Clinically Based Therapy for Social Anxiety

“When we are afraid we ought not to occupy ourselves with endeavoring to prove that there is no danger, but in strengthening ourselves to go on in spite of the danger.”

- Mark Rutherford

The anxiety of the socially anxious has its basis in the expectation of negative experience arising from social situations. This expectation is not based in present fact. Rather, it is formed by the belief that a previous bad experience will repeat itself in the present situation.

A dog that was frequently struck in the head by a previous owner will, for the rest of its life, tend to exhibit signs of fear whenever the new owner lifts a hand to its head–even if the intent is only to give a loving scratch behind the ears. This is because the unfortunate dog, like us, is subject to having memories“hardwired”through the secretion of certain brain chemicals (cortisol and oxytocin to be exact) during traumatic or highly stressful experiences.7

Once these memories are hardwired, events that cause them to be retriggered may actually result in strengthening the hardwired, negative response. This is true even when those earlier memories are not fully brought to consciousness. Hence a person who experiences social anxiety at the thought of public speaking will not reduce his anxiety with more frequent speaking engagements. At best he will only increase in his speaking proficiency. But because the original hardwired memory is actually reinforced at each speaking event, his anxiety remains. In fact, it may even get worse. 

Thankfully we are not dogs….

But as with the dog, the root of a person’s anxiety lies in the expectation of impending negative consequences. That is, the person experiences anxiety because he is thinking that bad things will happen. Such thinking is understandable. After a panic-inducing experience the brain hard-wires the memories in an effort to prevent the person from experiencing a similar situation in the future. When that hard-wired memory is stimulated even a little, the person will immediately experience the same feelings of panic. It is a natural defense mechanism. Where this mechanism become debilitating is when it is stimulated too easily. 

This is similar to how the body’s natural immune response can become over responsive to certain stimuli, resulting in an allergic reaction. Some allergic reactions are relatively trivial: sneezing and watering eyes from hay fever for example. But some allergic reactions can easily become life-threatening: for example severe peanut and bee sting reactions.

But unlike a purely physiological allergy response, anxiety is complex interaction between physiology and what the person is thinking and feeling–and his reactions to what he is thinking and feeling.

To be certain, we are subject to the same neurochemical secretions brought on by traumatic or stressful situations as are dogs. But, unlike dogs, we are capable of thinking about our thinking–a process called“meta-cognition.”This is extremely good news for those who experience social anxiety. 

It is precisely because we are capable of meta-cognition that clinical therapists often treat patients who are on the social anxiety spectrum with Cognitive Behavioral Therapy (CBT).

CBT is one of the oldest and most practiced forms of therapy for individuals suffering from anxiety and depression. Using this approach for social anxiety in particular, the therapist will start with training the person in the basic ideas about thinking and meta-cognition.8When the person starts to grasp how to think about thinking, the therapist will then help the person to examine the link between the his expectations of negative consequences in social settings and the experience of anxiety in preceding those settings. The initial goal will be for the person to comprehend that it is his expectations–not the social event itself–that gives rise to the anxiety. The second goal will be to teach the person how change his expectations about the results of social experiences. 

A variant to CBT is Acceptance and Commitment Therapy (ACT).9 ACT, like CBT, requires a meta-cognition process in those being treated. But where CBT focuses on helping individuals change their feelings and emotional responses, ACT focuses on helping individuals accept their feelings as matter of fact and then to progress forward. ACT is often utilized with patients who do not respond to CBT treatments or who show continue to experience anxiety symptoms after treatment. 

A person undergoing CBT treatment will, hopefully, learn to feel better in anticipation of a public speaking engagement. A person undergoing ACT treatment will learn that“this is what anticipating a public speaking engagement feels like,”and learn to process those feelings without introducing additional emotional responses.