Social anxiety disorder is the most common anxiety disorder. It is characterised by an intense and pervasive fear of being in a particular social situation, of performing some performance in public, or, more generally, of having to interact with unknown people. Unlike shame or shyness, people with social anxiety realise the completely irrational origin of their fears. Yet, they cannot control the feeling of panic in any way and adopt avoidance strategies.

In recent years, especially with the advent of social networks, the percentage of people suffering from social anxiety has increased disproportionately, probably fuelled by the glossy life we can observe on every page of every person posting any content. Social anxiety is related to the strong feeling of inadequacy and the terror of adopting wrong, embarrassing or disappointing behaviour. This feeling is amplified by what we can find on any social network.

A social avoidance mechanism develops as a response to (real or presumed) expectations of perfection, which then translates into living a facade life by systematically avoiding physical interactions.

From a biological point of view, social anxiety is but a rather obvious response to forced coexistence with too many people whom our brain cannot recognise as belonging to its own pack and whom it, therefore, tries to avoid, as it has no valid elements to assess the trustworthiness of these individuals.

Pathological anxiety is an excessively intense response or occurs in situations where anxiety should not normally be present. It is an intrusive and disabling response that afflicts various aspects of the individual’s life. Furthermore, while anxiety is a well-defined emotion over time, pathological anxiety is chronic and not always triggered by an actual trigger.

In the long term, an anxiety disorder can lead to the development of other pathologies, such as insomnia, paranoia, self-harm, depression, suicidal thoughts, etc.

In a natural situation, when we see or hypothesise a danger, our body prepares itself to fight it or run away from it, putting in place a whole series of mechanisms that will ensure the right energy and physical performance during a stressful period.
All the sensations we experience, both mental and physical, are all aimed at the same goal: fight or flight.

Nervous system
Primarily, adrenaline is released by the sympathetic nervous system, a highly excitatory substance that increases the heart rate and prepares the muscles for action by mobilising energy reserves. The sympathetic nervous system is forced to relax after a certain period of activity.
Together with adrenalin, cortisol, famous as the stress hormone, is raised and dedicated to regulating the body’s metabolic expenditure by interacting mainly with insulin and glucagon. It also interacts with receptors in the brain to control the fight-or-flight response.

Cardiovascular System
The heart rate and contraction power increase thanks to adrenalin, which forces the blood to circulate faster to supply all the necessary muscles with oxygen.
In addition, blood is redistributed through the dilation and contraction of blood vessels, giving preference to skeletal muscles and minimising flow to more peripheral parts (skin, fingers, digestive system, etc.).

Respiratory system
Breathing increases in frequency and depth to provide the proper oxygen supply and to be able to free the blood from carbon dioxide faster. In addition, the right supply of oxygen to the brain allows hyper-focus on resolving the situation.

Sweat glands
The increase in sweat secretion has two main objectives:
make us more slippery so that the predator cannot easily grab us;
preventing the body from overheating in a problematic situation
In addition, the emanation of odour signals could play a role in activating this type of response.

Behavioural system
During the fight-or-flight response, subjects may manifest aggression or escape attempts, associated with the very meaning of the fight-or-flight response; the organism tries to get away from what makes it feel trapped and threatened at all costs.

Mental system
All focus goes to the dangers and threats in our environment, with even episodes of paranoia and frenzy. During this response, focusing on a specific topic unrelated to one’s survival is almost impossible.

Generally, in a usual case, anxiety is triggered by two events:

• Perception: the perception of danger or more commonly, a stressor or trigger activates the fight-or-flight response. This stressor can come from a living or non-living element;
• Anticipation: the anticipation of a danger or a dangerous situation triggers the body’s preparation; according to our brain, crossing a forest full of wolves or taking an exam are exactly the same thing, a stressful event from which one must protect oneself or flee.

The fundamental difference between perception and anticipation lies in the fact that in the former case, the danger is certain, while in the latter, it is only hypothesised, which emphasises that there is no need for a real threat for our organism to prepare itself for one, it is enough to imagine that there is a danger to put all our systems on alert.

