Social Anxiety in a Global Pandemic

The exacerbated structural barriers preventing effective treatment of social anxiety since COVID-19: strategies and resources to cope and ease the transition back to social normalcy

When I arrived at McGill as an international student in 2018, I already had a bad case of social anxiety, yet I somehow convinced myself I could build a new life across the Atlantic. Despite my mission to start with a clean slate, I quickly realized how much some of my most dreaded social fears were realized during university life – I was constantly exposed to people, living in the centre of Montreal with my roommates. Getting out of the house for anything – a party, a drink, or even just a walk – felt like a monumental task. I was lucky enough to be well-accompanied throughout my time in Montreal and felt like I had finally achieved an equilibrium, until the pandemic hit. 

As we all learn to adapt to this public health crisis, general feelings of fear, worry, and stress have become all too familiar, especially over long periods of isolation during lockdown. Many reports have shown how much people not only miss their loved ones, but also more generally the normalcy of human contact, most particularly human touch. Dr. Tiffany Field, director of the Touch Research Institute of Miami, calls this “touch deprivation.” 

But for me, the beginning of lockdown in March 2020 provided a different experience. A national study in China reported that lockdown measures had a buffer effect on social anxiety in pandemic regions, providing people with social anxiety disorder a temporary break from their fear of socializing. At first, the idea of staying at home was a relief, rather than a problem.

What about a year later? As vaccinations begin to roll out in some parts of the world, talks of the lingering “post-COVID” future have reactivated and magnified social fears. The idea of reconnecting with the outside world and adapting to “normal” life after isolation feels scary and overwhelming to me and others with social anxiety.

Beyond social stigma, there are still deeply ingrained structural barriers that prevent effective treatment of social anxiety disorder and other mental health conditions. During lockdown, pre-existing flaws in the healthcare system have only made it harder for people with mental illness to access care and support. 

Hopefully, my experience with social anxiety and some of the strategies and coping skills I’ve learned along the way can be helpful to anyone struggling during this time, and can assist in easing the transition back to social normalcy. 

What is social anxiety?

Beyond shyness or introversion, social anxiety disorder – also called social phobia – is characterized by a long-term and overwhelming fear of social situations. People with social anxiety experience intense and persistent fears of embarrassment, rejection, and humiliation from others, often leading them to avoid social situations entirely. 

Social anxiety disorder is the second most commonly diagnosed form of anxiety disorder. According to the World Health Organization (WHO), social anxiety disorder affects over 15 million adults worldwide. Treatment of social anxiety is inadequate – although it’s a common condition, studies show that “only a small minority of patients with this condition have it appropriately diagnosed or treated.”

Symptoms of social anxiety disorder can vary widely between individuals. However, some of the most common symptoms include

  • Extreme anticipatory anxiety about social interactions and performance situations
  • Fear of being judged by others in social situations
  • Fear of being visibly nervous in front of others
  • Being embarrassed or humiliated
  • Fear of accidentally offending someone
  • Fear of being the center of attention

People with social anxiety disorder report low self-esteem, negative thoughts, and sensitivity to criticism. This link to low self-esteem feeds into a vicious cycle; people with the disorder often hold long-term beliefs that they are no good in social situations. In any social situation, I’m often so overwhelmed by the physical sensations that take over me – sweating, stammering, shaking – that I’m convinced my anxiety is visible, strengthening my beliefs that I am no good in social situations. Before, during, and even after a social situation, I’m so focused on monitoring exactly how badly I’m performing that it stops me from paying proper attention to a conversation I might be engaged in. 

Although untrue, these beliefs are frequently unable to be not challenged because of avoidance and other safety behaviours. This perpetuates feelings of shame, guilt and sadness, because people with social anxiety tend to harshly judge and criticize themselves for not being able to engage at all in “normal” social interactions. That’s what social anxiety feels like to me: it’s relentlessly battling with yourself day and night.

