Social Anxiety: What it is and how to manage it.
It is normal for human beings to experience feelings of nervousness or shyness from time to time. Some people are naturally shy or introverted so they may have less desire for social interaction. Social anxiety disorder or social phobia occurs when an individual experiences marked fear or anxiety about one or more social situations in which there is possible scrutiny by others. Common examples include meeting new people, giving presentations, or being observed while eating or drinking. The individual fears they will act in a way that will result in rejection or criticism (The Diagnostic and Statistical Manual; 5th ed., DSM-5; American Psychiatric Association, 2013).
When I work with clients who have social anxiety, I frequently utilize insights and strategies from the Clark and Wells model of social anxiety (1995). In this model, it is posited that there are cognitive and behavioral processes which exacerbate and maintain social anxiety. In early sessions, I provide psychoeducation on the following factors: self-focused attention, safety behaviors, anticipatory anxiety, automatic thoughts, and post-event reprocessing. After the client demonstrates an understanding of these concepts, we work together to identify how each of these factors contributes to the client’s anxiety.
Self-focused attention refers to excessive internal focus on one’s physical sensations, thoughts, behaviors, or characteristics of the self that may be negatively perceived by others. The individual may be overly focused on how their heart feels, whether they are sweating or shaking and how this may lead to rejection or criticism. Excessive self-focus can result in individuals missing important information from their environment. They may come across as distracted or disinterested which can negatively impact their social interactions. Thus, it can result in eliciting the very reactions which are feared.
Safety behaviors are behaviors that are utilized to neutralize anxiety. With social anxiety, common examples include avoidance of feared situations, avoiding eye-contact, and being overly focused on one’s cell phone. Safety behaviors are problematic because they provide temporary relief, but they tend to increase social anxiety over time. The individual develops the belief that they are unable to tolerate anxiety without using special behaviors. Additionally using safety behaviors reinforces the brain’s belief that these situations are dangerous.
Anticipatory anxiety involves worrying about a future event, often focusing on the potentially threatening aspects. The more that a person imagines a worst-case scenario for a social situation, the more anxious they will be, again reinforcing the idea that these situations are dangerous.
Automatic thoughts refer to thoughts, perceptions, and interpretations which happen on an automatic level, often outside our conscious awareness. Individuals with social anxiety may experience negative thoughts about the self, such as, “People think I’m boring,” or “I’ll make a fool of myself.”
Post-event reprocessing occurs when the individual rehashes or ruminates after the social interaction. The focus tends to be on negative aspects of the situation while disqualifying the positive. Typically, the more the situation is rehashed, the more distorted and negative the memory becomes.
After I provide psychoeducation to clients, I collaborate with them to develop strategies to address these cognitive processes and behaviors. Mindfulness strategies can be used to help shift to a more outer focus. A common strategy used is: 5 things that can be seen, 4 things that can be felt or touched, 3 things that can be heard, 2 things that can be smelled, and 1 thing that can be tasted. An alternative for taste is to focus on breathing in and out.
It is also important to increase awareness of safety behaviors with a plan to gradually reduce and eliminate these behaviors. For example, if the person uses their cell phone to feel less anxious at parties, they might be instructed to leave the phone at home or keep it in their pocket during the party. The individual needs to relearn that they can tolerate social discomfort without attempting to neutralize the anxiety. Like other anxiety disorders, I often utilize some form of exposure therapy. Exposure involves creating situations in which the individual can face their fears without using safety behaviors. I frequently use behavioral experiments when treating social anxiety. When creating behavioral experiments, I assist the client with identifying a distorted thought or belief related to the social situation. For example, the person may believe that people don’t like talking with them. To help challenge this belief, we will identify an experiment to test it out. To increase new learning, it is important to engage in experiments multiple times and in multiple contexts. The client may be instructed to ask for help at 3-5 different stores during the week. They would be instructed to record their prediction about the experiment, the actual outcome, and then a new belief. Lastly, to help decrease post-event reprocessing, I encourage clients to recognize when they are ruminating about a social interaction and to engage in healthy distraction, instead.
When clients regularly attend therapy and complete their homework, they tend to be quite successful in learning to manage their social anxiety. It is a wonderful experience when clients begin to report increased confidence and connection with others after using these strategies. If you or someone you know is dealing with social anxiety, feel free to reach out!
American Psychiatric Association (2013). Diagnostic & Statistical Manual of mental disorders (5th ed.).
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Social phobia: Diagnosis, assessment, and treatment. (pp. 69-93). The Guilford Press.
If you experience a life-threatening emergency or become concerned about the ability to keep yourself or others safe, visit your nearest emergency room or call 9-1-1. If you are experiencing suicidal thoughts, you may call the Suicide Prevention Hotline at 9-8-8 to talk to a trained professional.
The content on this website is meant for informational purposes only and is not intended to take the place of mental health diagnosis and treatment. All information is provided on an "as is" basis. Heilman Psychological Services, PLLC does not assume responsibility or liability for any errors or omissions that may occur.
