The maintenance of social anxiety

Social anxiety, or social phobia is a debilitating condition marked by a persistent fear of being humiliated or scrutinized by others. It is the third most common mental health problem after depression and substance abuse. It typically develops in adolescence but is not uncommon in children. Approximately 10% of people struggle with social anxiety worldwide. Social anxiety persists in the absence of treatment and can have detrimental long-term consequences. It can have a high level of impairment and affect all areas of life. It makes day-to-day tasks, such as going shopping or talking on the phone very difficult. In fact, it makes most things that involve being observed by others difficult. These include walking into a room when other people are already seated, eating or drinking in public, using public toilets, speaking to strangers, working in groups, walking alone in the hallways, or performing in front of an audience. Sufferers fear that they will say or do something that they believe will be humiliating or embarrassing. Common concerns include the fear of sweating, shaking, blushing, stumbling over words, looking anxious, or appearing boring, stupid, or incompetent.

Why is it that some people are so much more afraid of social situations than others? Psychological theories suggest that social anxiety results from problematic beliefs about oneself and one’s social world, which lead socially anxious individuals to interpret social situations in an extremely negative fashion. These negative interpretations are maintained by certain processes that the individual engages in, to be prepared or safe. One of them is increased self-focused attention, which is linked to a decrease in the observation of other people and their responses. Individuals with social anxiety tend to focus their attention inwards, focusing on thoughts such as: “You are embarrassing yourself”, “They will laugh at you”, “They can see you are anxious, because you are blushing, and your hands are shaky”. Because their attention is inwards instead of outwards, they have no way of validating if anyone is indeed looking at them. Individuals with social anxiety may also use misleading internal information (feelings and self-images) to make excessively negative assumptions about how they appear to others (e.g.,” My heart is pounding, everyone will know that I’m anxious”).

People struggling with social anxiety often develop unhelpful coping strategies, or so-called safety behaviors. These behaviors are intended to decrease the level of anxiety in the moment or to prevent feared catastrophes. Safety behaviors can vary. They can be as simple as for example: holding a water bottle during a presentation, always being glued to one’s phone to avoid social interactions or speaking very fast. Although safety behaviors may bring temporary relief from anxiety, they have negative long-term consequences.  They maintain negative beliefs, increase feared symptoms, and make the individuals come across to others in ways that are likely to elicit less friendly responses.

Another unhelpful process that socially anxious individuals engage in, are negatively biased pre- and post-event processing. Pre-event processing bias is related to anticipation. Individuals with social anxiety are prone to anticipate the worst in any social situation. The thoughts that occur during the anticipation are usually of catastrophic nature (e.g., “What is I freeze and have nothing to say”). Anticipation often also prompts internal rehearsals, where the individuals would rehearse what they could potentially say in thousands of possible scenarios. This processes naturally increases the level of anxiety. With regards to post- event processing, we have all been in situations when we may have said or done something that we were not proud of afterwards. An example of such situation could be having “a glass too many” at a work Christmas party and saying something inappropriate to one’s colleague or boss. The morning after we would wake up, remember the event and a negative thought would enter our mind e.g.  “Omg what did I say to him/her? Why did I do it?”. This memory would typically trigger other negative, often self- deprecating thoughts like: “So embarrassing”, “How will I show my face at work on Monday”, “Everyone will laugh at me at the office”. This ruminative process of thinking would make us feel anxious and uncomfortable. While it happens to all people every now and then, individuals with social anxiety engage in such post-event processing significantly more than others. Their level of anxiety is therefore continuously high.

Social anxiety can be effectively treated. Cognitive therapies are commonly used to combat the fear of social situations. What typically happens in treatment is that the clients learn which of the coping strategies they have adapted are in fact maintaining the problem. They work on decreasing these behaviors, learn how to pay attention outwards instead of inwards and how to relate to their negative cognitions differently. At The Little White House, we offer and array of treatments for social anxiety. For more information call 60547202. For a free consultation, click here.

Posted in Psychologist musings and education.