Social anxiety doesn’t just impact social life, but extends to work and school as well – for many people, social anxiety can prevent them from going about their regular daily routine, especially when unpredictable or last-minute social situations come up. When I was living in Montreal, I would be regularly triggered in my own living room when my roommates would invite their friends over without warning, even if they were just passing by. Outside the home, I would dread crossing paths with someone I might know or recognize. When it eventually happened, I would freeze on the spot and it would take me days to muster the strength to attend classes again.

During the COVID-19 pandemic, people with social anxiety have found taking phone calls or video conferences a lot harder. Personally, I really struggle with activating my video in remote classes – the thought of it being uploaded for the whole McGill community to view stops me from participating in classes that I might have otherwise enjoyed in-person. 

The constant pressure to be the most outgoing, assertive, and talkative has pervasive effects that can prevent people with social anxiety from breaking out of a cycle of negative, unhelpful beliefs about themselves. As it interferes with and alters the daily life of many with the disorder, social anxiety can be debilitating – preventing you from living your life.

Social anxiety during a pandemic: a double-edged sword

Isolation has removed people with social anxiety from many of their triggers, temporarily mitigating their anxiety..

However, one of the main evidence-based treatments for social anxiety disorder is exposure therapy. With no gradual exposure to their social fears, long-term isolation has meant that people with social anxiety are more likely to believe and feed into their “thinking errors,” or cognitive distortions. According to psychoanalytic psychologist Dr. Emily Anhalt, in lockdown, “We are not gathering experiences that disprove our worries; there’s no gradual exposure. Normally when you are being social in a regular way, you are having some of your worries disproven. ”

Having social anxiety before COVID was hard; living in the centre of Montreal with roommates meant being constantly exposed to my social fears. I felt like I was relentlessly battling with myself, day and night. But often, once I was able to confront the triggers I was trying so hard to avoid, they would turn out to be not so terrifying.

Strategies to manage social anxiety: therapy, self-care, staying connected & meditation

Over the years, I have learned a number of coping skills that may be of use to those struggling with social anxiety during this time. Living with social anxiety is burdensome, and although sometimes it may feel too painful to endure, there are strategies that can help manage stressful situations and alleviate anxiety.

Seeking professional help and accessing care

Finding a trained healthcare professional to help you deal with your fears is one step to overcoming social anxiety. Although the idea of confronting these fears is challenging, starting and maintaining a formal treatment program can allow you to manage your anxiety comfortably. 

I know how hard it is to seek treatment – you might feel reluctant or embarrassed to discuss your fears – but remember that professionals are trained to provide you a secure space free of judgement. If public health measures allow it, research support groups. McGill’s Student Wellness Hub offers group therapies for both generalized anxiety and social anxiety. This is a great way to unite with people who are experiencing those fears, feel acknowledged, and build a support system for yourself.

Additionally, if you are currently on medication, build a routine that works for you. Making it more visible (on your night table), scheduling an alarm, or even asking a peer to remind you can help you make sure to take it regularly. 

Seeking professional help may not be a viable option for everyone given their social or financial situations. Most international students cannot access medical insurance issued by the Régie de l’Assurance Maladie du Québec (RAMQ). Only nine other countries in addition to France are eligible for the provincial health plan, leaving international students to opt for the McGill International Health Insurance Plan for which they are automatically charged the annual IHI fee of $1128 upon registration at McGill. For students who cannot seek care in McGill Student Wellness Hub services, private clinics are an expensive alternative which require students to pay cash up-front, with normal fees for a consultation starting anywhere from $100 and up. 

Researching social anxiety and understanding its mechanisms

Something that really helped me decrease feelings of frustration towards myself was researching the causes and effects of social anxiety. 

The amygdala – the part of the brain that controls fear responses – is  hyperactivated in situations that are perceived as threatening. This triggers all of the physiological symptoms like rapid heartbeat, muscle tension, dizziness, stomach troubles, and out-of-body sensations, which are associated with the ‘fight-freeze-fight’ (FFF) response. Whether real or imagined, people with social anxiety have such intense fears related to social judgement that their brains interpret social interactions as legitimate threats. 

