Let’s face it—tremors can be really embarrassing when they happen in public. In a world that craves normalcy, tremors may be perceived as abnormal behavior. No one knows this better than people who suffer from tremor-related movement disorders, such as Essential Tremor (ET) and tremor-dominant Parkinson’s Disease (PD).
To understand how their tremors may affect the mental health of people with tremor-related movement disorders, I spoke with Dr. Idan Aderka. Idan is a Clinical Psychologist who is a Professor in the Department of Psychology at the University of Haifa in Israel. His area of focus is studying and treating Social Anxiety Disorder (SAD).
When Socializing Creates Anxiety
Idan began our conversation by pointing out that people who suffer from social anxiety disorder often have shaking hands when they are overcome by anxiety. He explained this type of anxiety is likely similar to what people with ET experience while socializing. Research shows that tremors can make a person embarrassed, which in turn aggravates the shaking, creating a vicious cycle.  ET patients report embarrassment which can too easily be trivialized by health care providers and others. Embarrassment is an emotion experienced often by people with social anxiety or SAD.
From a psychological perspective, Idan explained that shaking hands contributes to an individual feeling of weakness, because others may perceive that they are unable to control themselves. They feel their shaking hands reveals a personal flaw, and that others will reject or avoid them, or perhaps say something hurtful.
People who suffer from ET or PD may subsequently avoid interactions to reduce facing perceived negative responses, or even to tamp down on their own negative feelings of shame and anxiety. Minimizing social interactions means that people with tremor may be able to avoid experiencing social anxiety in the short term.
Avoiding Social Situations
Unfortunately, escaping social situations may lead to a person with ET withdrawing from family and friends. People who feel isolated can experience depression, sadness, and despair without the needed social support.  Research has suggested that loneliness puts people at risk for developing other health problems such as acceleration of cognitive decline, decreased quality of life, and (if left unchecked) even increased likelihood of mortality. 
Coping With Anxiety
What can people with tremor-related movement disorders do to handle their feelings of social anxiety and head off potential social isolation?
Idan discussed Cognitive Behavioral Therapy (CBT) as a treatment model that is frequently used to treat patients with social anxiety disorder. Idan reinforced that successful treatment requires that people consult with a mental health professional to understand how CBT can benefit them for their specific situation.
The basic idea behind this therapy is that patients are exposed to anxiety-provoking situations so they can recognize how their fears are often not realized.  One example of treatment is providing techniques to patients on how to help them adjust to personal conversations.
Catch Social Isolation Early
It is critical for caregivers and patients to stay aware if someone with a tremor-related disorder is beginning to pull back from interacting with friends and family. Shaking hands when shaking hands is embarrassing, but it is much healthier than not reaching out at all.
1. WebMd. Don’t be embarrassed by essential tremors. https://www.webmd.com/brain/news/20010606/dont-be-embarrassed-by-essential-tremors#1/. Accessed June 12, 2019.
2. Lundervold, DA, Ament, PA, Holt P. Social Anxiety, Tremor Severity, and Tremor Disability: A Search for Clinically Relevant Measures. Psychiatry J. 2013.
3. Tilvis RS, Laitala V, Routasalo P, Pitkala K. Suffering from loneliness indicates significant mortality risk of older people. J Aging Res. 2011.