What’s the difference between shyness and social anxiety?
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What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.
The terms “shyness” and “social anxiety” are often used interchangeably because they both involve feeling uncomfortable in social situations.
However, feeling shy, or having a shy personality, is not the same as experiencing social anxiety (short for “social anxiety disorder”).
Here are some of the similarities and differences, and what the distinction means.
How are they similar?
It can be normal to feel nervous or even stressed in new social situations or when interacting with new people. And everyone differs in how comfortable they feel when interacting with others.
For people who are shy or socially anxious, social situations can be very uncomfortable, stressful or even threatening. There can be a strong desire to avoid these situations.
People who are shy or socially anxious may respond with “flight” (by withdrawing from the situation or avoiding it entirely), “freeze” (by detaching themselves or feeling disconnected from their body), or “fawn” (by trying to appease or placate others).
A complex interaction of biological and environmental factors is also thought to influence the development of shyness and social anxiety.
For example, both shy children and adults with social anxiety have neural circuits that respond strongly to stressful social situations, such as being excluded or left out.
People who are shy or socially anxious commonly report physical symptoms of stress in certain situations, or even when anticipating them. These include sweating, blushing, trembling, an increased heart rate or hyperventilation.
How are they different?
Social anxiety is a diagnosable mental health condition and is an example of an anxiety disorder.
For people who struggle with social anxiety, social situations – including social interactions, being observed and performing in front of others – trigger intense fear or anxiety about being judged, criticised or rejected.
To be diagnosed with social anxiety disorder, social anxiety needs to be persistent (lasting more than six months) and have a significant negative impact on important areas of life such as work, school, relationships, and identity or sense of self.
Many adults with social anxiety report feeling shy, timid and lacking in confidence when they were a child. However, not all shy children go on to develop social anxiety. Also, feeling shy does not necessarily mean a person meets the criteria for social anxiety disorder.
People vary in how shy or outgoing they are, depending on where they are, who they are with and how comfortable they feel in the situation. This is particularly true for children, who sometimes appear reserved and shy with strangers and peers, and outgoing with known and trusted adults.
Individual differences in temperament, personality traits, early childhood experiences, family upbringing and environment, and parenting style, can also influence the extent to which people feel shy across social situations.
However, people with social anxiety have overwhelming fears about embarrassing themselves or being negatively judged by others; they experience these fears consistently and across multiple social situations.
The intensity of this fear or anxiety often leads people to avoid situations. If avoiding a situation is not possible, they may engage in safety behaviours, such as looking at their phone, wearing sunglasses or rehearsing conversation topics.
The effect social anxiety can have on a person’s life can be far-reaching. It may include low self-esteem, breakdown of friendships or romantic relationships, difficulties pursuing and progressing in a career, and dropping out of study.
The impact this has on a person’s ability to lead a meaningful and fulfilling life, and the distress this causes, differentiates social anxiety from shyness.
Children can show similar signs or symptoms of social anxiety to adults. But they may also feel upset and teary, irritable, have temper tantrums, cling to their parents, or refuse to speak in certain situations.
If left untreated, social anxiety can set children and young people up for a future of missed opportunities, so early intervention is key. With professional and parental support, patience and guidance, children can be taught strategies to overcome social anxiety.
Why does the distinction matter?
Social anxiety disorder is a mental health condition that persists for people who do not receive adequate support or treatment.
Without treatment, it can lead to difficulties in education and at work, and in developing meaningful relationships.
Receiving a diagnosis of social anxiety disorder can be validating for some people as it recognises the level of distress and that its impact is more intense than shyness.
A diagnosis can also be an important first step in accessing appropriate, evidence-based treatment.
Different people have different support needs. However, clinical practice guidelines recommend cognitive-behavioural therapy (a kind of psychological therapy that teaches people practical coping skills). This is often used with exposure therapy (a kind of psychological therapy that helps people face their fears by breaking them down into a series of step-by-step activities). This combination is effective in-person, online and in brief treatments.