But the brain is reprogrammable! Neuroplasticity, or the ability of neural networks in the brain to change and create new circuits and connections, is possible with the help of therapies like Cognitive Behavioural Therapy (CBT). Involving gradual exposure to social situations, CBT aims to retrain the brain to react more rationally and reflectively during social encounters that hold no real danger. This helps to challenge the thoughts and beliefs that may cause some of their fears. 

Alongside psychotherapy, I try to set “homework” for myself – a time when I actively confront and reflect on my thoughts and triggers. One of the most common helpful exercises I use is the “7 Column CBT Thought Record.” The strategy helps identify the automatic negative thoughts that occur during social situations (What horrible things do you tell yourself as you’re being triggered?), and then asks you to challenge these negative thoughts rationally. Through reason, you can gradually replace these negative thoughts with more realistic and positive ways of looking at social situations that trigger your anxiety. 

Personally, this very basic video explaining the FFF process in the context of social anxiety has helped me rationalize my fears. It’s also helped me acknowledge my ‘inner child’ and her desire to protect me from anything that might be endangering my survival. 

Practicing positive self-affirmations

Mirror talk – saying positive affirmations in front of the mirror – is shown to boost self-confidence. Personally, I try to practice mirror talk every morning, with the help of post-its; it helps me feel more positive about myself before I start my day.

Here are some examples of positive affirmations:

  • I am doing my absolute best
  • I believe in my abilities and myself 
  • I have all it takes to be successful and confident
  • I show compassion to others and myself 
  • I let go of my fears, anxieties, and negative thoughts
  • I can face this day and its challenges with strength
  • I deserve to live and deserve to be loved 
Staying connected and “shifting the spotlight” to others

It’s hard to maintain connection with others when you have social anxiety. There might be times when you feel confident enough to respond to text messages, and others where the thought of opening up a message or attending a class is insurmountable. Personally, I’ve found that it is helpful to have a template message response to send to close ones. It helps me to confront my fear while letting others know what I am struggling with. It’s also a way to give myself a break from fixating on what others might be thinking about me. 

Example template message for friends

I’ve also found that “shifting the spotlight” has been helpful in social situations – instead of focusing on your own performance, try to focus on the person you are speaking with. When we shift away from how others might be perceiving us, we not only show compassion towards ourselves but also to others. Finding extracurricular activities and volunteer positions has personally helped me with this – when we stop being self-critical, we begin to reconnect with others around a cause, a purpose. 

Noticing the negative self-talk: Mindfulness meditation and radical self care

Having social anxiety has made me feel like I’m in constant survival mode. Over the last year, I’ve practiced mindfulness with the help of peers and resources, like apps and videos, and it’s been a massive game changer. Meditation and breathing exercises have provided me with invaluable time to feel more present and cultivate compassion for myself. More specifically, it has taught me to be more aware of and “catch” negative social judgements of myself and assumptions others might hold of me. Meditation and mindfulness-based stress reduction programs have been shown to mitigate symptoms of anxiety, helping restore confidence and improve overall ability to interact and connect with others.

Getting a one-year subscription to Headspace and enabling notifications has propelled me to integrate mindfulness practice into my daily routine. An annual subscription costs $69.99 which may be inaccessible to some (unfortunately students at Canadian universities are not eligable for the student discount). As an alternative, Headspace has recently launched an 8-episode series on Netflix, “Headscape Guide to Meditation,” which teaches the basics and techniques of meditation (and which anyone with a Netflix subscription can access). Each episode tackles a theme – from stress-management to dealing with pain – and incorporates a guided meditation at the end. 

To know more about how to catch negative self-talk, you might want to refer to these self-help books: NHS Self-Help Guide, The Social Anxiety Workbook, and Overcome Social Anxiety and Shyness

In times of stress and lockdown, yoga is a fantastic mind-body practice that incorporates popular stress-reducing techniques to help you find more inner peace. Combining physical poses, controlled breathing and meditation, yoga is shown to reduce symptoms of anxiety and improve personal well-being. This free Youtube video by Yoga With Adriene really helps me when I’m stuck in a vicious cycle of self-criticism and need to show myself some compassion. To start the day off right, morning sun salutations – a series of poses performed in a sequence to create a flow of movement – are great. If you don’t already have a yoga mat and can’t afford one, you can use a towel or rug.

