a variety of approaches that can be utilized to support your well-being. Some of the comprehensive, trauma-specific modalities The Guest House offers to address underlying challenges include eye-movement desensitization and reprocessing (EMDR), somatic experiencing (SE), and group therapy.
Eye-Movement Desensitization and Reprocessing
EMDR therapy highlights the mind-body connection in which the psychological distress of trauma manifests itself. Thus, the goal of EMDR therapy is to recall stressful past events and reprogram the distressing memory. Through specific rapid eye movements, you can reprogram the distressing memory with a new positive belief. However, one of the concerns about processing traumatic memories is re-traumatization. Yet, with EMDR therapy, you are not forced to talk about your traumatic experiences in great detail.
Rather than being re-traumatized, you focus directly on changing traumatic emotions, thoughts, and or behaviors. Focusing directly on the way distressing memories have been stored can help reduce and eliminate distressing symptoms to heal. EMDR therapy creates a safe space to address those distressing memories found in trauma and social anxiety with less stress. Furthermore, therapies like EMDR can work effectively with holistic modalities like SE.
Somatic Experiencing
Much like EMDR, SE builds connections between the mind and body to heal. Specifically, SE is a body-oriented therapy that focuses on the physical sensations in the body and or how the body feels. The bodily nature of SE speaks to the fight-or-flight stress response found in social anxiety and trauma. Your body’s response to traumatic stress has left you stuck in the fight-or-flight response, which creates a constant physical and psychological defensive state. Therefore, trauma gets stuck in the body and manifests itself in conditions like social anxiety and SUD.
To help dismantle stuck trauma, SE works through a bottom-up processing approach that modifies your stress resources. Rather than focusing on issues with cognitive and emotional deregulation, SE explores your internal sensations. By noticing your bodily sensations, you can indirectly approach traumatic memories. Through an indirect process, it is easier to tap into those difficult-to-process traumatic thoughts and feelings. Listed below is the bottom-up process SE takes to support challenges with trauma and co-occurring disorders:
- Awareness of bodily sensations
- You can recognize how different emotions feel in different parts of the body
- Somatic social anxiety symptoms
- Stomach pain
- Muscle aches, tension, or pain in the neck and back
- Headache
- Somatic social anxiety symptoms
- You can recognize how different emotions feel in different parts of the body
- Recognizing the relationship between bodily sensations and stress
- You learn how to notice and reflect on the specific feelings that come up when you are under stress
- Able to notice the bodily sensations associated with specific emotions
- Using guided imagery to learn how to focus on positive sensations, thoughts, and memories
- Guided imagery helps you use all your senses to imagine a deeply detailed scene
- You typically focus on creating a vivid image of a relaxing or happy scene
- Helps you relax
- Deepens your insight into yourself from a more positive frame of mind
- You typically focus on creating a vivid image of a relaxing or happy scene
- Guided imagery helps you use all your senses to imagine a deeply detailed scene
Looking at trauma-specific approaches like EMDR and SE have clear relationships to effectively address co-occurring challenges. More specifically, EMDR and SE are quite useful for SUD, social anxiety, and trauma. Although group therapy has a long history with SUD, it may be difficult to imagine its use for social anxiety.
Group Therapy
In general, the definition of group therapy is straightforward. Group therapy is when several clients engage in therapy with one or more clinicians at the same time. Within the group therapy, there are several different types you can utilize to support your recovery:
- Psychoeducational groups
- Support groups
- Cognitive-behavioral groups
- Skill development groups
- Interpersonal groups
The many different types of group therapy can speak to its ability to be a versatile tool for lasting recovery. Thus, group therapy can treat a variety of conditions like anxiety, depression, and PTSD. Nonetheless, on the surface, it seems like group therapy would lead to more anxiety for someone with social anxiety. However, group therapy can help you find connections and understanding through shared experiences. One way that group therapy is effective for social anxiety is the continuous exposure to social situations.
Moreover, unlike attending social events in your daily life, group therapy provides access to support from clinicians and peers. With support in group therapy, you can learn how to reframe negative thoughts and feelings concerning traumatic social situations. Therefore, a trauma-specific approach to healing gives you access to a wide variety of therapeutic tools to address your unique experiences and needs.
Fostering Healing With a Trauma-Specific Approach at The Guest House
At The Guest House, we recognize self-defeating thinking and behaviors found in SUD and mental health disorders like social anxiety are often coping mechanisms for trauma. Recognizing the intersecting relationships between challenges with SUD, trauma, and mental health disorders social anxiety is fundamental to recovery. Without understanding co-occurring challenges, you are unable to receive the proper care you deserve to heal.
Therefore, we provide a safe and non-judgmental space where holistic trauma-specific care guides our commitment to your healing. Whether you face challenges with trauma, SUD, and or social anxiety, we will meet you where you are to address your specific experiences and needs. There is a recovery path for you to heal as a whole person and thrive in long-term recovery.
Trauma, SUD, and social anxiety share a close relationship as trauma often manifests as self-defeating thinking and behaviors like anxiety and substance use. Further, co-occurring conditions develop and are exacerbated by each other. Traumatic experiences can erode your sense of safety to contribute to anxiety and self-medicating, while substance misuse can lead to brain changes that contribute to anxiety. Thus, the intersection of conditions can feel daunting to address. However, you can heal trauma and comorbidities with trauma-specific approaches like EMDR, SE, and group therapy by increasing self-awareness and self-understanding to dismantle self-defeating patterns. At The Guest House, we are committed to providing modalities to support your individual experiences and needs for healing. Call us at (855) 483-7800 today.