Here is a link to a video version of this blog: https://youtu.be/ATkvv7X1XCA
Social Anxiety Disorder (SAD) is a widely distributed condition across the general population with a lifetime prevalence rate of 13% interferes with occupational, educational, and interpersonal functioning of those afflicted[i]. The signature of SAD is a disabling fear or anxiety of being criticized, outed, and rejected by others in social situations. The genesis of SAD is diverse, with the genetic transmission for the propensity to develop the disorder being found in 30-60% of casesi. Other factors include behavioral inhibition, circumstances in life that combine social situations with a humiliating or rejecting experience, unhelpful cognitive appraisals of internal and external stimuli, and an insecure attachment profile. Hence, a combination of transactions between nature and nurture is at play here. For this article, I will focus on three interconnected domains; behavioral inhibition to the unfamiliar, safety behaviors, and unhelpful thinking, all of which can be treated with psychotherapy and/or rehabilitative skills training at Believe Behavioral Health. Finally, I will offer three potential coping strategies for each category.
1. Behavioral Inhibition to the Unfamiliar
Behavioral inhibition (BI) refers to an innate temperamental feature that is associated with increased limbic system activity. The limbic system houses the brain’s threat detection system and is involved in activating the stress response and return to homeostasis. Elevated BI consists of autonomic nervous system arousal, a reactive limbic system, and has been linked to elevated physical and social anxiety, all of which provide a crosswalk to the development of SAD in adolescents and adults. In short, BI involves an overactive limbic brain and interacts with unhelpful thinking, and avoidance of situations.
Coping Solutions for BI:
A. Downregulate the nervous system by choosing from an array of mind-body practices such as deep breathing, progressive muscle relaxation, or meditation.
B. Practice being in social scenes that elevate anxiety while using coping thoughts, accepting the moment, and doing one thing to improve the moment.
C. The mental health care relationship itself cultivates an environment in which emotions can be labeled, expressed, felt, and dissolved.
2. Safety Behaviors
Individuals tormented by SAD arm themselves with a stockpile of avoidance strategies called safety behaviors. Safety behaviors, as employed by individuals with SAD, are strategies designed to mask the detection of one’s perceived incompetence from others. In turn, these self-defeating strategies, which are in and of themselves socially debilitating, receive undo credit for one’s navigation of a social situation and eliminate the reception of evidence that challenges longstanding and irrational expectations of others’ critical performance evaluations. Indeed, safety behaviors such as averting one’s eyes during transactions with another person, finding an excuse to not go to the party, or using a cell phone to avoid communicating are used to uphold an internalized implicit rule that I must not let others know I am anxious for me to be ok and help preserve the status quo of the belief that I am socially incompetent. I cannot even be around people. Succinctly put, safety behaviors in SAD are anything that involves avoidance and eliminating potential detection of anxiety by others, all of which further entrench unhelpful beliefs and limbic reactivity.
Coping Solutions for Safety Behaviors:
A. Schedule a specific mission or experiment to engage in a social situation without the safety behavior. For example, “at this next meeting I will greet at least three people first while looking them in the eye.” People do better with roles to carry out.
B. Expose yourself to attention on purpose. This is a bold coping skill but effective. For example, plan to say a word on an engagement, change your hair style, or wear a graphic t-shirt that will cause people to look at you.
C. Systematic desensitization. This skill involves scheduling a set of activities that have created anxiety starting with the least anxious event while preventing enactment of safety and avoidance behaviors by calming the nervous system and engaging our adaptive thinking.
3. Unhelpful Evaluations of Internal and External Events
Irrational, narrow, and faulty cognitions are instrumental in the development of SAD. According to cognitive theory, SAD is created and maintained by irrational fears of public censure, magnification of the cost of the imagined punishment, and minimization of one’s ability to manage itii. Individuals with SAD retain a hyper-focused internal attention on their physiological arousal combined with negative self-evaluations, effectively creating a barrier to new input that could indicate a false alarm of danger. Moreover, the evaluation of post-event performance by individuals with SAD tends to be riddled with “negative autobiographical memories of the event,” igniting anxiety related to future social interactions and strengthening avoidance and safety behaviors[ii]. In effect, those with SAD are overly attentive to their internal sense of anxiety, evaluate social circumstances negatively, perceive social cues as indicative of danger, and then afterward, laser in on their perceived flawed actions during the event, all of which contribute to further avoidance, enactment of safety behaviors, and a feverish limbic system.
Coping Solutions for Unhelpful Evaluations:
A. Complete a basic cost-benefit analysis. Ask yourself what the advantages and disadvantages are of keeping a line of reasoning such as, “I can’t stand meeting new people.”
B. Put pseudo danger in its place. This involves reorganizing actual danger vs false alarms. Your brain is fine, it just needs a tune-up. Real danger involves tornadoes, grizzly bears, and robberies. False danger involves the opinions, looks, or gestures from others.
C. So what, now what? Ok so let us suppose others do see your nervous apprehension in social events or you make a foot in mouth comment. What is the worst that can happen?
Joseph Smullen, LCSW is a therapist with Believe Behavioral Health. Believe Behavioral Health offers case-management, rehabilitative skills training, and psychotherapy to children, adolescents, and adults. For more information or to schedule an appointment please call 361.894-8734.
[i] Narr, R. K., & Teachman, B. A. (2017). Using advances from cognitive behavioral models of anxiety to guide treatment for social anxiety disorder. Journal of Clinical Psychology: in Session, 73(5), 524-535.
[ii] Lampe, L. A. (2009). Social anxiety disorder: recent developments in psychological approaches to conceptualization and treatment. Australian and New Zealand Journal of Psychiatry, 43, 887-898.