What do Americans most? When surveyed about their greatest fear, Americans placed death second. Public speaking was first.

The shakes and cold sweats many of us feel when we talk in front of a group are just one vivid example of —an excessive fear of being judged negatively.

People with severe social anxiety have few friends, drop out of school, may even be unable to work. Milder forms--which are far more common--take their toll in missed opportunities for advancement, evenings and just plain frustration.

But there's a lot you can do.

1. Realize anxiety is natural. Anxiety is the normal response to perceived danger – the body and mind rev up in readiness for fight or flight by producing adrenaline. This is useful. Without adrenaline, we can't perform at our best.

Concern about what others think it's natural, too. Humans evolved as a social species. We depend on one another to survive. Fear of negative judgment helps ensure harmony in the "pack."

What inflates these feelings to overwhelming proportions is probably nature and nurture. Anxiety runs in families. Certain create an overly sensitive alarm system. If your parents were highly critical but wary of outsiders – or if you had early humiliating experiences – this could've laid the groundwork for social anxiety.

2. Anxiety isn't reality. Everyone has an interior monologue – a constant stream of thoughts that affects mood and energy. Social anxiety feeds on thoughts that exact exaggerate danger, foresee dire consequences and attribute negative judgments to others. Thoughts like, "This meeting will be a disaster" or "I feel nervous, and it shows" sow seeds from which the whole nasty experience – racing heart, cold sweat – grows.

Thinking this way is just habit. And, like most habits, it can be changed.

Tune in to your thoughts. What are you telling yourself when you feel nervous about entering a room…Giving a presentation at a meeting…Approaching a salesclerk? Keep a diary to record each situation, your thoughts and level of anxiety you experience. Anxiety producing thoughts are almost always distortions and exaggerations: Everyone is staring at me…I always sound like a fool…If I make a mistake, I'll never live it down.

The antidote isn't but realistic thinking. Examine your anxiety producing thoughts critically and correct them.

Example: You attend a business lunch with people you don't know. You think, it will be a disaster… I’ll have nothing to say… Everyone will know how I am.

Realistic correction: Lunch will probably go well… I'm usually articulate and make a nice impression… And if things don't go perfectly, it won't be the end of the world. We'll take care of business, and that's what people will remember.

You can also try defusing your thoughts, as I wrote about here.

3. Try relabeling. Symptoms of anxiety and excitement are almost identical. If you feel revved up and think, "I'm getting anxious," it creates a destructive spiral. But if you think of it as “getting excited," you'll feel more prepared and capable.

4. Breathe away anxiety. One of the worst things about anxiety is the feeling that once it starts, it will build uncontrollably. Breathing slowly and deeply from your abdomen eases anxiety. To practice, while in bed, rest your hands on your abdomen. Breathing deeply through your nose to a count of four, let your abdomen rise as you inhale. Your chest should remain still. As you breathe out – to a count of four – your abdomen should flatten. Slow your breathing to eight breaths per minute.

After you become accustomed to this kind of breathing, practice it while sitting, standing and eventually in the course of your daily activities. Soon it will feel easy and natural.

Then whenever you start feeling anxious, be aware of your breathing. If it is shallow and rapid, consciously shift to slow abdominal breathing.

5. Shift your focus. Anxiety turns your inward. You notice your heart racing…Worry that your hands are shaking…Grade your performance as you give it, almost always negatively. This is certain to increase your anxiety.

Instead: focus your attention on the task itself, whether it's emphasizing key points in the presentation or pouring wine at a party. If you're talking to someone, attend closely to what he or she is saying. Think about how he might be feeling and rather than what to say next.

If anxiety continues to build, focus on neutral factors—the color and texture of the carpet, or the feel of the papers you’re holding in your hand. Such a shift in focus will interrupt the anxiety cycle and let you attend to the business at hand.

6. Be willing to experience discomfort. Some things are worth doing even if you're anxious. You will be amazed at what you can do while still feeling a lot of unpleasant sensations. Sometimes people will notice your anxiety; other times, they won't. Either way, you'll feel better about yourself if you go ahead and act--do what you value. As I heard leading ACT ( ) psychologist Steven Hayes say, "Be willing to stand in the hurricane and do what you think is important."

7. Tolerate Uncertainty. This is a tough one. Most people like things to be clear cut--to know where things stand. Unfortunately, life doesn't always cooperate. You must eventually face the ugly truth that you can't control everything. Not everyone will like you. Not everyone will approve of your every action. Sometimes your best bet is to go with the flow and learn the gentle art of acceptance.

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