Reader’s Question

I’m a 20-year-old male in college. I have horribly low social self-confidence. I can never relax in social settings. I get nervous, anxious, and self-conscious. I have low self-esteem and doubt my ability to be natural and to be accepted.

One of the things I’m always self-conscious about is my voice. It’s kind of high-pitched by nature, but social stress tightens my throat and makes speaking comfortably nearly impossible. I find myself prefacing most things I say with the thought, “How can I say this to minimize the discomforting sound of my voice?” I hate it. A lot. I’m also self-conscious about how skinny I am, but I find it hard to eat a lot (especially when I’m stressed), and working out is hard for me for reasons I won’t go into. I also sometimes get a headache or splotches on my neck in social settings.

I’m at a point in my life where I really want to be making new friends, but it’s almost impossible with this social anxiety. I think my life could be 100 times better if simply had confidence, but, try as I might, I haven’t been able to muster any. I force myself to do some things, go to some social events, but so far it hasn’t helped at all.

I hate this crippling condition. I want a way out. Whenever I try to trace the source of this social anxiety, I usually conclude that it probably has something to do with some identity issues I have. I spent a lot of my life conforming to the standards of others, living in their definitions of who I should be instead of defining myself. I guess I was too insecure to just be me from the beginning. Anyway, the immediate necessity in my life is that I gain the confidence to interact comfortably on a social level. Like I said, I’ve tried pushing myself, and it hasn’t helped much. I also don’t think I’m anywhere near solving all the identity issues from my past.

I’ve been on Prozac for two months, and the dosage was just increased to 40 mg because it hasn’t helped at all. I’m not looking for a quick fix, but, then again, I kind of am. Do you have any suggestions?

Our Clinical Psychologist’s Reply

From what you report, there are a lot of issues affecting your self-confidence, including what may be a Social Anxiety Disorder. And while you may not yet be optimally medicated, the reality is that most often medication alone is not the answer.

The effectiveness of cognitive-behavioral strategies in dealing with anxiety-related problems is well documented. Essentially, the strategies involve challenging thinking patterns that fuel anxiety and lead to behaviors that perpetuate poor self-esteem. One of the thinking patterns evident in your comments that can contribute to anxiety is the “extreme” type of interpretations you seem to make. Thoughts like “horribly” low self-esteem, “impossible” speaking ability, etc. not only reflect your anger and frustration, but also cast an interpretation about the seriousness of your issues that can only serve to heighten anxiety levels. So, in addition to possibly working with a counselor or therapist who specializes in helping folks overcome anxiety and increase self-efficacy, you might begin a program of increased self-acceptance by toning-down the harsh self-assessment embedded in the extreme labels you employ in your self-talk.