Understanding Social Anxiety

Social Anxiety Disorder (Diagnostic Code 300.23 in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition – DSM IV) is marked by a persistent fear of social or performance situations in which embarrassment may occur along with an immediate anxiety response often reaching the level of panic. Some of the causative features of this disorder include:

• Hypersensitivity to criticism
• Negative self evaluation
• Fear of rejection
• Poor assertiveness skills
• Undeveloped social skills

Many people with Social Anxiety cope by avoiding many social situations they would like to attend. In some cases, the anxiety and panic is so great, a person simply cannot leave the house. Simple errands such as going to the market become highly stressful. Social Anxiety can disrupt normal family relations, work and recreation. It is a disorder that is often treated with medication. However, Cognitive Behavior Therapy has proven to be quite effective for not only social anxiety, but generalized anxiety as well. Social anxiety, however, is specifically characterized by the onset of anxiety in social situations such as being at work, at the movies, in meetings, at the store….

Cognitive Behavior Therapy (CBT) works well with social anxiety because the causative features are psychological, or cognitive, in nature. A hypersensitivity to criticism is a thought process…it is not an organic, biological process. As such, it can be treated through cognitive restructuring, which is a part of the process involved in CBT. Negative self evaluation is also a cognitive process, as is fear of rejection. Assertiveness skills, which are more behavioral than cognitive, can be learned; a number of books are available on assertiveness skills training and a net search on the topic will yield a plethora of information. Social skills too can be learned. However, all strictly behavioral skills are cognitively related as we think about our behaviors which can augment or diminish those behaviors. A person who thinks they will fail in an attempt to be more socially adept will more likely fail than one who thinks they can do it.

Our cognitive process has a tremendous influence on our behaviors. Because we think in word pictures…ie, self talk and mental imagery, we can create impressions of behavior before the fact. We can visualize within our mind a behavior we would like to enact in a given setting. This type of exercise is very effective for overcoming social anxiety in specific settings. For example, a person could visualize themselves going to the market and superimpose upon that visualization feelings of ease and security. This method of projecting a behavior and the feelings associated with that behavior is commonly used in athletics and stage acting where the performer will visualize the behavior they would like to execute repeatedly and with positive emotions. This exercise “primes” the mind and cognitive processes which is the foundation for behaviors.

One of the basic tenets of CBT is that it is not the external situation that causes our anxiety but rather how we think about that external situation. So, if we find ourselves in a social setting and start telling ourselves with our self talk that people are looking at us, criticizing us, judging us….then we would likely, and somewhat naturally, feel self conscious, perhaps anxious, and maybe even panicky. But, and here is the problem, those thoughts may not be true. Those people may not be looking at us, criticizing us or judging us. But, if we tell ourselves it is happening, then we respond as if it were fact….even when it may not be. Internalized self talk is not based on fact and the imagery that self talk generates can be totally off base. But, that does not matter one iota….We can think we are going to die if we walk out of the house….but, that does not mean it will actually happen. Nevertheless, if we so think, we will feel very panicky. If we can change our thinking towards more realistic interpretations of situations and events…then we can reduce or even eliminate the anxiety and panic.

If you are suffering with social anxiety or social phobia, consider doing a net search on Cognitive Behavior Therapy. There are several good books and many articles available online. If you go to www.openmindcounseling.com/articles_library.htm, you will find some links to articles about CBT.