Your question: Can I have friends if I have social anxiety?
By
OptimistMinds
| Reviewed by
Dr. Mark Mohan Kaggwa
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Author bio
The Optimistminds editorial team is made up of psychologists, psychiatrists and mental health professionals. Each article is written by a team member with exposure to and experience in the subject matter. The article then gets reviewed by a more senior editorial member. This is someone with extensive knowledge of the subject matter and highly cited published material.
Reviewer bio
Dr. Mark Mohan Kaggwa is a psychiatrist with experience in both clinical and research work. Major research contributions have been in forensic psychiatry, suicidology, medical education, and addiction psychiatry. He writes and reviews articles on these topics.
Brief bio
I have a wealth of expertise and experience in research and publication in psychiatry. I am a psychiatrist who has led and participated in several research projects and trainings, covering various topics such as addiction, forensic psychiatry, student mental health, and suicidology. I have a strong track record of mentoring and guiding early career researchers, especially students, to achieve academic excellence and recognition.
I have supervised and supported several students to publish their first peer-reviewed articles in high-impact journals such as the Lancet. Five of my mentees have received prestigious awards for their scientific contributions through publications, conference presentations, and travel grants. I derive great satisfaction and motivation from seeing others succeed and grow in their research careers.
Through mentoring activities, I have also enhanced my research and publication skills, resulting in over 70 publications in the past three years. My notable publications include several Lancet Psychiatry papers, widely cited and whose findings are implemented in various settings. I have also won several awards for my writing skills, such as the best journal article from the Royal College of Psychiatry Journals in August 2023.
Many of my articles have been featured on the cover pages of various journals, reflecting their significance and impact. I have also disseminated my research findings through conferences, seminars, and lectures, where I have been invited as a keynote speaker on three occasions.
I am passionate about solving real-world problems and improving the lives of people with mental health issues, especially those who are marginalized and vulnerable, through a team-based approach. I believe in training others to increase the field’s diversity of knowledge and perspectives.
I have extensive experience in data analysis, research methodology, design, and implementation science, which enables me to execute and train others effectively and efficiently. I am also a motivated team leader, an innovative problem solver, and a collaborative partner. My contribution is instrumental to this project’s success and advancing knowledge in this field.
Ongoing research projects:
- Self-harming behaviours among forensic patients in Ontario.
This project which started in December 2022, focuses on identifying the risks associated with physical self-harming behaviors and their related correlates
Role: Principal Investigator
- Suicide, all-cause mortality, and self-harming behaviours among forensic patients in Ontario.
This project is based on administrative databases to determine trends of suicide and all-cause mortality among forensic patients in Ontario. The project has been running since July 2023 to date
Role: Principal Investigator.
- Horticulture therapy’s role in reducing aggressive incidences among forensic patients in Ontario.
In this stepwise pragmatic cluster-randomized, we employ horticulture therapy in rehabilitating forensic patients in Ontario.
Role: Principal Investigator
- A preliminary study exploring the relationship between electroretinography waveforms and suicidal behaviour severity.
This project seeks to identify the waveforms that are related to suicidal behaviours among patients with depression. Recruitment for the study started in October 2023
Role: Principal Investigator
- Positions, Scientific Appointments, and Honors
| 2023 – present | American Psychiatry Association Colloquium fellow 2023, American Psychiatry Association, USA |
| 2022 – present | McMaster Forensic Psychiatry fellowship, McMasters University Department of Psychiatry and Behavioural Neuroscience, Hamilton, Canada |
| 2018 – 2021 | First Mile Fellowship (Masters support program), Massachusetts General Hospital Institute of Health Professions, USA
|
- Contributions to Science
- Suicidology epidemiology
I have been involved in projects investigating the prevalence of suicidal behaviours in various parts of the world. This work has reported the burden and associated factors among the following populations: university students, individuals affected by food insecurity, and those affected by the COVID-19 pandemic.