During an experiment conducted on a brood of mice, it was realised that the feeling of anxiety is closely linked to the ability to control events.
In the experiment, the mice (divided into two groups) were free to roam around a very spacious cage. When they were hungry, they only had to press a button on the wall and food was provided. The mice thus learnt that they could control the food by employing the button.
At a certain point, the button in one of the two groups stops working: high concentrations of adrenalin and cortisol and states of panic and fear are recorded in the mice (the mice were adequately fed as soon as the measurements were finished, and no one was harmed).
Our power to control a situation, to anticipate it, to foresee it or simply to be able to manage it is closely linked to the development of a more or less intense sense of anxiety.

The control of events and their predictability is a key point for the brain, which is why routines are reassuring and why many people suffering from anxiety disorders may come to develop obsessive-compulsive behaviour (repeated practices that serve to calm the state of the brain through the false belief that they can have control over several things), paranoia (belief that there is always something beyond their control, be it because of a person or some other entity), and control mania (a subgroup of obsessive disorders).

By virtue of what has been explained so far, it is easy to understand how new and never-experienced situations can be a serious problem for those suffering from an anxiety disorder.
A new situation puts one in the horrible position of having no control on the one hand and being able to imagine everything that can go wrong on the other, confronting the individual with two of the strongest triggers of anxiety.
In addition, experience plays a key role. When we face a new situation that goes wrong, our brain registers negative feedback. So each time situations of the same type go wrong, this negative feedback will become the basis of anticipation for future situations.
The settling of negative feedback stimulates the negative rejection response to the type of situation under scrutiny and pushes the individual to want to distance himself from that type of situation even actively, putting in place the avoidance strategies mentioned above.
What happens, in this case, is described as a vicious circle:

• The individual participates in a situation;
• For whatever reason, the situation returns a negative feeling;
• The brain registers that this situation generates a negative psychophysical state;
• The individual tries to avoid the situation;
• The situation is proposed again, and the individual does not want to participate;
• The cycle begins again;

The psychological feedback of one situation is fundamental and decisive for participation in all similar situations to come.

The easiest and most immediate way to counteract anxiety is to go along with it. This means either fighting the situation or running away from it as far as possible. Unfortunately, it is not always possible to adopt this strategy. Often, the situation that generates our state of malaise is obligatory, such as school or work. Just as often, the origin of our malaise is not identifiable in a concise and easily avoidable situation.

The closest action to combat is physical training: a condition in which the body uses its released energy reserves and engages with the same intensity as it would in a fight. Physical training also helps adrenalin and cortisol levels drop quickly and justifies using extra oxygen. Responding to stress and anxiety with physical training can help avoid generating a negative feedback response, as the body perceives the situation as normal.

Cognitive-behavioural therapy has proved useful in many cases: this therapy consists, in its standard version, of gradual in vivo exposure and cognitive restructuring (destruction of a belief and replacement with a new belief); the former technique falls into the realm of desensitisation: the more we expose ourselves to a stimulus, the more it loses its stimulating effect, functioning like addiction to drugs. Unfortunately, cognitive behavioural therapy has its limitations, such as the fact that it does not take into account the patient’s past and the origin of the disorder. It merely works on the here and now, proving efficient in many cases but insufficient or inadequate in others.

Trying to combat anxiety by creating a routine is a correct but risky step: having a routine is certainly useful, but flexibility is an important characteristic. If a routine becomes fossilised in the brain and becomes the fundamental focus of an individual’s well-being, it could lead to obsessive-compulsive disorder. The ability to adapt was born precisely to react to unforeseen situations and ensure our survival.

In the life of a person with anxiety disorders, social relationships are difficult to establish and, when established, difficult to maintain. These difficulties often increase the negative feedback received from social interactions and, if poorly managed, can aggravate the disorder.