For more support or further reading
Online resources about social anxiety include:
- This Way Up’s online program for managing excessive shyness and fear of social situations
- Beyond Blue’s resources on social anxiety
- a guide to looking after yourself if you have social anxiety, from the Western Australian health department
- social anxiety online program for children and teens from the University of Queensland
- inroads, a self-guided online program for young adults who drink alcohol to manage their anxiety.
We thank the Black Dog Institute Lived Experience Advisory Network members for providing feedback and input for this article and our research.
Kayla Steele, Postdoctoral research fellow and clinical psychologist, UNSW Sydney and Jill Newby, Professor, NHMRC Emerging Leader & Clinical Psychologist, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Can Home Tests Replace Check-Ups?
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I recently hit 65 and try to get regular check-ups, but do you think home testing can be as reliable as a doctor visit? I try to keep as informed as I can and am a big believer in taking responsibility for my own health if I can, but I don’t want to miss something important either. Best as a supplemental thing, perhaps?❞
Depends what’s being tested! And your level of technical knowledge, though there’s always something to be said for ongoing learning.
- If you’re talking blood tests, urine tests, etc per at-home test kits that get sent off to a lab, then provided they’re well-sourced (and executed correctly by you), they should be as accurate as what a doctor will give, since they are basically doing the same thing (taking a sample and sending it off to a lab).
- If you’re talking about checking for lumps etc, then a dual approach is best: check yourself at home as often as you feel is reasonable (with once per month being advised at a minimum, especially if you’re aware of an extra risk factor for you) and check-ups with the doctor per their recommendations.
- If you’re talking about general vitals (blood pressure, heart rate, heart rate variability, VO₂ max, etc), then provided you have a reliable way of testing them, then doing them very frequently at home, to get the best “big picture” view. In contrast, getting them done once a year at your doctor’s could result in a misleading result, if you just ate something different that day or had a stressful morning, for example.
Enjoy
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We looked at 700 plant-based foods to see how healthy they really are. Here’s what we found
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If you’re thinking about buying plant-based foods, a trip to the supermarket can leave you bewildered.
There are plant-based burgers, sausages and mince. The fridges are loaded with non-dairy milk, cheese and yoghurt. Then there are the tins of beans and packets of tofu.
But how much is actually healthy?
Our nutritional audit of more than 700 plant-based foods for sale in Australian supermarkets has just been published. We found some products are so high in salt or saturated fat, we’d struggle to call them “healthy”.
We took (several) trips to the supermarket
In 2022, we visited two of each of four major supermarket retailers across Melbourne to collect information on the available range of plant-based alternatives to meat and dairy products.
We took pictures of the products and their nutrition labels.
We then analysed the nutrition information on the packaging of more than 700 of these products. This included 236 meat substitutes, 169 legumes and pulses, 50 baked beans, 157 dairy milk substitutes, 52 cheese substitutes and 40 non-dairy yoghurts.
Plant-based meats were surprisingly salty
We found a wide range of plant-based meats for sale. So, it’s not surprising we found large variations in their nutrition content.
Sodium, found in added salt and which contributes to high blood pressure, was our greatest concern.
The sodium content varied from 1 milligram per 100 grams in products such as tofu, to 2,000mg per 100g in items such as plant-based mince products.
This means we could eat our entire daily recommended sodium intake in just one bowl of plant-based mince.
An audit of 66 plant-based meat products in Australian supermarkets conducted in 2014 found sodium ranged from 316mg in legume-based products to 640mg in tofu products, per 100g. In a 2019 audit of 137 products, the range was up to 1,200mg per 100g.
In other words, the results of our audit seems to show a consistent trend of plant-based meats getting saltier.
Looking for plant-based meat? Check the label for the sodium content.
Michael Vi/Shutterstock
What about plant-based milks?
Some 70% of the plant-based milks we audited were fortified with calcium, a nutrient important for bone health.