1) Kaggwa M.M, Akatussasira R, et. al. The global burden of suicidal behaviour among people experiencing food insecurity: A systematic review and meta-analysis. Journal of Affective Disorders. 2023. https://doi.org/10.1016/j.jad.2023.09.012
2) Nahrin R, Al-Mamun F, Kaggwa M.M, et al. Prevalence and factors associated with suicidal ideation among students taking university entrance tests: revisited and a study based on Geographic Information System data. BJPsych Open. https://doi.org/10.1192/bjo.2023.526
3) Abaatyo, J., … Kaggwa, M.Ml. Suicidal behaviour among inpatients with severe mental conditions in a public mental health hospital in Uganda. BMC Psychiatry 23, 346 (2023). https://doi.org/10.1186/s12888-023-04858-x
4) Kaggwa MM, Nuwamanya S, Ashaba S, Rukundo GZ, Harms S. An Adolescent’s Use of Veterinary Medicines: A Case Report Exploring Addiction. Journal of Psychoactive Drugs. 2021/08/08 2021;53(4):339-344. doi:10.1080/02791072.2021.1873466
5) Kaggwa MM, Muwanguzi M, Nduhuura E, et al. Suicide among Ugandan university students: evidence from media reports for 2010–2020. BJPsych International. 2021;18(3):63-67. doi:10.1192/bji.2021.13
6) Mamun MA, Al Mamun F, Hosen I, … Kaggwa MM, et al. Suicidality in Bangladeshi Young Adults During the COVID-19 Pandemic: The Role of Behavioral Factors, COVID-19 Risk and Fear, and Mental Health Problems. Risk Manag Healthc Policy. 2021;14:4051-4061. doi:10.2147/rmhp.S330282
7) Kaggwa MM, Arinaitwe I, Muwanguzi M, et al. Suicidal behaviours among Ugandan university students: a cross-sectional study. BMC Psychiatry. 2022/04/01 2022;22(1):234. doi:10.1186/s12888-022-03858-7
8) Kaggwa MM, Mamun MA, Najjuka SM, et al. Gambling-related suicide in East African Community countries: evidence from press media reports. BMC Public Health. Jan 24 2022;22(1):158. doi:10.1186/s12889-021-12306-2
9) Kaggwa MM, Rukundo GZ, Wakida EK, et al. Suicide, and Suicide Attempts Among Patients Attending Primary Health Care Facilities in Uganda: A Medical Records Review. Risk Manag Healthc Policy. 2022;15:703-711. doi:10.2147/rmhp.S358187
10) Rukundo GZ, Wakida EK, Maling S, Kaggwa MM, et al. Knowledge, attitudes, and experiences in suicide assessment and management: a qualitative study among primary health care workers in southwestern Uganda. BMC Psychiatry. Sep 12 2022;22(1):605. doi:10.1186/s12888-022-04244-z
11) Manouchehri A, Marznaki ZH, Atim LM, Mohammadian Amiri M, Kaggwa MM. The relationship between causes of suicidal attempts in Iran and individual and social variables: a retrospective study. BMC Psychiatry. Dec 12 2022;22(1):780. doi:10.1186/s12888-022-04449-2
12) Kaggwa MM, Najjuka SM, Favina A, Griffiths MD, Mamun MA. Suicidal behaviors and associated factors among medical students in Africa: A systematic review and meta-analysis. Journal of Affective Disorders Reports. 2022/12/09/ 2022:100456. doi:10.1016/j.jadr.2022.100456
13) Al-Mamun, F., Kaggwa, M.M., Hosen, I. et al. Suicide related to the COVID-19 pandemic in India: A systematic review. Discov Psychol 3, 2 (2023). https://doi.org/10.1007/s44202-022-00063-1
- University student’s mental health
Following my experience as a student and seeing many of my colleagues face vast challenges in their pursuit of knowledge. I investigated various aspects of university students’ mental health to find solutions to an ever-growing problem. I have published a few peer-reviewed articles on subjects ranging from depression, burnout, behavioural addictions, and sexual risk behaviours, among others.
