I am walking through the woods on a peaceful day and I suddenly see a huge grizzly bear standing on its hind legs looking at me. I am paralyzed with fear. My heart rate accelerates, my mouth feels dry, my muscles tighten, my mind goes blank, my skin gets clammy, and I feel like I just drank 10 Red Bull Energy drinks.
These are all very adaptive fight or flight responses my body produces to protect me from the huge animal. Under this stress response, I will move faster, bleed less if hurt, be fueled by energy hormones, and will be less distracted by irrelevant details going through my mind. The Fight or Flight response is rooted in my instincts as an automatic response to help me survive when my wellbeing is threatened.
What if this survival response got triggered every time I had perform a new social interaction? My body and mind respond to a social interaction with another person as if I am about to be devoured by a grizzly bear. Having the survival response trigger when it is not needed can be exhausting and bring a person’s quality of life to a standstill.
Social anxiety disorder is the fear of being judged and evaluated negatively by other people, leading to social avoidance as means of coping. Fear of embarrassment or being in situations where you could be scrutinized by others is often the trigger for symptoms.
Some people with social anxiety disorder endure situations that makes them anxious, but do it with overwhelming anxiety. Social anxiety disorder is associated with signs of a lower life quality, such as dropping out of school, lower work productivity, and lower income (Edmund Bourne, Ph.D. 2015). To be diagnosed with this disorder, the fear must be persistent for at least six months.
Human beings are built for connection with other humans. To experience disproportional fear in response to a social need is analogous to feeling fear every time you are hungry for food. Eventually, the person will waste away as food is avoided. Nutrients needed for growth are absent. Similarly, social anxiety disorder is a problem a person should not ignore how to overcome.
We need some anxiety in our lives to prompt our strivings for growth and maturity as a person. The key is to learn how to manage the anxiety so that it is not so overwhelming that we cannot function.
Creating a Recovery Plan
The first step in creating a recovery plan for social anxiety disorder is getting help creating a recovery plan. Meeting with a therapist, reading a book on different treatment approaches, and enlisting the support of family and friends all make a difference.
Just to give the reader some examples of some common elements to a good recovery plan, this article will summarize some popular interventions for this disorder. Different areas to aid in coping with social anxiety disorder often include: relaxation training, changing core beliefs, exposure tasks, and practicing personal assertiveness.
Human beings have an innate level of internal arousal. We are probably born with a certain level of sensitivity to our environment. I like to think of it like a volume knob. Some people are wired with their “arousal knob” turned way up and are more vulnerable to anxiety disorders as a result. In other words, someone who feels things more intensely is more likely to get overwhelmed by their feelings in a context they perceive as threatening to their security.
People with Social Anxiety Disorder often have a negative social experience in their past that left them feeling degraded or humiliated. Performance situations are then avoided, which ultimately strengthens the anxiety response to social situations.
Relaxation training is an important component to treating social anxiety disorder because it is thought to aid the person in coping more effectively with high internal arousal. The relaxation response is opposite of the fight or flight response in the body. Decreases in the following bodily functions accompany relaxation training: heart rate, respiration, blood pressure, muscle tension, oxygen consumption, and analytical thinking. Increases in skin resistance and alpha wave activity in the brain also accompany relaxation training (Edmund Bourne, Anxiety and Phobia Workbook, 2015).
Ultimately, we tend to perform best when we feel good and relaxed. A person is more likely to work at mastering a social situation that has gone negatively in the past if the effects of anxiety are lessened by the relaxation response. There are many forms of relaxation training that include methods such as guided imagery, yoga, progressive muscle relaxation, and abdominal breathing.
The methods out there are probably not as important as the consistency with which a person practices stimulating the relaxation response. Twenty to thirty minutes per day of practice can produce results that generalize into a person’s daily functioning. Relaxation training is a way to turn the volume knob down so a person struggling with social anxiety disorder is freed up to face situations they have learned to avoid.
Changing Core Beliefs
Understanding the relationship between what we think and how it affects our willingness to participate in social activities that are difficult is a key intervention for treating social anxiety disorder. The more negative or extreme thought content is, the more anxiety is generated.
For example, if a person with social anxiety disorder thinks to themselves, “I will look like a fool if I speak up at the office meeting today,” they are likely to experience enough anxiety to not speak up. There is a direct relationship between the intensity of thoughts and the intensity of feelings.
The goal with any anxiety disorder is to bring anxiety levels down, so the person is freer to engage in previously avoided behavior that they can learn to improve. Using the above example, changing the above thought about speaking up at a meeting to something less intense, like “I am concerned that others won’t like my ideas” creates a great opportunity to work on the issue.
Edmund Bourn, Ph.D. recommends five questions for lowering the intensity and challenging mistaken beliefs:
1) What is the evidence for this belief? Looking objectively at all your life experience, what is the evidence that this is true?