This is good news as a 2019-2020 audit of 115 plant-based milks from Melbourne and Sydney found only 43% of plant-based milks were fortified with calcium.
Of the fortified milks in our audit, almost three-quarters (73%) contained the recommended amount of calcium – at least 100mg per 100mL.
We also looked at the saturated fat content of plant-based milks.
Coconut-based milks had on average up to six times higher saturated fat content than almond, oat or soy milks.
Previous audits also found coconut-based milks were much higher in saturated fat than all other categories of milks.
Some plant-based milks were healthier than others.
TY Lim/Shutterstock
A first look at cheese and yoghurt alternatives
Our audit is the first study to identify the range of cheese and yoghurt alternatives available in Australian supermarkets.
Calcium was only labelled on a third of plant-based yoghurts, and only 20% of supermarket options met the recommended 100mg of calcium per 100g.
For plant-based cheeses, most (92%) were not fortified with calcium. Their sodium content varied from 390mg to 1,400mg per 100g, and saturated fat ranged from 0g to 28g per 100g.
So, what should we consider when shopping?
As a general principle, try to choose whole plant foods, such as unprocessed legumes, beans or tofu. These foods are packed with vitamins and minerals. They’re also high in dietary fibre, which is good for your gut health and keeps you fuller for longer.
If opting for a processed plant-based food, here are five tips for choosing a healthier option.
1. Watch the sodium
Plant-based meat alternatives can be high in sodium, so look for products that have around 150-250mg sodium per 100g.
2. Pick canned beans and legumes
Canned chickpeas, lentils and beans can be healthy and low-cost additions to many meals. Where you can, choose canned varieties with no added salt, especially when buying baked beans.
3. Add herbs and spices to your tofu
Tofu can be a great alternative to meat. Check the label and pick the option with the highest calcium content. We found flavoured tofu was higher in salt and sugar content than minimally processed tofu. So it’s best to pick an unflavoured option and add your own flavours with spices and herbs.
4. Check the calcium
When choosing a non-dairy alternative to milk, such as those made from soy, oat, or rice, check it is fortified with calcium. A good alternative to traditional dairy will have at least 100mg of calcium per 100g.
5. Watch for saturated fat
If looking for a lower saturated fat option, almond, soy, rice and oat varieties of milk and yoghurt alternatives have much lower saturated fat content than coconut options. Pick those with less than 3g per 100g.
Laura Marchese, PhD Student at the Institute for Physical Activity and Nutrition, Deakin University and Katherine Livingstone, NHMRC Emerging Leadership Fellow and Senior Research Fellow at the Institute for Physical Activity and Nutrition, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Bee’s Knees?
If you’d like to pre-empt that runny nose, some say that local honey is the answer. The rationale is that bees visiting the local sources of pollen and making honey will introduce the same allergens to you in a non allergy-inducing fashion (the honey). The result? Inoculation against the allergens in question.
But does it work?
Researching this, we found a lot of articles saying there was no science to back it up.
And then! We found one solitary study from 2013, and the title was promising:
But we don’t stop at titles; that’s not the kind of newsletter we are. We pride ourselves on giving good information!
And it turned out, upon reading the method and the results, that:
- Both the control and test groups also took loratadine for the first 4 weeks of the study
- The test group additionally took 1g/kg bodyweight of honey, daily—so for example if you’re 165lb (75kg), that’s about 4 tablespoons per day
- The control group took the equivalent amount of honey-flavored syrup
- Both groups showed equal improvements by week 4
- The test group only showed continued improvements (over the control group) by week 8
The researchers concluded from this:
❝Honey ingestion at a high dose improves the overall and individual symptoms of AR, and it could serve as a complementary therapy for AR.❞
We at 10almonds concluded from this:
❝That’s a lot of honey to eat every day for months!❞
We couldn’t base an article on one study from a decade ago, though! Fortunately, we found a veritable honeypot of more recent research, in the form of this systematic review:
Read: The Potential Use Of Honey As A Remedy For Allergic Diseases
…which examines 13 key studies and 43 scientific papers over the course of 21 years. That’s more like it! This was the jumping-off point we needed into more useful knowledge.