1) Kaggwa MM, Devine J, and Harms S. The opioid crisis fuelled by health systems: how will future physicians fare? BJPsych International, 2023, 1-3, https://doi.org/10.1192/bji.2023.12
2) Sserunkuuma, J., Kaggwa, M. M., et al. Problematic use of the internet, smartphones, and social media among medical students and relationship with depression: An exploratory study. Plos One, 18(5), e0286424. https://doi.org/10.6084/m9.figshare.22794644
3) Kajjimu J, Kaggwa MM, Bongomin F. Burnout and associated factors among medical students in a public university in Uganda: A cross-sectional study. Adv Med Educ Pract. 2021;12:63-75. doi:10.2147/amep.S287928
4) Al Mamun F, Hosen I, Misti JM, Kaggwa MM, Mamun MA. Mental Disorders of Bangladeshi Students During the COVID-19 Pandemic: A Systematic Review. Psychology research and behavior management. 2021;14:645-654. doi:10.2147/PRBM.S315961
5) Najjuka SM, Checkwech G, Olum R, Ashaba S, Kaggwa MM. Depression, anxiety, and stress among Ugandan university students during the COVID-19 lockdown: an online survey. Afr Health Sci. Dec 2021;21(4):1533-1543. doi:10.4314/ahs.v21i4.6
6) Kaggwa MM, Kajjimu J, Sserunkuma J, et al. Prevalence of burnout among university students in low- and middle-income countries: A systematic review and meta-analysis. PLoS One. 2021;16(8):e0256402. doi:10.1371/journal.pone.0256402
7) Kaggwa MM, Arinaitwe I, Nduhuura E, et al. Prevalence and Factors Associated With Depression and Suicidal Ideation During the COVID-19 Pandemic Among University Students in Uganda: A Cross-Sectional Study. Front Psychiatry. 2022;13:842466. doi:10.3389/fpsyt.2022.842466
8) Kihumuro RB, Kaggwa MM, Kintu TM, et al. Knowledge, attitude and perceptions of medical students towards mental health in a university in Uganda. BMC Med Educ. Oct 20 2022;22(1):730. doi:10.1186/s12909-022-03774-0
9) Kihumuro RB, Kaggwa MM, Nakandi RM, et al. Perspectives on mental health services for medical students at a Ugandan medical school. BMC Med Educ. Oct 25 2022;22(1):734. doi:10.1186/s12909-022-03815-8
10) Kaggwa MM, Muwanguzi M, Najjuka SM, et al. Risky sexual behaviours among Ugandan university students: A pilot study exploring the role of adverse childhood experiences, substance use history, and family environment. PLoS One. 2022;17(11):e0277129. doi:10.1371/journal.pone.0277129
11) Muwanguzi, M., Kaggwa, MM., et al. Exploring adverse childhood experiences (ACEs) among Ugandan university students: its associations with academic performance, depression, and suicidal ideations. BMC Psychology, 2023/01/13.
- Influence of family caregivers and peer influence on patient’s mental health
From the unique perspective of using caregivers in caring for mental health patients in Mbarara Regional Referral Hospital. I embarked on understanding their roles, burdens, and significance in patients’ recovery. I continued to explore this in different populations, such as those involved in the criminal justice system. In this adventurous journey, I published a few peer-reviewed articles.
1) Kaggwa, M.M, Olagunju, A.T, Prat, S, Harms, S, and Chaimowitz, G. Peer support mental health teams in correctional settings in Uganda. Lancet Psychiatry, January 2023. https://doi.org/10.1016/S2215-0366(22)00431-X.
