A concerned mother wrote and asked me for suggestions for her son who was in his first semester at college in a different state. She was feeling helpless from afar, and wanted to know how to advise him about his long-standing social anxiety and depression, which had flared in his new environment. This is what I told her.

Dear Worried Mom,

I can certainly understand and empathize over your anxiety from afar concerning your son’s depression and social anxiety. I have been there.

My general advice to you comes as a number of standard suggestions.

1. First the physical. If he is not sleeping, eating, and exercising adequately he needs to start. A physician’s exam to rule out any physical causes is important.
2. If there is a known cause to the start of his social anxiety, that is a starting point for him to explore. Sometimes that is a part of one’s personality, and the desire to address it must be present.
3. Does he have any hobbies or interests that could lead him to join a small club/organization/group with a shared interest? Even if he just starts peripherally by observing a gathering.
4. Does he have even one person he trusts he can talk to? One idea if he does is for that person, while staying present, to introduce him to another person in a safe environment. Your son might need to be able to control when he comes/goes and how long he may want to interact. Starting small is key to expanding your friendship circle.
5. He can just go to a small coffee shop and be around other people without engaging. Sometimes just the interaction of ordering something can help, especially if he makes an attempt to engage and be pleasant with the staff.

When someone lives with social anxiety, they experience a level of anxiety beyond what most of us do. This is based on what they assume others may be thinking of them. The sensation of constantly feeling judged is very real.

The Reality Of Social Anxiety

In reality, most people don’t think much at all about a single interaction. It’s just the story we tell ourselves that keeps us miserable. It can easily lead to depression and low self esteem, the opposite of happiness. And the thing is, most don’t realize that happiness is simply a byproduct of accomplishing goals that stretch us. Happiness is not a goal in and of itself. I say this to you as I often hear parents say “I just want my child to be happy.”

If your son does not want therapy, let go of trying to make him attend. Feel free to forward this email to him, and let him know I would be happy to see him if he changes his mind.

The national suicide hotline is 1-800-273-8355. The Trevor Project is another important source for the LGBTQ community. Their number is 1-866-488-7386. These people understand what it is like and want you to reach out, 24/7. The Trevor folks even have a texting option. Your son’s school will also likely have a counseling center, which is a place to start as well.

In short, there is help available, but your son must initiate it. I hope your son finds his way forward. He absolutely can change this if he is willing to do the work.

My best to you both, and to him, for change in 2019.

Page Rutledge, LCSW, MPH, MSW, CHt

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