2) Does this belief invariably or always hold true for you?
3) Does this belief look at the whole picture? Does it take into account both positive and negative ramifications?
4) Does this belief promote your well-being and/or peace of mind?
5) Did you choose this belief on your own, or did it develop out of your experience growing up in your family?
Going through this series of questions about an anxiety-provoking thought is designed to come up with a more adaptable cognition that allows the person to participate in feared social activities that they would normally avoid. After going through the above questions, the goal is to synthesize a new thought with more balanced elements. This can be very difficult to do at first, but with the help of a supportive therapist, people with social anxiety disorder can learn to challenge core beliefs that interfere with their social functioning.
Phobias develop as result of sensitization. Basically, the sufferer learns to associate a particular stimulus (like public speaking) with anxiety. By avoiding the stimulus, the person is rewarded by getting rid of anxiety. The more avoidance of the stimulus, the stronger the anxiety response gets when faced with the avoided activity. It’s almost like a path that is constantly traveled through the woods. The more it is traveled, the clearer path is created.
Neuroplasticity is a term scientists use to refer to the brain’s ability to form new neural connections throughout a person’s life. While anxiety reactions can get hardwired into a person’s experience, new wiring can also be established through facing fears.
In the Anxiety and Phobia Workbook by Edmund Bourne, Ph.D., he describes the re-wiring process as follows:
“Exposure is the process of unlearning the connection between anxiety and a particular situation. For exposure to occur, you need to enter a phobic situation directly, letting your anxiety rise and enduring the anxiety for a period of time to learn that you can actually handle your anxiety in a situation you’ve been accustomed to avoid. The point is to 1) unlearn a connection between a phobic situation (such as driving on the freeway) and an anxiety response, and 2) gain confidence in your ability to handle the situation regardless of whether anxiety comes up. Repeatedly entering the situation will eventually allow you to overcome your previous avoidance.”
The key to beginning exposure tasks is starting by breaking an overwhelming situation into smaller chunks. This aids in mastering anxiety in successive stages instead of all at once. For example, if the fear is of public speaking, the first step might be just imagining oneself speaking in front of a crowd while replacing negative cognitions with positive ones. The next step might be practicing in a mirror, then in front of a small group of friends, and so on until the big situation can be faced. Once a person can engage in the feared situation, confidence starts to build as the person’s skill improves. At this point, the brain is literally being rewired!
Personal Assertiveness Practice
Assertive communication is considered a direct, non-reactive, clear and honest manner of self-expression. One way it can aid in overcoming social anxiety disorder is by breaking communication down into some key components. As discussed above, breaking overwhelming tasks into smaller tasks allows for greater room for practice and mastery.
The key elements of assertive communication include the following: identifying personal needs, describing facts, sharing personal feelings, making personal requests, and providing positive reasons for cooperation to the request. For example, if I was angry with a friend who constantly borrowed money, never paying it back, my first step would to figure out my need. My need in this case would be “trust.”
After I identify my need, I would make a time to speak with my friend describing the facts (non-emotional) between us. “Fred, I noticed that the last 10 times I have lent you money, I have not been paid back.” Then feelings, “It hurts my trust in our friendship when you do not follow through with commitments you make to me.” Finally, requests and positive reason(s) for cooperation: “I need you to pay me back promptly when you borrow money from me. This builds trust and makes me feel good about our continued friendship.”
If Fred wants me to feel good about our relationship, he will start paying me back. Worst case scenario, I did not let anxiety set a boundary in a relationship that was hurting me in some way.
When I practice assertive communication with clients, I like teaching the steps in a made-up situation first, having them practice each step until they feel comfortable with it. Once the client is doing well with a made-up situation, we shift to a real life problem in their life where personal assertiveness will help. The key with assertiveness training is to learn the steps and have the opportunity to practice with a supportive person.
The above areas of intervention are meant to provide an overview of intervention for social anxiety disorder to give the reader an idea of what treatment is like. This is a very difficult disorder to overcome, which a short article does not give nearly the substance to achieve.
The main point I want to get across is that there is help for this problem. A person with social anxiety disorder does not need to live their life with limits on what they can do as a result of the disorder. Recovery is not only possible, but very achievable. If you, or someone you know, is struggling with social anxiety disorder, give us a call. We have many skilled therapists who can assist in creating a recovery plan for this condition.
“Grizzly Bear,” courtesy of Elizabeth Meyers, unsplash.com, CC0 License; “Friends,” courtesy of Alexis Brown, unsplash.com, CC0 License; “Relaxation,” courtesy of Kosal Ley, unsplash.com, CC0 License; “Victory,” courtesy of Dino Reichmuth, unsplash.com, CC0 License