2) Kaggwa MM, Najjuka MS, Kesande C, et al. Length of stay of hospitalized patients at tertiary psychiatry facilities in Uganda: the role of caregiver’s presence. Discover Mental Health. 022/07/04 2022;2(1):15. doi:10.1007/s44192-022-00018-x
3) Kaggwa, M.M, Najjuka SM, Mamun, MA, Griffiths, MD, Nyemara, N, and Ashaba, S. Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma. BMC Psychiatry. January 2023. http://dx.doi.org/10.1186/s12888-023-04553-x
4) Nuwamanya S, Nkola R, Najjuka SM, et al. Kaggwa MM. Depression in Ugandan caregivers of cancer patients: The role of coping strategies and social support. Psychooncology. Oct 26 2022;doi:10.1002/pon.6057
5) Najjuka SM, Iradukunda A, Kaggwa MM, et. Al., The caring experiences of family caregivers for patients with advanced cancer in Uganda: A qualitative study. Plos One, October 2023.
- Mental healthcare and psychiatry epidemiology in Uganda
I have also contributed to understanding Uganda’s mental healthcare system through written commentaries, perspectives, reviews, and primary research.
1) Kaggwa MM, Harms S, Mamum M, A. Mental health in Uganda. Lancet Psychiatry; 2022. Oct;9(10):766-767. doi: 10.1016/S2215-0366(22)00305-4.
2) Kaggwa MM, Najjuka SM, Bongomin F, Mamun MA, Griffiths MD. Prevalence of depression in Uganda: A systematic review and meta-analysis. PLoS One. 2022;17(10):e0276552. doi:10.1371/journal.pone.0276552
3) Abaatyo J, Kaggwa MM, Favina A, and Olagunju AT. Readmission and associated clinical factors among individuals admitted with bipolar affective disorder at a psychiatry facility in Uganda. BMC Psychiatry, 23, 474 (2023). https://doi.org/10.1186/s12888-023-04960-0
4) Abaatyo, J., Favina, A. & Kaggwa, M.M. Absconding among admitted patients with bipolar affective disorder diagnosis in Uganda. BMC Psychiatry 23, 318 (2023).
5) Anyayo L, Ashaba S, Kaggwa MM, Maling S, Nakimuli-Mpungu E. Health-related quality of life among patients with bipolar disorder in rural southwestern Uganda: a hospital-based cross-sectional study. Health and Quality of Life Outcomes. 2021/03/10 2021;19(1):84. doi:10.1186/s12955-021-01729-5
6) Kaggwa MM, Namatanzi B, Kule M, et al. Depression in Ugandan Rural Women Involved in a Money Saving Group: The Role of Spouse’s Unemployment, Extramarital Relationship, and Substance Use. Int J Womens Health. 2021;13:869-878. doi:10.2147/ijwh.S323636
7) Kaggwa MM, Acai A, Rukundo GZ, Harms S, Ashaba S. Patients’ perspectives on the experience of absconding from a psychiatric hospital: a qualitative study. BMC Psychiatry. 2021/07/26 2021;21(1):371. doi:10.1186/s12888-021-03382-0
8) Kaggwa MM, Najjuka SM, Harms S, Ashaba S. Mortality Among Patients Admitted in a Psychiatric Facility: A Single-Centre Review. Clinical Audit. 2021 2021-06-17 2021;13:21-28. doi:10.2147/CA.S308757
9) Kaggwa MM, Nkola R, Najjuka SM, Bongomin F, Ashaba S, Mamun MA. Extrapyramidal Side Effects in a Patient with Alcohol Withdrawal Symptoms: A Reflection of Quality of the Mental Health Care System. Risk Manag Healthc Policy. 2021;14:2789-2795. doi:10.2147/rmhp.S314451
You can view some of my scholastic work from the following
eRA COMMONS: ORCID ID: https://orcid.org/0000-0002-4733-154X
Scopus Author ID: https://www.scopus.com/authid/detail.uri?authorId=57221518864
Researchgate ID: https://www.researchgate.net/profile/Mark-Kaggwa
Loop profile: https://loop.frontiersin.org/people/926359/overview
Semantic Scholar Link: https://www.semanticscholar.org/author/Mark-Mohan-Kaggwa/2046806840
Google scholar: https://scholar.google.com/citations?user=pPNqr_AAAAAJ&hl=en
My reply:
Hi, I hope this message finds you well. My name is Cesar Guedez, a psychologist trained in cognitive behavioral therapy.
