Avoid calling strangers? Are you afraid to speak in front of an audience? Can’t meet? These are all manifestations of social anxiety. Sometimes, from ordinary shyness, it turns into a disorder that prevents us from living. How to deal with it? Psychotherapist Stefan Hofmann answers.
How to find your love if you are literally unable to open your mouth to say a few words and get to know someone or someone you like? How to get a good job if you are afraid to go to an interview? And if you come, then sit, blushing to the ears, and you can’t really answer a single question.
People who suffer from this problem are fun to watch in movies. But in real life, there is no reason for fun here. Social anxiety, turning into a clinical disorder, breaks people’s lives. Is it possible to help them and at what point should the alarm be sounded?
Psychologies: If you try to find out the signs of social anxiety from the Internet, it seems that almost all of us have it.
Stephen Hoffmann: And there is. Social anxiety is built into us by evolution. We are social animals, we need to be part of a group. But one must distinguish between ordinary anxiety and social anxiety disorder as a clinical diagnosis. At the heart of social anxiety is the fear of being rejected, ridiculed.
For those who suffer from this disorder, fear takes precedence over all other emotions. They have difficulty – or not given at all – the simplest social interactions. As a result, they shut themselves off from society and doom themselves to constant, everyday suffering.
They lead a lonely life – not because they like it, but because they are unable to build relationships. They choose a job they don’t like just because it doesn’t involve socializing. They cannot start a family. In short, the problem seriously reduces the quality of their lives.
How to define the line that separates “normal” anxiety from pathology? Let’s say I need to make a speech. I am terribly worried, I blush, going up to the podium, I stumble …
And that’s completely normal! There would be more cause for concern if you did not experience any excitement at all in this situation.
Why?
Because if a person does not worry at all about how they treat him and how others see him, this indicates his problems. So, for example, psychopathy can manifest itself. Psychopaths do things without wanting or being able to understand how they will affect other people.
Let’s say I can’t get up to the podium at all? And instead I run away and hide under the table?
But this, I’m afraid, is already a disorder. Especially if, for example, your career depends on the speech you need to deliver. In fact, the line you’re asking about is often quite obvious. For our patients and their environment.
If a person is not at all worried about how they are treated and how others see him, this indicates problems.
So, for example, psychopathy can manifest itself.
When anxiety starts to cause real problems rather than discomfort, you need to take action. In any case, specialists have in-depth interview techniques that allow us to determine whether we are dealing with social anxiety or social anxiety disorder.
And if it’s a disorder, should it be treated? Are there any medications?
In principle, yes, in therapy, for example, selective serotonin reuptake inhibitors can be used – drugs from the group of antidepressants that are also prescribed for many other types of disorders. These drugs help to suppress anxiety, but they cannot eliminate the fear of rejection – the root cause of the disorder. But psychotherapy in this situation gives good and stable results.
This is reassuring to hear. Because the number of mental disorders is increasing so rapidly that there is a suspicion that they are “invented” specifically to sell us more and more new pills.
Yes, some disorders do suggest that they were invented under the formulas of pharmacists. And some others disappear suddenly when companies take a drug off the market. But social anxiety disorder is not one of those “inventions.” It is a disease that brings suffering to many people. According to available data, 13% of the population experience social anxiety disorder during their lifetime – at least in Western countries.
Can exercise and meditation help with anxiety?
Meditations are useful, but for other problems. And in the case of social anxiety disorder, I consider the exposure technique to be the most effective: immersing the patient in those situations that create the greatest difficulties for him. But I would advise you to contact specialists, because the exposure can be quite a painful experience that you need to prepare for.
Independent reading of books or articles is not always enough for this. Exposure is the experience of consciously entering situations that the patient is avoiding. The experience of being able to stay in them without fleeing. The experience of their constant repetition.
Could such an experience be traumatic in itself?
That is why I recommend contacting specialists. Our therapy is not those swimming lessons where a person is simply thrown into the river from a bridge. There is no risk of drowning, because at first we still teach the patient to enter the water, breathe in it, swim in shallow water. We usually form small groups of 4-6 people with similar problems.
In the case of social anxiety disorder, I think the most effective technique is exposure: immersion in situations that create the most difficulties.
Such a group with two therapists is the most effective. It already creates a kind of social environment and thus provides the initial skills to overcome social anxiety.
We invite the participants to speak to the group with some speeches, at first very short and simple. For example, participants can talk about their work, hobbies, some hobbies.
