Social anxiety (a.k.a. social phobia) is a fear that makes its sufferers feel like they’re going to screw up or embarrass themselves in public. This can get quite severe, causing you to have panic attacks not only when you’re in public, but also just at the thought of going out into a social interaction as simple as shopping, or going to a movie where you barely have to do any real interacting at all.
As the phobia digs its claws deeper into you, you’ll begin to find more and more ways to avoid social interactions. At first this doesn’t seem so bad and you can make excuses, and you get to avoid thinking about what you’re really doing, what’s really happening for you.
As it gets worse you’re going to start avoiding pleasurable activities like going out to dinner with your friends. A sufferer’s world can become so restricted that they become shut-in. It’s pretty easy for people with this condition to feel alone thanks to the very nature of the phobia. But you shouldn’t – it’s the third most common psychological disorder found in adults around the world.
The Growth Of Social Anxiety
Social anxiety quite often begins in adolescence, which is a time of huge emotional and social development. However it can also grab a hold of people later in life, especially if they’ve had to deal with a life-changing event or circumstance like changing schools, going to university, divorce, being fired, or the onset of a potentially embarrassing health condition.
Social anxiety sufferers often become very anxious, they can experience physiological symptoms, like excessive sweating or blushing. These situations can lead sufferers to seek cures for symptoms rather than cures for the actual social phobia itself, because the sufferer doesn’t want to admit the problem. For example they might seek help to rid themselves of physical symptoms through drugs or a medical procedure. But this obviously doesn’t help weed out the root of the problem.
The Shame Of It
Shame is at the heart of social anxiety. Usually the sufferer is either afraid of being ashamed (a feeling brought on by one’s own self) and/or being shamed by others. This shame feeds into itself. Since you avoid social life you feel like you’re the perfect candidate for the label of someone who needs to “get a life.” However you feel like you can’t “geta life” (a.k.a. socialise) because you don’t have a life (thanks to the phobia) which means you think you’re not going to be interesting to interesting people who could lead you on to doing interesting things.
There are basically two categories of social anxiety. The first is referred to as “generalised” and this is more intense – the sufferer can be afraid of any and all forms of social interaction.
“Non-generalised” social anxiety is not as bad, it’s associated with specific social interactions like speaking engagements, or going to a specific event.
Social phobia sufferers are scared of having their ongoing flaws revealed and being shamed. Social phobia can also lead to excessive behaviours to avoid shame. Some may drink too much to “loosen up”. Others may go the opposite route and become teetotalers because they fear how they might act while under the influence.
The Cognitive Model For Social Anxiety
The cognitive model provides us with a solid, evidenced based understanding of social anxiety. What happens is that when you enter a social situation you have steadfast preconceived notions about yourself. Perhaps you’ve set a subconscious rule that you absolutely positively must be the funniest person in the room. Or that you can’t let people get to really know you because then they’ll find out that you’re boring. Or perhaps you have an ever-present belief that “I’m a big weirdo and oh gosh, a whole room of people is about to find this out about me.”
So you start to intensely monitor yourself for warning signs of undesirable behaviour that will alert people and make them shame you. “I’m twitchy,” “I smell bad,” “My voice is going to crack,” “Am I being boring?” and so on. You over analyse, and dissect social situations after they occur, looking for proof that your negative beliefs hold true.
Cognitive Therapy For Social Anxiety
Cognitive therapy is the most evidenced and proven approach for dealing with social phobia and social anxiety. Cognitive therapy not only helps sufferers “deal with” their problem, it goes beyond that, attempting to dig right down to the root of why someone continues to suffer social anxiety despite the fact that the feared shameful social catastrophes never occur even after hundreds of social interactions.
Clinical Psychologists using Cognitive Therapy will most likley ask you to go through a specific recent example of a social anxiety attack, in great detail, piecing together your thought process at the time. We then try to figure out how you maintain your phobia – this is a combination of your behaviour, emotions, and beliefs. You will also work on worst-case scenarios by going deeper with your assumptions. For example let’s say you went to a party and you were chatting with a pretty woman:
How did you feel?
“I felt sure she could see that I was red in the face and sweating like crazy.”
So let’s say that was true – she did notice. What do you think she would think about you if she did?
“She’d think I was stupid, afraid of women instead of being an attractive man.”
So let’s say thatis true, and she did think that about you. What would that mean to you?
“That I’ll never appear intelligent or attractive enough to be date-material and I’ll end up alone.”
After establishing your thought-processes you’ll move on to the physical manifestations of your social phobia, sweating, stammering, avoidance of eye-contact, etc.
Next come your defensive measures (when you throw up your shields) to hide your perceived fears – excessive drinking, trying to be funny, etc.
There will also be a focus on figuring out where you are in the situation. What we mean by this is that many people who suffer social anxiety tend to take on an observer status – “Oh gosh does he see that my eyelid is twitching? I would totally see it.” Trying to process how you come across takes a lot of focus and detracts from your ability to have a decent social interaction… and yes, there’s that negative feedback loop again.
Paying Attention To The Right Things
A clinical psychologist will work to get you out of that observer mode, and back into the comfort of a true social interaction. You do this by doing what you’re already doing – you have conversations with your psychologist.
In one form of conversation your psychologist will ask you to do your usual – observing yourself and taking note of if you’re living up to your expectations for yourself. (For example, if you’re the type of sufferer who tries to force themselves to be the funniest person in the room).
Then you’ll have another conversation where your psychologist will ask you to focus on the other person/people you are having a conversation with (in this instance it’s your psychologist) – on the way they react to what you’re saying.
At the end of this you’ll get honest feedback about which of the two conversations your psychologist found more engaging. After a couple of tries at this you’re going to start to realise just how much effort and focus it takes to observe yourself while trying to interact with another human being.
There are two main goals to this forms of cognitive therapy. First, it’s to get your attention focused outward, away from yourself. This will make your social interactions smoother, easier, and better for the people you’re interacting with.
The second goal is to get you to realise that you’re not nearly as bad as you think you are. For example if you think you’re a blusher, your psychologist might video a conversation and on replay you’ll see that your particular hue is no redder than any other person’s, or that the blushing is minimal at the most. You might even be prompted to pick the red you think you blush from paint swatches – you choose tomato but in reality you barely make it past a very faded pink.
What will follow is more behavioural experimentation, if you fear being clumsy, you may be encouraged to knock over a glass of water at dinner so you can see that nobody cares.
You might be shown public opinion polls that show people barely register the thing you shame yourself about the most.
Finally, you’ll think back to social interactions you’ve had in lots of detail. In these post-mortems you’ll concentrate on the content of the interaction, rather than your feelings. This again helps you shift your observations off of yourself, away from your distorted perception, and on to the external world around you.
Medication
Some people with social anxiety benefit from taking medication. Medication may be prescribed if a) it’s your strongly preferred choice b) your therapy hasn’t helped c) there’s a long wait-list for therapy or d) you’re suffering from crippling amounts of depression secondary to the social fears.
Here’s the thing to remember though – generally speaking drugs suspend while therapy cures (or gives you the tools you need to get your life back on course). Roughly 50% of people relapse after they discontinue their medication. You’re probably going to find that most if not all Clinical Psychologists are going to want to have an attempt at your social phobia with cognitive therapy first, if they have any say in the matter.
As always, if you have questions, please get in touch.