Getting support from McGill services

Establishing contact with your professors

Since the start of the pandemic, I’ve only recently had to disclose my social anxiety with my professors. With remote learning, participating in limited groups in conference or seminar settings have been as anxiety-provoking as they are in person. However, in my experience, I’ve found professors at McGill understanding and willing to accommodate – don’t hold back from going into more personal details, because those actually might help others better understand your particular circumstances. 

What might help is writing a ‘template email’ requesting accommodations. This will decrease significant distress in times when you might be feeling too overwhelmed to write an email from scratch explaining your situation. Reach to me via email if you need help writing it out, I’d be happy to help out.  

Example template message to professors
Registering at the OSD & requesting accommodations

McGill’s Office for Students with Disabilities (OSD) is the first point of entry if you’re struggling with academics due to permanent and temporary disability, illness and injury. The OSD provides accommodations for students that need support in the realm of academics and offers a range of services aimed to help you better navigate your well-being and achieve academic success. Know your rights. Don’t feel guilty for requesting accommodations. You’re struggling, you need them, and that is perfectly okay. 

However, McGill’s OSD has come under a lot of scrutiny in the past few years. Despite increasing numbers of affected students, the OSD’s office lack of staff, capacity, and resources has created new challenges for students. Complaints regarding difficulties with registration at the office, accessing accommodations, and receiving adequate quality of services have become a major concern since Fall 2015, when changes were made to the provincial grant funding structure leading the OSD to fall short from $1.2 million. At the end of Winter 2019, the OSD stopped paying their note-takers, leaving many OSD students without proper access to accommodations. 

Students have reported problems with the OSD that directly stem from underlying institutional problems, especially those affecting McGill’s funding and organization. McGill’s health services often provide students with temporary solutions to permanent problems. Band aid services include limiting the amount of sessions with therapists or learning skills advisors. 

Students have also expressed their concerns at the OSD’s failure to address their complaints, especially after a Fall 2019 student report found that many recurring issues remain uninvestigated. This lack of accessibility and acknowledgement adds yet another burden to students registered or trying to register at the OSD. Even once registered  (which in itself demands to provide sufficient documentation attesting a disability), students are more often than not asked to provide additional documentation to support their requests to professors.

Since my first year at McGill, I’ve experienced many painful instances where I’ve felt neglected by the OSD and the University at large. At times, it’s been hard to access information and/or accommodations that it causes additional distress. 

The process of registering, requesting accommodations and contacting professors has undeniably been exacerbated since the COVID-19 pandemic. With limited staff and constraints due to public health measures, it’s been harder than ever to feel properly accommodated. In a global pandemic where institutions should be adapting to remote life, this situation is likely experienced by many students, and creates a financial barrier to mental health services by forcing students to seek alternative, private services. 

Reasonable Consideration Requests, a new addition implemented by the OSD since Fall 2020, aims to provide a liaison between OSD students and professors to discuss semester accommodations. On top of adding more steps to accessing services, people with social anxiety might feel added weight put on their shoulders. Although these measures aim to provide help, agreements ultimately fall in the hands of professors instead of the OSD. And, as stated in RCRs, “these supports cannot be guaranteed.” Having social anxiety makes it hard to reach out to professors and disclose the reasons why completing a presentation/conference/seminar implicates barriers for you. 

Looking forward

While many people with social anxiety are reluctant to seek professional help due to social stigma and feelings of isolation and shame, institutional barriers are making it unreasonably hard for students who have a diagnosis to access care. In the midst of this global pandemic, providing effective health services for university students has never been so urgent. Moving forward, McGill should take greater accountability for its lack of resources and provide all its students, regardless of their location, support during COVID-19. Ultimately, opening up conversations will only contribute to developing a more accessible and inclusive campus. 

Since the beginning of the pandemic, I have become hopeful that more awareness is being raised for social anxiety and other mental illnesses. I look forward to a near future when people will feel more comfortable sharing their experiences of isolation and enjoy human connection again.

You are not alone. Be kind to yourself.