Social anxiety

Social phobia, often also known as social anxiety, is a fear of negative judgement or poor performance in social situations.

Social situations may refer to any circumstances involving interacting with other people. For one person, this may relate to meetings at work, whereas for someone else it may be social gatherings like parties that may be the problem. For some people, all social situations may be problematic.

The difference between the general nervousness that we all experience sometimes, for example public speaking gets a lot of people feeling quite anxious, is that the social anxiety sufferer will be severely impacted being in the situations they fear. They may also go over situations in their minds to review how they performed and get stuck on this for some time, or they may choose to avoid some situations altogether because they find them too difficult to cope with.

People may avoid situations for many reasons, e.g. for fear of being attacked by someone. The common factor in social phobia is a fear of being judged negatively by others. Everyone experiences some level of anxiety at some point, but this type of anxiety is specific to social situations in which the anxiety experienced is intense and constant and is linked to how the person feels they may be perceived by
others or how they feel they “performed” in these situations. The level of anxiety tends to be exaggerated compared to the actual level of threat posed by the situation.

Social phobia is often linked to self esteem and confidence. Low self esteem and confidence can lead us to question ourselves and the decisions we make more than usual. This may lead us to dwell on how other people think about us and how well we do things. Again, this can be situation specific. You may feel very confident at home, knowing you are a good partner, parent and homemaker, but struggle with confidence at work, so only be affected there, or vice versa. You might not feel this anxiety in all situations.

You might find it hard to believe, but social phobia is a very common anxiety disorder. A study in America found that 12% of adults there will have social anxiety at some point in their lives. People tend to feel alone with it because a key feature is embarrassment. This keeps sufferers from talking about their problem for fear of further embarrassment. It is not something you can see just by looking at someone, and because people tend not to talk about it, sufferers can end up feeling alone, different and isolated with their problem.

In Cognitive Behavioural Therapy, we view the problem as a vicious cycle incorporating four areas that may affect you.

For someone suffering social anxiety these areas may look something like this:

• Physically – e.g. blushing, shaking, heart and breathing rate increasing, feeling faint or dizzy, have “butterflies” in your stomach, feel hot and sweating more than usual
• Emotions – e.g. anxious, fearful, nervous
• Thoughts – e.g. preoccupied with how others are thinking about you and struggling to keep focussed on the situation itself. Thinking you are not good enough or are making a fool of yourself
• Behaviour – e.g. keeping to a corner of the room, avoiding eye contact, avoiding conversation, not holding drinks or plates in case people can see you shaking, avoiding situations.

We call this a vicious cycle because things may have developed in each area that continue to keep us feeling socially anxious. To demonstrate, think about whether you would feel confident or anxious if you believed other people thought you were making a fool yourself. Each area has a knock on effect on the others, which helps maintain negativity. In therapy, we’d challenge how you are affected in all these areas, to create an alternative realistic balanced cycle to replace the vicious one.

It is important to know what the nature of your social anxiety is. Do you experience this at any time, around anyone?

Are there people who you feel safe with? Do you find situations easier to deal with if you are with this person? Are there things you do to help you find situations easier such as avoiding eye contact or trying to stay at the back of the room? Are some situations so difficult that you try to avoid them altogether?

It is helpful to really get to know how your anxiety impacts you. This can give you an idea of which way of helping might be the most important for you. You could keep a diary of your anxiety, to help you find out when it is at its worst, what seems to help ease it and what doesn’t, and what kind of things you tend to be thinking about when it is happening.

Anxiety has a big impact on how your body feels. This could be anything from feeling like your heart is pounding, sweating, feeling hot, shaking and so on. This can make you feel very uncomfortable and feel that the situation you are worried about is even harder to deal with.

You can help how you feel in social situations by practising relaxation techniques. The aim of these is to help make the anxiety feelings more manageable, though it may not get rid of them altogether.

If you feel your breathing is speeding up, you can focus on taking slow calm breaths in and out through your nose whilst slowly counting to ten or focusing on a word that you find calming (you could even use the word “calm”). There are many relaxation techniques available.

