From the Guidelines
The most appropriate follow-up question for a patient reporting anxiety in social situations would be: "Can you tell me more about these social situations that make you anxious and how they affect your daily life?" This open-ended question encourages the patient to elaborate on their specific triggers, the severity of their symptoms, and the functional impact of their anxiety, as outlined in the clinical practice guideline for social anxiety disorder by the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology 1. Understanding these details is essential for proper assessment of potential social anxiety disorder versus normal nervousness. The question avoids making assumptions about the nature of their anxiety while creating space for the patient to describe physical symptoms, avoidance behaviors, and coping mechanisms they may be using. Some key points to consider when assessing social anxiety disorder include:
- The cardinal feature of social anxiety disorder is marked fear or anxiety about one or more social situations in which one may be under the scrutiny of others 1
- The fear or anxiety is disproportionate to the real dangers posed by the social situation and its sociocultural context 1
- The fear, anxiety, or avoidance is persistent, typically lasting 6 months or more, and causes clinically meaningful distress or impairment in social, occupational, or other important areas of functioning 1 This information will help determine whether the anxiety represents a clinically significant condition requiring intervention or a normal response to social stress. Additional helpful follow-up questions might explore onset, duration, and exacerbating factors, but the primary goal is to understand the patient's subjective experience and how significantly it impacts their functioning.
From the FDA Drug Label
Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. Generalized anxiety disorder is characterized by unrealistic or excessive anxiety and worry (apprehensive expectation) about two or more life circumstances, for a period of 6 months or longer, during which the person has been bothered more days than not by these concerns At least 6 of the following 18 symptoms are often present in these patients:
- Motor Tension
- Autonomic Hyperactivity
- Vigilance and Scanning
The most appropriate follow-up question would be to ask the patient to elaborate on their anxiety symptoms, such as: Can you tell me more about your anxiety in social situations? How long have you been experiencing these feelings? How often do you experience them? 2
From the Research
Follow-up Questions for Anxiety in Social Situations
When a patient mentions feeling anxious in social situations, it's essential to ask follow-up questions to understand the severity and impact of their anxiety. Some possible follow-up questions include:
- Can you describe a recent situation where you felt anxious in a social setting?
- How often do you experience anxiety in social situations, and how long does it typically last?
- What are some physical symptoms you experience when you're feeling anxious in social situations, such as a racing heart or sweating?
- Have you avoided any social situations due to feelings of anxiety, and if so, how has this affected your daily life?
Assessing Anxiety Symptoms
Studies have shown that cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective treatments for anxiety disorders 3, 4, 5, 6, 7. To assess anxiety symptoms, healthcare professionals can use standardized measures such as the Generalized Anxiety Disorder 7-item scale (GAD-7) or the Hospital Anxiety and Depression Scale (HADS) 3.
Treatment Options
Treatment options for anxiety disorders may include CBT, SSRIs, or a combination of both 4, 5, 6, 7. The choice of treatment depends on the individual's preferences, severity of symptoms, and other factors. Studies have shown that combining CBT and SSRIs can be an effective treatment approach for anxiety disorders, particularly for youth with depression and anxiety 6 or obsessive-compulsive disorder 7. However, the added benefit of CBT may not be statistically significant until later in treatment 6, 7.