We’re not going to cite all those here—we’re a health and productivity newsletter, not an academic journal of pharmacology, but we did sift through them so that you don’t have to, and:
The researchers (of that review) concluded:
❝Although there is limited evidence, some studies showed remarkable improvements against certain types of allergic illnesses and support that honey is an effective anti-allergic agent.❞
Our (10almonds team) further observations included:
- The research review notes that a lot of studies did not confirm which phytochemical compounds specifically are responsible for causing allergic reactions and/or alleviating such (so: didn’t always control for what we’d like to know, i.e. the mechanism of action)
- Some studies showed results radically different from the rest. The reviewers put this down to differences that were not controlled-for between studies, for example:
- Some studies used very different methods to others. There may be an important difference between a human eating a tablespoon of honey, and a rat having aerosolized honey shot up its nose, for instance. We put more weight to human studies than rat studies!
- Some kinds of honey (such as manuka) contain higher quantities of gallic acid which itself can relieve allergies by chemically inhibiting the release of histamine. In other words, never mind pollen-based inoculations… it’s literally an antihistamine.
- Certain honeys (such as tualang, manuka and gelam) contain higher quantities of quercetin. What’s quercetin? It’s a plant flavonoid that a recent study has shown significantly relieves symptoms of seasonal allergies. So again, it works, just not for the reason people say!
In summary:
The “inoculation by local honey” thing specifically may indeed remain “based on traditional use only” for now.
But! Honey as a remedy for allergies, especially manuka honey, has a growing body of scientific evidence behind it.
Bottom line:
If you like honey, go for it (manuka seems best)! It may well relieve your symptoms.
If you don’t, off-the-shelf antihistamines remain a perfectly respectable option.
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The Burden of Getting Medical Care Can Exhaust Older Patients
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Susanne Gilliam, 67, was walking down her driveway to get the mail in January when she slipped and fell on a patch of black ice.
Pain shot through her left knee and ankle. After summoning her husband on her phone, with difficulty she made it back to the house.
And then began the run-around that so many people face when they interact with America’s uncoordinated health care system.
Gilliam’s orthopedic surgeon, who managed previous difficulties with her left knee, saw her that afternoon but told her “I don’t do ankles.”
He referred her to an ankle specialist who ordered a new set of X-rays and an MRI. For convenience’s sake, Gilliam asked to get the scans at a hospital near her home in Sudbury, Massachusetts. But the hospital didn’t have the doctor’s order when she called for an appointment. It came through only after several more calls.
Coordinating the care she needs to recover, including physical therapy, became a part-time job for Gilliam. (Therapists work on only one body part per session, so she has needed separate visits for her knee and for her ankle several times a week.)
“The burden of arranging everything I need — it’s huge,” Gilliam told me. “It leaves you with such a sense of mental and physical exhaustion.”
The toll the American health care system extracts is, in some respects, the price of extraordinary progress in medicine. But it’s also evidence of the poor fit between older adults’ capacities and the health care system’s demands.
“The good news is we know so much more and can do so much more for people with various conditions,” said Thomas H. Lee, chief medical officer at Press Ganey, a consulting firm that tracks patients’ experiences with health care. “The bad news is the system has gotten overwhelmingly complex.”
That complexity is compounded by the proliferation of guidelines for separate medical conditions, financial incentives that reward more medical care, and specialization among clinicians, said Ishani Ganguli, an associate professor of medicine at Harvard Medical School.
“It’s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests,” she said. If someone has multiple medical problems — say, heart disease, diabetes, and glaucoma — interactions with the health care system multiply.