Another one is progressive muscle relaxation, where you start at your feet, tensing and relaxing your toes, and working through all of your muscles until you reach the very top of your head. You need to be careful if you have any physical health problems and allow for these or seek medical advice first.

If you practise relaxation regularly outside of the social situations that cause you anxiety, it can be easier to recall and use these techniques when you are in the situations you worry about. Regular relaxation (including meditation) has been shown to help reduce anxiety.

Social anxiety sufferers often have unhelpful thoughts that encourage them to avoid situations or at least make them feel difficult to deal with. These are usually to do with guessing that things will go wrong, and assuming that the other people in the social situations will think badly of them.

For example: John worried about team meetings. He thought that he would end up making a fool of himself somehow and imagined that other people would judge him as not good enough or stupid. He thought people would see he was anxious, see him sweating or shaking, and think that he could not cope.
Would you want to go into a situation if you felt that this was going to be the outcome?

John is displaying unhelpful thinking here. He has decided what the outcome of the situation is. To John, his expectations are already true. If he does go into this situation, this will be the outcome. He will make a fool of himself and people will think bad things about him. But how does he know this? Surely, you cannot know what will happen in a situation unless you try it out? How many times have you gone into a situation and the outcome has been exactly the same every time? So how do we challenge this?

Here are some questions to help challenge how you think about social situations that you find difficult:

• What would it look like if he imagined this going well instead?
• What evidence does he have that this outcome he imagines is likely to come true? (How many times has he made a fool of himself in a team meeting?)
• What positive things could his colleagues think about John? Has he had colleagues complimenting him or giving him positive feedback before?

These questions may seem straightforward and quite simple, but someone suffering from social anxiety will tend to see things as John does: negatively. These types of questions can help to deliberately try and think in a different way, and challenge the automatic negative way of thinking.

People suffering from social anxiety worry that other people will think bad things about them such as:

• They know that I am anxious and think I am stupid
• They can see me shaking/sweating and think I am weird
• They think I am boring
• They are not interested in anything I have to say
• They know I am incompetent
• They can see I am struggling to make conversation and think I am stupid.

It is important to remember that these are only thoughts about what others are thinking. They are only guesses! This means that they may be incorrect.

What else could people be thinking? Are you over-estimating how negatively people are thinking about you? Do your thoughts about what other people are thinking get worse depending on how anxious you feel?

Think about being in the social situations that cause you anxiety. What are you aware of?

You may find that in these situations, your attention focuses completely on how you are performing. You will be thinking about how visible your physical anxiety symptoms are and whether everyone present can see you are struggling. Think of this like a typical interrogation scene: all the attention is on you, the light is in your eyes and you cannot think about anything else.

Often this is something you would do to try and control how you perform in these situations, but it can end up making you feel worse rather than better. For example you may feel that your hand is shaking, so you focus on trying to make it stop, this can actually aggravate the sensation, or at least make you more conscious that you might be shaking, and this makes you worry even more that people will be aware of it. Often, the image in your mind of what you look like to others can end up being exaggerated, rather like a
caricature.

Apart from this, if your attention is focused internally, on what is happening to your body, then you are not fully giving your attention to the situation around you. This can lead you to feel that you have lost the thread of the conversation, or feel it hard to take part in what is actually happening, creating more of a feeling of separateness and that other people seem to find it easier to deal with these situations than you.

To challenge this, you can practise choosing what to pay attention to. This can help you appreciate how different a situation can feel depending on where you put your attention.

Have a go at this: The next time you are walking to the local shop, try your best to focus on sensations within your body. What are your feet doing? What is in your mind? How do you imagine you look walking down the street? Notice any impact this has on how you progress.

On the return journey, focus your attention outside of yourself as much as possible. Take in the details of your environment. How many people or cars are around? What colours can you see? How warm is it?
When you are home, compare these experiences and see how helpful or unhelpful you felt they were in terms of how much they helped you manage the situation. Is this something you could apply to difficult social situations?