Anxiety is a universal experience. To a greater or lesser extent, we all feel anxiety at various times in our lives. Anxiety is necessary because it triggers an alert in our body, indicating that we must take action to avoid a potential threat. However, when anxiety becomes very intense and recurrent, it causes problems.
There are several types of anxiety, one of the most common is social anxiety, also known as social phobia. This problem is characterized by a persistent avoidance of social situations. People with social anxiety feel excessive embarrassment, fear and worry when they are in social situations, almost always because they are afraid of the judgment or assessment that others make of them (1).
If you are someone who is dealing with social anxiety, although you may feel alone and misunderstood, social anxiety is a fairly common problem. Approximately 12% of adults experience social anxiety (2), and although it is most common in young people between the ages of 18 and 29, it occurs indiscriminately regardless of age, gender or any other variable.
Social anxiety becomes a problem because it causes people to isolate themselves or avoid contact with others, leading to loneliness and self-criticism that leads to depression. Therefore, social anxiety should not be confused with normal shyness. While in shyness people are quiet and introverted, but can function without major problems in social spaces, people with social anxiety feel an overwhelming panic in situations such as making a school or work presentation.
Making friends with social anxiety can be a tough task. Social anxiety has been shown to be a predictor of future loneliness, because fear of negative evaluation by others in social situations leads people with social anxiety to isolate themselves, avoiding relationships with potential partners or friends (3).
If you have social anxiety, you are probably wondering if you can have friends. The answer is yes. Social anxiety does not have to define your life. It is an obstacle but not an impediment to social situations such as getting a job, friendships or a partner. Therefore, you need to learn strategies to cope with the symptoms of social anxiety, and to deal in a reassuring way with the process of making friends.
What does it feel like to have social anxiety?
Social anxiety occurs exclusively in social contexts, such as being in a crowd, on public transportation, when giving a presentation in class or at work, trying to socialize to make new friends, at a job interview, even simple everyday activities such as talking to a cashier at the grocery store.
The symptoms of social anxiety are both physical and emotional, and are generally characterized by the fear of being judged or criticized negatively by others. Other common symptoms are:
- Muscle tension.
- Tachycardia and shortness of breath.
- Anticipation of social activities well in advance, e.g., fear of a college presentation weeks before it occurs.
- Feeling of extreme embarrassment in social settings.
- Avoidance of social activities for fear of feeling anxious.
- Feeling of dizziness.
- Avoidance of eye contact.
- Feeling panic when a stranger asks you a question on the street.
- Difficulty making friends and dating.
Why do making friends cause social anxiety?
There are few studies that prove the effect of social anxiety on the establishment of friendships. However, it is concluded that the most common problem in people with social anxiety is the process of maintaining friendships and the fear of intimacy (4).
Friendships depend on several factors to function in a healthy way. Some of these factors are trust, security, and intimacy. People with social anxiety may face severe difficulties in “opening up” emotionally with their friends, recounting personal experiences and talking about their problems, fears, and insecurities.
This does not mean that people with social anxiety are “bad friends,” but rather that they struggle with establishing trust with others because of the idea that they are constantly under judgment or criticism. If you have social anxiety I’m sure you understand what I’m talking about; it’s not that you don’t trust your friends or that they are bad people, but that something in your mind tells you that you should avoid talking about intimate things because others might judge you.
This is a concern that often overwhelms people with social anxiety: the idea that they are bad friends or bad partners because they don’t have the confidence to express themselves to others. I would like to tell you that this is not your fault, as it is part of social anxiety to constantly feel that others are criticizing you, even if you are in the presence of people you trust.
This problem makes it difficult for people with social anxiety to maintain long-term friendships, as people tend to reject or avoid those they feel they do not trust or feel secure enough to be friends with.
Therefore, it is important that you learn to modify your social skills, as friendships are considered a key factor in emotional well-being. As much as you may sometimes try to fool yourself by saying that “you don’t need friends”, the truth is that we all need people, outside of our family circle, to confide in and support us in difficult times.
How to develop friendships with social anxiety?
