QUESTION
I am the mother of a 16-year-old boy who needs help dealing with situations where he feels uncomfortable. For example, when he meets new people he will not make eye contact, he shifts nervously and drops his head and shoulders. He avoids situations in which he has to talk to people he doesn’t know, and my heart goes out to him when I see him so uncomfortable in new situations. He has friends, and gets on well with his teachers, but he finds new situations and new people difficult and does not know how to manage them. Could you please advise me how to find someone qualified who would be able to teach him coping skills that he could use when he feels awkward?

ANSWER
It sounds as if your son is experiencing symptoms of social anxiety, which can become particularly intense during the teenage years when the pressure to fit in and meet people can be at its highest.

Your son is not alone as social anxiety – popularly understood as an extreme form of shyness – is the most common of all the anxiety disorders, affecting as many as one in eight people.

Your son’s behaviours – averting eye contact and dropping his shoulders – are the classic “safety behaviours” that people display when they are experiencing social anxiety; others include freezing, and becoming tongue tied.

Although these safety behaviours are coping mechanisms intended to reduce anxiety, paradoxically they usually do the reverse as they make it harder for the person to talk and make it less likely for people to talk to them, and so the social situation becomes more awkward and anxiety-ridden.

At the heart of social anxiety is an over-self-consciousness, whereby the teenager is very self-aware and focused on what is happening to them rather than other people. For example, their internal dialogue might run something like this: “Oh, I’ve nothing to say”; “Is everyone looking at me?”; “Am I blushing?”; “I feel as if I am I shaking”, and so on.

If unaddressed, social anxiety can have a negative impact on a person’s life and cause them to avoid important social situations and miss out on significant events and experiences. Indeed, most people with social anxiety want to find ways to overcome it and to manage more effectively in their lives.

SOLUTIONS TO SOCIAL ANXIETY
A skills-focused approach to overcoming social anxiety whereby the person learns positive communication and self- management skills is usually the best approach. In particular, the Cognitive Behavioural Therapy (CBT) approach can be effective. Useful skills that your son can learn include:

Learning to break the pattern of self-consciousness
People can learn to direct their attention outwards when in social situations by making an effort to listen actively to other people and/or to tune into the environment.

Replacing “safety behaviours” with more helpful ones
For example, learning to look at the person talking rather than looking away.

Learning communication strategies
People can rehearse what to say in social situations and practise saying this so it becomes second nature.

Identifying and challenging unhelpful socially anxious thoughts
These include ‘Everyone is looking at me’ or ‘I don’t know what to say’.

Learning mindfulness techniques
Mindfulness can help manage one’s feelings of anxiety and directing one’s attention.

GETTING HELP 
Solutions to social anxiety can be learned as part of an individual or group therapeutic programme with a professional, and I have a list of potential resources at the end of this article. However, a lot of the skills can be learned through good self-help books and resources , such as Overcoming Social Anxiety by Gillian Butler, that you could read with your son.

The key is finding out what sort of help he would engage with. A lot depends on what he perceives as the problem, how able he is to talk about it and what solutions he would like to try. Indeed, some young people find it hard to seek help from a mental health professional, at least initially, and it is important to remember that there are lots of other ways that he can learn to cope.

GAINING SOCIAL SKILLS
Lots of young people tackle their social anxiety and become more socially confident by taking a leadership role in a hobby or special interest, such as leading a school project, organising an event, becoming more involved in a sport or helping out in a charity.

As well as teaching social skills, such strategies also build their confidence and self-esteem. I frequently recommend An Gaisce, or the President’s Awards, as an excellent programme that helps young people to learn new personal skills and get involved with community and sporting activities.

There are also many ideal special interests that teach many of the skills needed to overcome social anxiety – and that don’t have the stigma of being a mental health programme – such as learning debating skills or public speaking, for example with the Toastmasters clubs.

MENTAL HEALTH RESOURCES 
Socialanxietydublin.com and socialanxietyireland.com provide good information and links. The latter runs a very successful evidence-based group programme for tackling social anxiety (contact them to see if it is suitable for teenagers).

Teencounselling.ie and jigsaw.ie provide youth counselling in a variety of locations in Ireland. There may also be a school counsellor in your son’s school whom he could arrange to see.

Another option is to contact your GP for a referral to your local primary care psychology or child and adolescent mental health service.

You can contact private psychologists and counsellors at psihq.ie, iacp.ie and icp.ie. Check that the therapist has special experience in helping young people overcome social anxiety.

Prof. John Sharry, Irish Times August 2015 John writes in The Irish Times Health+ every Tuesday.
His website for courses is www.solutiontalk.ie