About a year old* and until now unpublished, here comes an essay about social anxiety theory and Cognitive Behaviour Therapy (the main treatment for social anxiety disorders); following a Social Phobia diagnosis a few years prior**…
Social Anxiety, part 1: defining social anxiety disorders
‘Normality’ is an ill defined, but eagerly used benchmark for human behaviour that has always confused me. The tricky bit is that normality does not exist, and everybody knows it but pretend that it is the standard for how people behave. There does not exist a normal person. Everybody is unique and different in some way.
People’s perceptions of what it is to be normal – what others might think about them and how they ought to behave – depend on culture, gender, age and many other factors, but any culture has a zone of normality defined by subtle rules, exceptions and grey areas. And in any culture, the need to belong and the fear of social exclusion shapes behaviours, personalities, the way people relate to each other and who they accept. Mild worrying about what others might think is a normal and benevolent aspect of being a social creature.
Social anxiety helps us to remain sensitive to the feelings and needs of others, which is a core foundation of cooperation and building relationships.
However, social fear can spin out of control and damage social confidence and the ability to pursue a fulfilling life. That is when social anxiety becomes a disorder.
Social anxiety disorders – extreme shyness, social anxiety and social phobia – are rooted in a hyper strict idea of normality, which causes intense worries about ‘what others might think’, underpinned by low self-esteem and assumptions of being evaluated negatively by others.
Social Phobia Diagnosis
A few years ago I saw my GP with yet another health problem that year (most of which I did not take to the GP). He asked questions about my mood and how I liked my work (I did not), had me fill out a questionnaire and eventually referred me to a psychologist for depression and social difficulties at work. The psychologist, P, suggested that I suffered from Social Phobia / Extreme Shyness.
At the time, I felt like I wasn’t a live person at work but a depressed zombie sleepwalking through the games and banter around me. I was uncomfortable with many of the everyday interactions such as entering and saying good morning (unsure of who to greet since it was an open plan office), the morning meeting briefs, talking on the phone, and any sudden informal chit-chat and surprising social event, such as birthday cake celebrations.
I was extremely shy from my first day at work and through the first year; often afraid to talk or on the brink of stuttering, and felt like my mind blanked out. The General Manager acted like I couldn’t do anything right and never let me forget the mistakes I had done. My 3 months probation was extended to ‘indefinite’ for nine months because ‘We are not sure’. After a year my anxiety began to fade and I was treated much better by the GM, but my discomfort then evolved into a part time depression and endless boredom during work hours.
The depression kicked in every morning when I stepped into the office, and gradually faded after I came home from work. I felt dead tired in most of my spare time, slept a lot and had little energy to pursue my own agendas.
I was often feeling unwell and was haunted by ridiculous injuries, like: tore my calf muscle when running, was incapacitated by excruciating shoulder pain for 3 weeks after taking these photos, and my front tooth broke off when I ate a piece of sticky candy.
Shoulder injury avoidance tip: do not maniacally snap underwater photos for 1 hour+ in cold water with no wet suit on.
While I was very depressed about my job, I didn’t really think it would help to leave it. I was quite certain the problem was me. My job search (which did take place, after all) was also hampered by Telephobia and feeling of alienation from the job advertisements ‘essential requirements’.
P explained social anxiety theory in quite a lot of detail and illustrated it with fictive (I presume) case stories. I also read a book about it. The diagnosis sounded reasonable, and social anxiety is very treatable with Cognitive Behaviour Therapy, so I decided to give the therapy a go.
The following is my thoughts about what I learned from Social Anxiety theory, and what I got out of Cognitive Behaviour Therapy strategies I tried.
Social Anxiety theory: what kind of people have Social Phobia
People who suffer from social anxiety disorders can be natural ‘people’s persons’… empathic, considerate and eager to please… whose strong people orientation and social sensitivity has gone wrong and paradoxically trapped them in social isolation.
They are stuck in the extreme right side of the ‘Anxiety VS Optimal Performance’ diagram:
It can be seen that an average performance can be obtained at two different levels of anxiety. A person who is reasonably calm will perform averagely well, as will a person who is very tense. However, should extra demands be placed on the reasonably calm person, there is a wide margin for anxiety to increase without performance deteriorating. On the other hand, for the person who is already very tense, a further increase in anxiety is likely to result in deterioration of performance.
where their anxiousness to perform well (socially and in other ways) is so strong that it prevents them from performing well. Their social anxiety is irrational, which is a good thing. They don’t have reason to be afraid of other peoples’ judgement, it is all in their head; so their worries are incorrect, and they ‘just’ need to overcome them.
Examples of irrational social anxiety sufferers completely dominated the social anxiety case stories; all sufferers were assumed to have inactive, but good latent social behaviour underneath their social anxiety disorders.
The optimistic assumption and lack of an alternative personality type seeded scepticism in me early on. I could think of plenty of examples where people are right when they feel they are being judged by others, make too many social mishaps and don’t have a clue about how to behave. People whose social fear is rational and rests on a solid, lifelong base of ostracism and social confusion… even if the intensity of their anxiety is irrational in the sense that it worsens their situation.
I suspected that trying to overcome shyness without addressing underlying social failures (thus think realistically, not optimistically, about one’s social behaviour) would just bring on new failures and then, new symptoms.
The body language barrier
There was another aspect of the therapy that didn’t quite work for me. It never occurred to me to address it or even think of it as relevant, but in hindsight it was such a major barrier that the therapy would never have worked no matter what.
The issue was caused by the sitting arrangement, which comprised two chairs confronting each other with no table or other barrier between. The room was small and dull. The set-up was that P sat right in front of me and looked straight into my face. Sometimes he would even lean forward towards me, reducing the distance further. He talked and talked; told more case stories, more examples, more symptoms, and occasionally asked for my input.
I couldn’t focus on anything but his eyes and changing face expressions; these huge intensive elements took up all my capacity, and I couldn’t think or sense my own feelings. I was far away, in mental exile. However, I knew I was expected to deliver words, face expressions, eye contact, and I talked and talked, like a robot. That was also the only way to interrupt the relentless stream of explanations.
I listened to myself from faraway, wondering where all those words came from, because it wasn’t from me. After the sessions I never felt like I had really said anything. However, I can see now that my words aligned perfectly with the case stories and the symptoms that were described to me; like a hand in a glove.
When I sporadically broke out of my invisible paralysis and could think and feel for a moment, I wondered where P’s assumptions about me came from. They matched the case stories 100%, but they didn’t match me. I started to think that he exaggerated my social anxiety symptoms and ignored everything that was ‘irrelevant’ to the diagnosis.
I did not mention to him that I have a noise sensitivity problem until late, as a side note, because I didn’t consider it to be a psychological problem… P was a psychologist so what could he do? (I have since ditched that ‘silo mentality’). But because I am oversensitive to noise and most social situations are noisy, many of the strategies and implied social goals of the theories sounded irrelevant to me.
I should maybe quickly mention that it wasn’t my first attempt at therapy… far from, and the ‘conversation overload’, mental shut down, and even the failure to consider aspects that ‘weren’t in that category’ was my standard behaviour in that situation. But I didn’t think of that either. So P didn’t really stand much of a chance.
All this may sound like I think the therapy was useless, or that the diagnosis was wrong. Neither is the case. I think the diagnosis was over-applied, but I do think I have social anxiety issues, and some of the Cognitive Behaviour Therapy strategies I learned were effective against those issues.
The next post is about Cognitive Behaviour Therapy strategies for treating Social Phobia.
** I still have the diagnosis (I think)