Social Anxiety

What is Social Anxiety?

What is Social Anxiety (Social Phobia Disorder)?

Mild social anxiety is common and known to most of us as an uncomfortable feeling of nervousness. This can occur when meeting new people or chairing a difficult meeting at work. Therefore, social anxiety can be very specific and may only occur for a person in certain situations, such as giving a presentation.

Others may experience social anxiety and fear in a number of situations and it can therefore become very difficult to cope with day to day life. In its more severe form social anxiety can impact on a person’s ability to work, attend social gatherings, answer the phone, go shopping, be in relationships and even leaving the house may be laced with feelings of self-consciousness.

Typical symptoms of social anxiety might include:

Thoughts: A person may experience self-doubting thoughts such as ‘I have nothing of interest to say’, ‘They will think I am dull’, ‘I will say something stupid’, ‘Others will see I am anxious’, ‘I need to control anxiety so no-body will be able to tell’.

Feelings: A socially anxious person may feel embarrassed, anxious and on edge and self-conscious.

Physiological Symptoms: These symptoms may include shallow breathing, heart racing, becoming sweaty, stomach cramps, shakey body, feeling light-headed and experiencing blushing.

Behaviour Patterns: These symptoms may include avoiding social situations, avoiding meetings, avoiding new people or leaving social situations earlier than other people. Other behaviours might be performed with the intention of keeping the socially anxious person safe. These are called safety behaviours and might include drinking alcohol to provide courage, staying quiet and in the background, hiding away or pretending to be ill.

As mentioned, in its more severe form a person may be diagnosed with Social Anxiety Disorder or by its other name, Social Phobia. The Diagnostic and Statistical Manual of Mental Disorder’s (DSM-5, 2013) definition and criteria for Social Phobia is as follows:

A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.

Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.

The person recognizes that this fear is unreasonable or excessive.

The feared situations are avoided or else are endured with intense anxiety and distress.

The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.

The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder. Copyright 2013, The American Psychiatric Association

What maintains Social Anxiety and Phobia?

i) Unhelpful Negative Thoughts: As pointed out in the symptoms section, people with social anxiety often have very negative thoughts about themselves and their social skills. These thoughts may occur before a social situation, therefore making negative predictions about possible interactions, which in turn increases anxiety. They may also experience negative thoughts during interactions and this lowers confidence in the moment. A person may also conduct a ‘post-mortem’ on their social interactions after the event and typically focuses on what they felt went wrong rather than the positive aspects of their experience.
ii) Avoidance: A socially anxious person may avoid certain social situations and this therefore prevents them from having positive experiences and by doing this keeps the negative thoughts unchallenged. A social anxious person may avoid situations for a long time and this also has the effect of making a social situation appear more daunting than it actually would be.

iii) Using Safety Behaviours: Safety behaviours are used with the idea that they will help a person to cope in social situations. As mentioned, examples would be drink/ drug use, avoiding eye contact and not saying anything. A socially anxious person may feel better in the short-term because of these behaviours but in the long-term they believe any social success was due to the safety behaviours used. This has the maintaining effect of keeping confidence low.

iv) The Self-Focus: A person with social anxiety monitors their bodily sensations. They typically overestimate these symptoms and others ability to see them. This maintains and worsens the physiological symptoms of anxiety in the moment.

What’s the Solution?

Using Cognitive Behavioural therapy interventions we will help you to challenge and restructure your negative thoughts. We will gradually and gently help you to stop avoiding situations and to reduce safety behaviours. We will also help you to reduce self-focus in social situations. By reducing these maintenance factors we will reduce the intensity of the vicious cycle of your social anxiety.

We always work collaboratively with our clients to provide the best results to therapy. Our service is confidential and we aim to foster a safe environment where you can feel positive and empowered.

A Social Anxiety Case Study

Isabella came to therapy because she had been experiencing social anxiety at work. She had been promoted two months prior to the session into a more senior role, which required her to manage a team of ten and chair meetings for her team and present performance information to the organisation as a whole in managers meetings. She had started to experience high anxiety in these situations and felt humiliated each time a meeting was held. Isabella said she was starting to feel depressed as a result and that she was reconsidering whether she would be able to do the role.

In the past she had managed her anxiety in meetings with a number of safety behaviours and avoidance techniques. She would always sit at the back in meetings, speak minimally – but usually agree with others, she would avoid meetings if she could, and if she could not would send her thoughts after a meeting via email rather than speaking up. Isabella thought this was a fair management technique and thought her coping strategies had worked for her until now. However, her strategies had maintained her anxiety as she taught herself they were necessary in order to survive socially in meetings. Isabella had always been able to show her skills and influence during one to ones and in small groups where she did not experience anxiety.

As a manager, when Isabella had to chair a meeting it would trigger beliefs and assumptions that people think she is stupid and boring. As a result, she understood these meetings to be socially dangerous. She would start to feel anxious before the meetings. In preparation she would go to the toilet a number of times to ensure she was as comfortable as possible for the meeting, she would drink coffee to stay alert, she would over prepare what she wanted to say and put this on slides, and she would tell people she felt ill and tired to reduce performance expectation. During the meetings she would be attentive for signs of boredom or displeasure from the listeners and she would stay very still and seated. These safety behaviours and the anxiety felt lead Isabella to become very self-focused, rather than focusing on the subject of conversation. The more she becomes aware of the anxiety the more she believes others are aware of the anxiety. This leads to her feeling humiliated, which in turn leads to more anxiety. As a result she becomes more rigid in her safety behaviours! Isabella said the anxiety can escalate so much so that she might have to leave the room to go to the toilet……this she considers to be total humiliation and that people will think she is stupid and weird, confirming her beliefs.

Cognitive behavioural therapy focused on a number of points here. We started work on modifying the self-processing. I arranged for Isabella to speak in front of my colleagues on a number of occasions and filmed it. Isabella was surprised to discover that although she felt very anxious it was not very visible on the video. In fact, she realised that any awkwardness that she could see was similar to what she sees when others speak at meetings. We then started using cognitive techniques to challenge thinking errors and negative beliefs, while working on dropping safety behaviours. Isabella began to experience a massive reduction in anxiety and was more focused on the content on the meetings than on herself. We then took treatment a stage further as Isabella wanted to push her performance and be more assertive as the team leader. We used cognitive techniques while working against past avoidance. Isabella became more confident in her role and was no longer considering a career step-down.

What Clients Say

i) Unhelpful Negative Thoughts: As pointed out in the symptoms section, people with social anxiety often have very negative thoughts about themselves and their social skills. These thoughts may occur before a social situation, therefore making negative predictions about possible interactions, which in turn increases anxiety. They may also experience negative thoughts during interactions and this lowers confidence in the moment. A person may also conduct a ‘post-mortem’ on their social interactions after the event and typically focuses on what they felt went wrong rather than the positive aspects of their experience.
ii) Avoidance: A socially anxious person may avoid certain social situations and this therefore prevents them from having positive experiences and by doing this keeps the negative thoughts unchallenged. A social anxious person may avoid situations for a long time and this also has the effect of making a social situation appear more daunting than it actually would be.

iv) The Self-Focus: A person with social anxiety monitors their bodily sensations. They typically overestimate these symptoms and others ability to see them. This maintains and worsens the physiological symptoms of anxiety in the moment.

How does therapy help to overcome these maintenance factors?

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