The conception of the existence of error plays a fundamental role in the life of a person suffering from anxiety disorders. Modern society, however, demonises error, selling an absurd and unattainable ideal of perfection, which instigates the individual’s state of anxiety, again generating a vicious circle or negative feedback loop.

Mindfulness

Mindfulness helps focus on the present moment, momentarily ignoring the before and after. Exercises related to mindfulness involve focusing on the present moment, removing thoughts of authoritarian judgement on things around us, and renouncing the application of the label ‘good’ and ‘bad’.

Breathing and meditation

Correct breathing can interrupt and return our body’s physiological response to normal while helping to calm the psychological response.

Muscle Relaxation

Exercises such as progressive relaxation or isometric relaxation can help calm the state of muscle tension that the body undergoes when the fight-or-flight mechanism is activated.

Cognitive behavioural psychotherapy

This therapy has proven very successful in treating anxiety disorders even in the long term, helping patients dismantle dangerous and/or self-destructive behaviour.

Exercise

Going along with the fight-or-flight mechanism helps your body perceive the situation as normal and manageable. The exercise forces your brain to distract itself from the object causing the state of anxiety and helps it reconsider its position in the situation it is in.

In addition, exercise releases endocannabinoids in the brain, which counteract the effects of adrenalin and cortisol.

There are six main anxiety disorders:

• Phobia: characterised by a disproportionate and irrational fear of a certain object (spiders, aircraft, dogs, etc.) that the subject is in no way able to control, despite realising that their anxiety does not stem from the actual object in question.
• Panic disorder: (violent and sudden fits of terror, tachycardia, nausea, fainting etc.) and Agoraphobia (fear of being in situations from which there is no quick escape, leading to avoidance of crowded places or places with no exits).
• Obsessive-compulsive disorder: characterised by recurring thoughts, images or impulses. These trigger anxiety/disgust and ‘compel’ the person to perform repetitive material or mental actions to calm themselves. 80% of patients have both mechanisms.
• Social phobia: The main characteristic of social phobia is the fear of acting, in front of others, in an embarrassing or humiliating way and of receiving negative judgements. On average, 13% of the global population suffers from it.
• Post-traumatic stress disorder: develops following exposure to a stressful and traumatic event that the person experienced directly or witnessed and that involved death, threats of death, serious injury, or a threat to one’s physical integrity or that of others. The person’s response to the event involves intense fear, a sense of helplessness and/or horror.
• Generalised Anxiety Disorder: The person with Generalised Anxiety Disorder experiences a constant state of anxiety, often concerning small things and characterised by apprehensive anticipation of negative or catastrophic events of any kind or nature. In addition to this excessive and uncontrollable preoccupation with any circumstance, generalised anxiety also manifests itself with somatic symptoms, such as sweating, flushing, heart palpitations, extrasystoles, nausea, diarrhoea, dry mouth, lump in the throat, etc.

There are basically two cases where anxiety seems to work in our favour:

The case of Productive Anxiety

It is defined as a condition of unofficially codified psychic distress, where the individual experiences a covert form of anxiety yet maintains good (often excellent) functioning in many areas of life, which runs counter to the classical definition of anxiety disorder.

People suffering from production anxiety are terrified of not reaching the set standards and often set even higher ones to not disappoint expectations.

Affected persons live in a constant state of fear, experience unexpected events and changes of plan with great discomfort and are generally perfectionists, often pathological.

Anxiety investment

Anxiety as a source of energy can be invested in. The master of this technique is Dr. Filippo Ongaro, creator of the Ongaro method, which consists of a scientific approach to improving psychophysical health, relationships and personal fulfilment based on four fundamentals: Inner Work, Nutrition, Nutraceuticals, Training.

Mark Manson also helps turn a series of heavy difficulties into strengths with a much more provocative, almost vulgar, but nevertheless entertaining method.

Ideally, by properly understanding the mechanisms that generate the fight-or-flight response in our organism, we can be able to control it and often anticipate it, preparing the situation so that we can use the energies released in the right way