Ganguli is the author of a new study showing that Medicare patients spend about three weeks a year having medical tests, visiting doctors, undergoing treatments or medical procedures, seeking care in emergency rooms, or spending time in the hospital or rehabilitation facilities. (The data is from 2019, before the covid pandemic disrupted care patterns. If any services were received, that counted as a day of health care contact.)
That study found that slightly more than 1 in 10 seniors, including those recovering from or managing serious illnesses, spent a much larger portion of their lives getting care — at least 50 days a year.
“Some of this may be very beneficial and valuable for people, and some of it may be less essential,” Ganguli said. “We don’t talk enough about what we’re asking older adults to do and whether that’s realistic.”
Victor Montori, a professor of medicine at the Mayo Clinic in Rochester, Minnesota, has for many years raised an alarm about the “treatment burden” that patients experience. In addition to time spent receiving health care, this burden includes arranging appointments, finding transportation to medical visits, getting and taking medications, communicating with insurance companies, paying medical bills, monitoring health at home, and following recommendations such as dietary changes.
Four years ago — in a paper titled “Is My Patient Overwhelmed?” — Montori and several colleagues found that 40% of patients with chronic conditions such as asthma, diabetes, and neurological disorders “considered their treatment burden unsustainable.”
When this happens, people stop following medical advice and report having a poorer quality of life, the researchers found. Especially vulnerable are older adults with multiple medical conditions and low levels of education who are economically insecure and socially isolated.
Older patients’ difficulties are compounded by medical practices’ increased use of digital phone systems and electronic patient portals — both frustrating for many seniors to navigate — and the time pressures afflicting physicians. “It’s harder and harder for patients to gain access to clinicians who can problem-solve with them and answer questions,” Montori said.
Meanwhile, clinicians rarely ask patients about their capacity to perform the work they’re being asked to do. “We often have little sense of the complexity of our patients’ lives and even less insight into how the treatments we provide (to reach goal-directed guidelines) fit within the web of our patients’ daily experiences,” several physicians wrote in a 2022 paper on reducing treatment burden.
Consider what Jean Hartnett, 53, of Omaha, Nebraska, and her eight siblings went through after their 88-year-old mother had a stroke in February 2021 while shopping at Walmart.
At the time, the older woman was looking after Hartnett’s father, who had kidney disease and needed help with daily activities such as showering and going to the bathroom.
During the year after the stroke, both of Hartnett’s parents — fiercely independent farmers who lived in Hubbard, Nebraska — suffered setbacks, and medical crises became common. When a physician changed her mom’s or dad’s plan of care, new medications, supplies, and medical equipment had to be procured, and new rounds of occupational, physical, and speech therapy arranged.
Neither parent could be left alone if the other needed medical attention.
“It wasn’t unusual for me to be bringing one parent home from the hospital or doctor’s visit and passing the ambulance or a family member on the highway taking the other one in,” Hartnett explained. “An incredible amount of coordination needed to happen.”
Hartnett moved in with her parents during the last six weeks of her father’s life, after doctors decided he was too weak to undertake dialysis. He passed away in March 2022. Her mother died months later in July.
So, what can older adults and family caregivers do to ease the burdens of health care?
To start, be candid with your doctor if you think a treatment plan isn’t feasible and explain why you feel that way, said Elizabeth Rogers, an assistant professor of internal medicine at the University of Minnesota Medical School.
“Be sure to discuss your health priorities and trade-offs: what you might gain and what you might lose by forgoing certain tests or treatments,” she said. Ask which interventions are most important in terms of keeping you healthy, and which might be expendable.
Doctors can adjust your treatment plan, discontinue medications that aren’t yielding significant benefits, and arrange virtual visits if you can manage the technological requirements. (Many older adults can’t.)
Ask if a social worker or a patient navigator can help you arrange multiple appointments and tests on the same day to minimize the burden of going to and from medical centers. These professionals can also help you connect with community resources, such as transportation services, that might be of help. (Most medical centers have staff of this kind, but physician practices do not.)