No problem has to define your life, and social anxiety is no exception. More than an impediment, your social anxiety is an obstacle that you must overcome in order to have a productive and satisfying life. There are strategies to consider so that you can work effectively with social anxiety.
It should be noted that social anxiety can only be diagnosed by a professional, and it is advisable to see a psychologist or psychiatrist if you feel that your social anxiety is consuming your life and worsening over time.
Social anxiety has been shown to be treatable with cognitive behavioral therapy. People learn strategies that improve their quality of life, and manage to cope with overwhelming social situations through questioning their irrational thoughts and socialization and communication techniques.
Breathing and relaxation
When anxiety symptoms occur, relaxation exercises are quite helpful. Close your eyes, inhale slowly for 3 seconds and exhale for another 3 seconds. Rest your hands on your abdomen and feel how the tension in your body progressively decreases. While you do this, repeat in your mind affirmation phrases, such as: “you can handle this situation, you have the strength to do it”. You can apply this exercise for 10 to 20 minutes a day.
Take the first step
It is common for people with social anxiety to have difficulty making friends because they wait for others to approach them. It will help to alleviate your anxiety symptoms and confront your fears if you take the first step in making friends. You can try it virtually first, by writing to people you like on social networks and initiating a general conversation or a conversation about a specific topic.
Then, you can approach groups of people with whom you share similar topics. In every city there are groups for movies, literature, sports, music and other topics of interest. By approaching these groups, introducing yourself and following the conversation slowly, you will be taking the first step in developing friendships.
Keep in touch with your friends
People with anxiety often find it difficult to maintain contact with their friends, which is perceived by others as disinterest. If you find it difficult to socialize in public spaces, you can add reminders on your phone to text your friends at a certain time of day, at least a couple of times a week. A simple “Hi, how have you been lately?” is enough.
Question your thoughts
Negative thoughts in social anxiety can ruin your life. Generally, when you are in places of socialization, thoughts like “no one wants me here”, “they sure are talking bad about me”, “I feel out of place, I should leave” come to you. It is hard work to understand that our thoughts are not facts, but this is reality.
Just because you think this way does not imply that it is the objective reality. Therefore, when these negative thoughts invade you, whether at work or in any other social space, you need to stop and question them. A functional and positive response to the above thoughts would be, “No one has said anything negative to me, I will try to fit into the space and try to start a conversation with someone.”
Develop your social skills
Something like initiating a conversation with a stranger can be a nightmare for many people with social anxiety. However, these are small steps you can take to cope with the symptoms of social anxiety and learn to control them. In a notebook you can write down a simulated conversation with a stranger or an acquaintance. It will help to look in the mirror and practice. Preferably, you can make the conversation about a topic of your interest, for example, a movie you recently saw or a nice restaurant you went to.
When you find yourself in a social setting, approach a person to start the conversation. If the person doesn’t know you, introduce yourself. Start talking about the topic you had in mind and practiced earlier. At the moment you may feel tense and overwhelmed, but by the end, regardless of how long the conversation lasts, you will feel that you have taken an important step in developing your social skills.
This is just one of several strategies you can apply in your day-to-day life to cope with the general pressure and fear you feel in social spaces, questioning that others may criticize you. Gradually, you can increase socialization, instead of talking to one stranger you will talk to three, and so on.
In my experience…
We all need someone to confide in to tell our problems and receive support. Friendships can be a lifeline, people who listen and help you unconditionally, and appreciate you for who you are. Therefore, it is necessary to work on getting and keeping lasting, healthy friendships, people with whom you can laugh and cry equally. Although this may feel impossible with social anxiety, it is an obstacle you must overcome with the tools and professional help you need. Having social anxiety does not impede making friends.
I believe you have the ability to improve and heal these feelings of discomfort you are experiencing now. The fact that you are seeking professional help through this medium proves it to me, and I applaud you for making that decision and being on track to improve your mental health and overall, your physical health
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References
Take Control of Your Anxiety Today: Personalized Counseling with BetterHelp
