Dr. Alex Dimitriu is a Stanford-trained doctor specializing in psychiatry and sleep medicine. His areas of expertise include anxiety, depression, bipolar disorder, ADHD, insomnia, and more. His practice, Menlo Park Psychiatry & Sleep Medicine, currently serves patients in the Bay Area.
One patient would become overly nervous before his weekly tech demonstrations. Despite always being prepared and knowing the information better than anyone else in the room, his stress levels would become so high that he could barely keep his hands steady enough to work the computer as he walked the auditorium of people through his presentation.
Another told me that, although she was perfectly comfortable giving large department-wide presentations, she would suddenly freeze up in one-on-one meetings with her manager. Her mouth would become so dry that when she would try and speak, her voice would crack. The sound was always humiliating to her and she felt like it made her sound meek rather than self-assured in her answers.
A third patient believed he had completely lost his self-confidence altogether. Having recently moved to the Bay Area away from friends and family, he had been trying to meet new people. Each time he’d walk into a networking event or happy hour, he could feel a burning hot flush take over his face and neck. He was so embarrassed by it that he would end up leaving the event before getting a chance to speak with anyone.
Though these patients all experienced different symptoms and struggled during very different situations, they all had one thing in common. When they came to me, they hadn’t yet recognized their nerves and physical manifestations as social anxiety.
Fear of judgment from others, social anxiety is one of the most common phenomena in the world. It can bring about intense feelings of self-doubt, chagrin, and even inadequacy. Though it’s something that nearly all of us face, it can appear in very different ways for different people. Each of us can experience social anxiety at various levels, from very mild to more extreme. And it can come about in disparate situations and at peculiar times. A situation that feels completely comfortable for one person may feel incredibly stressful to another.
And people approach handling their anxieties in very different ways as well. For some, simply practicing more or finding time for additional preparation beforehand can be enough to minimize their stress levels. Others find sports psychology and mental strength training exercises to be helpful. Many of my patients find benefit from exposure therapy where, with my direction, they undergo a series of small exercises over time to help them become more comfortable during high-pressure situations.
But for some of my patients, like those I mentioned earlier, mental strength training techniques and exposure therapy exercises alone simply aren’t enough. Their social anxieties are heightened by an overactive adrenaline rush. Their own bodies actually get in the way and keep them from being able to do whatever it is they’re trying to do. All of a sudden they struggle to work a computer because their hands are shaking so badly. They become afraid to speak up knowing their voice is going to crack once they do. They begin avoiding certain situations altogether fearing they’ll be embarrassed.
For patients like these, I recommend beta-blockers.
Beta-blockers are a medication used for many different purposes, from heart conditions to blood pressure. They’ve also been scientifically shown to help minimize the physical manifestations of anxiety. They simply take away the shakiness, sweaty palms, and rapid heartbeat that so many of us experience before a big moment.
People who suffer from social anxiety tend to have a high amount of self-awareness and experience a lot of self-criticisms, leaving them to be highly reactive to whatever is around them. Beta-blockers can help break that cycle by blocking the sensations of adrenaline.
Beta-blockers can often be a good solution for patients like those I mentioned above as they have no mental effects, allowing them to preserve their mental clarity. Other medications often prescribed to minimize anxiety, like Xanax and Valium, have been shown to sometimes cause mental slowing and fuzziness.
Many of my patients tell me that after taking beta-blockers, they feel more present, more tuned into the moment. Comfortable even. Shaky hands disappear, voice levels are more steady, and they describe themselves as feeling “just normal”. They’re able to simply focus on whatever it is they need to do and feel more confident while doing it.
The medical community is continuing to explore the full extent to which beta-blockers can successfully minimize stress during high-pressure situations. Some studies suggest that beta-blockers may be beneficial in the treatment and even prevention of PTSD.
I can say from my experience with my clients who have tried a beta-blocker prescription, that by preventing the adrenaline response, a lot of presentations and other socially scary situations can become less traumatic. Several of my patients have come back amazed at how “unremarkable” the moments they once felt were nerve-wracking have now become.
To learn more about beta-blockers as a treatment for social anxiety, visit here.