If you don’t understand how to do what your doctor wants you to do, ask questions: What will this involve on my part? How much time will this take? What kind of resources will I need to do this? And ask for written materials, such as self-management plans for asthma or diabetes, that can help you understand what’s expected.
“I would ask a clinician, ‘If I chose this treatment option, what does that mean not only for my cancer or heart disease, but also for the time I’ll spend getting care?’” said Ganguli of Harvard. “If they don’t have an answer, ask if they can come up with an estimate.”
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit http://kffhealthnews.org/columnists to submit your requests or tips.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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We Hope This Email Blows Your Tits Clean Off
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The Right Kind Of “Email Hacks”!
Are you a Gmailer or an Outlookista? Whatever your preference, you’re probably facing many of the same challenges that most of us face in our work and personal lives:
Email’s greatest strength (its ease of accessibility) brings about its greatest problem (our inboxes are cluttered and chaotic), not to mention that each of us are usually managing a whole flock of email addresses.
Sometimes we put productivity resources up against each other; that’s not what we’re going to do today! Each of these can play a role alongside each other; grab as many as will make your life easier:
ProtonMail: this is an email client; it’s the nicest, simplest, easiest, free email client that doesn’t track, let alone share, everything you do.
Bonus: there also exists ProtonCalendar (it’s a calendar that doesn’t share your data), ProtonDrive (it’s a cloud storage provider that doesn’t share your data) and, because they’re indeed serious about your privacy, ProtonVPN (it’s a VPN that, of course, doesn’t share your data).
Clean Email: maybe you’re stuck with the email provider you have. It happens. But it doesn’t have to be a chaotic mess. This tool will make tidying your email (and keeping it tidy!) a simplified dream.
See How Clean Your Email Can Get With Just A Few Clicks!
Right Inbox: a Gmail extension with many useful features, including read receipts, emails scheduled for later (e.g: time your email to send at 7am to look like a morning lark when in fact you’re peacefully snoozing), add unforwardable “For Your Eyes Only” notes to emails, and more.
Power Up Your Gmail With The Right Inbox Extension!
Email Finder: find the verified work email address of any person, so long as you know what company you’re looking for them in! No more “I thought it was lastname.firstname@ and it was firstname.lastname@”, no more “the wrong John Smith”, no more “undelivered” bounceback notices. Just: your email delivered.
Never Hear From The Mailer Daemon Again, With Email Finder!
Unroll.me: love your subscriptions, but hate the clutter? Unroll.me aggregates them for you in a virtual roll-up, with an “unroll” button to read them.
Get What You Really Want From Your Subscriptions, With Unroll.Me!
On which note, anything you’d like to hear more of from us? Let us know! You can always just hit reply, or use the feedback widget at the bottom of this email
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Hello Sleep – by Dr. Jade Wu
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We’ve reviewed other sleep books before, so what makes this one stand out?
Mostly, it’s because this one takes quite a different approach.
While still giving a nod to the sensible advice you’ve already read in many places (including here at 10almonds), Dr. Wu looks to help the reader avoid falling into the trap (or: help the reader get out of the trap, if already there) of focussing so much on getting better sleep that it becomes an all-consuming stressor that takes up much of the day thinking about it, and guess what, much of the night too, because you’re busy working out how sleep-deprived you’re going to be tomorrow.
Instead, Dr. Wu recommends to work with your body rather than against it, worry less, and ultimately sleep better. Of course, the “how” of this is what makes most of the book.
She does also give chapters on things that may be different for you, based on such things as hormones, age, or medical conditions.
The writing style is pop-science but with frequent references to scientific papers as appropriate, making good science very accessible.
Bottom line: if you’ve tried everything else and/but good sleep still eludes you, this book will help you to end the battle and make friends with your sleep (a metaphor the author uses throughout the book, by the way).
Click here to check out Hello Sleep, and indeed get better sleep!
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