This is not an easy task for many of our patients. But we teach them to focus their attention not on their own fear and anxiety, but on those to whom they turn, for example.
On the other hand, staying face to face with your anxiety, without trying to run away from it or suppress it, is also very important. And sometimes the task is to stand in front of the group and not say anything at all, but just stand there, feeling anxious and letting yourself know that nothing terrible is happening.
After that, the real expositions follow?
No, no, don’t get ahead of things. In the next step, we move on to more complex speeches. For example, participants must speak on a topic that they know little about. Or express your views, knowing for sure that the group will not share them.
The complication occurs gradually, the work goes on one two-hour session per week. And only around the seventh session do we move on to “field” expositions, when our participants perform some actions no longer within the group, but in the outside world.
Which ones?
Those that can be regarded by themselves as wrong, violating their ideas about norms and decency. Things they would never do. For example, imperceptibly, but on purpose, drop a plate of food on the floor in a restaurant. And then ask the waiter to clean everything up and bring a new dish. Or sing loudly in the subway at rush hour. Or walk into a store, select a few items, ask them to pack them, and then announce, “Sorry, I changed my mind and won’t buy anything.”
When Anxiety Starts Causing Real Problems, Not Discomfort, Take Action
It is important to understand that our members are certainly not doing anything illegal or harming anyone. The maximum that threatens them is to be mistaken for people unpleasant and rude. Very well! There are a lot of really rude and unpleasant people in the world, and they live quite normally.
And it is important for our participants to go beyond the limits that they have set for themselves, and to understand that no catastrophe will occur in this case. They do not become criminals, do not fall through the ground, and the whole world does not immediately come running to pillory them. This awareness gives freedom – the understanding that you have the power to change your own rules of relationships with society.
How effective is this therapy?
Most effective. In addition, the effect is very long-lasting. Imagine: 12 sessions is enough for people to go years, and often decades, without experiencing serious problems with social anxiety. These 12 sessions are simply life changing.
Does social anxiety affect everyone in the world equally? Is there a difference between representatives of, for example, Eastern and Western cultures?
There is, but I myself would very much like to know what it is due to. I did a lot of research on this issue, but did not find the answer. In Japan and China, for example, people report much less social anxiety.
In the West, social norms are more fluid and indefinite than in the East. We have to decide how to behave
And perhaps the fact is that social norms in these countries are very strict. They do not give much room for interpretation, and in almost any situation you know how you can behave and how not.
In the Western world, these norms are much more fluid and vague. We often have to guess, to decide for ourselves how to behave. That can not but provoke social anxiety. But on the other hand, perhaps the rigid framework of Eastern culture simply does not allow complaining about problems: in Japan and China, not only social anxiety disorders, but many other types of disorders are much less.
Social anxiety, by definition, depends on external factors. Does she have internal causes? Education, predisposition?
Of course have. For example, it is very likely that a timid and shy child, as an adult, will have difficulty entering into social interactions. As early as two and a half months, certain types of reactions and behaviors of the child may indicate future problems.
First of all, it is high reactivity – for example, overreacting to loud sounds, new toys, new situations and new people. If in these cases the child cries loudly, tries to hide, seeks salvation from the parents, the likelihood of developing social anxiety disorder is markedly higher.
Can parents help children avoid this?
Yes, and the sooner they do it, the better. Parents should encourage their children to contact other people, the outside world. In this case, everything can be changed, no matter whether it is a simple habit, character trait or temperament. To be honest, I am generally sure that if you make the necessary efforts, you can change everything.
Exercise from the exposition technique “Bitter Medicine”
The exposure technique involves immersion under the guidance of a psychotherapist in those situations that the patient fears.
Here are a few tasks that are given during therapy:
Stand in front of the entrance to the Park of Culture and ask ten people: “Do you know where the entrance to the Park of Culture is?”
Order a donut from a coffee shop, “accidentally” drop it on the floor, and say, “I accidentally dropped my donut… Can I have another one?” (The goal is to get another one without paying for it.)
Stand on a street corner and chant “God Save the Tsar” loudly for 10 minutes.
(For male patients) Ask the pharmacist to sell you condoms. When she brings them, ask: “Is this the smallest size you have?”
Stefan Hofmann is a clinical psychologist, professor at Boston University (USA), head of the Laboratory for Psychotherapy and the Study of Emotions, president of the International CBT Association. Author and editor of books on cognitive behavioral therapy and anxiety disorders.
We thank the Center for Cognitive Therapy and its director Yakov Kochetkov for their help in arranging the interview.