Reaching out to social anxiety

Introduction to social anxiety

Social anxiety is a serious condition that I feel is often overlooked and under recognised by many people, even those that are affected by its symptoms. As a therapist, I am passionate about raising awareness of the condition and how the talking therapies have the potential to help. One website claims that social anxiety is the ‘the third largest mental health care problem in the world’ (Socialphobia.org, 2018). Given the prominence of anxiety and depression in the news, this is a serious statistic and one worthy of attention.

The World Health Organisation describe it as ‘a fear of scrutiny by other people in comparatively small groups’ (WHO, 1992:113). The fear can be so intense that you may feel sick or have a panic attack. A wide variety of situations are included, most of which will be predictable to the sufferer. For example, you know that if you go to an exercise class and your technique is corrected by the instructor, it will be embarrassing. However, this is likely to feel so embarrassing that you flush bright pink and want the ground to open up and swallow you whole. Or it could be that being asked to answer a question in front of work colleagues puts you right on the spot. On answering, you may feel as though you are being excessively judged and need to run out of the room. 

The use of avoidance

The examples are literally endless. All of them are incredibly uncomfortable and very distressing to the point that it can feel better to avoid any predictably awkward situation altogether. Of course, in the short term it will feel much better to avoid the intensely upsetting feelings. In fact, many people become so adept at avoiding their particularly awkward social situation that years and even decades can pass in which these habits become well embedded. Given that social anxiety generally begins during teenage years, a person’s life can be shaped around avoidance of these events.

Given enough time, avoidance becomes an unconsciously used tactic, so much so that you may find yourself not leaving the house. This removes the need for any social situation, which will probably only have the effect of making the matter worse in the long run. Even in therapy, without an awareness of avoidance, progress and change are unlikely to happen. It may be the case that by attending counselling every week you feel as though you are doing the right thing to help yourself ‘get better’.

Becoming more aware

However, as the weeks pass, nothing really changes. This can be frustrating and give the impression that you need therapy indefinitely. However, even though you are aware that social anxiety is inhibiting your desired lifestyle, you may not be fully aware of its true extent. The skilled counsellor will be looking out for avoidant behaviour during your sessions and be able to discuss them with you. For example, by consistently arriving late to sessions, you are avoiding having a full session and reducing the chance of a deeper discussion with your counsellor. Thus, you may not get the opportunity to get to the core of your social anxiety before each session finishes.

Alternatively, it could be in what you decide to bring into the sessions for discussion. Every week you will probably be faced with challenging social situations. Each one feels at least as important and distressing as every other, so they have equal validity and must be discussed with your counsellor. Without a doubt, important social dynamics can be understood. However, it is likely that this is an example of avoiding a more general discussion looking at beginning to challenge some of the ways you view and react to social situations. It is important to remember that no matter how out of control you feel in a certain situation, you always have a choice - how you react.

Furthermore, the more awareness you have about yourself - bodily sensations, thoughts and beliefs; the more choice is available. In any given situation, if you can start by noticing these things, it becomes possible to challenge the potentially irrational thoughts. For example, ‘am I really as pink as I feel?’ or ‘is everyone really looking at me?’ or, hardest of all, ‘what is the worst that can happen if my thoughts come true?’. Being able to consider these and the many others gives you the chance to react or behave differently.

Being brave enough to discuss the elephant in the room

However, no one said it was going to be easy. We are considering trying to change habits of a lifetime, which is a very brave thing to do. You will need to be feeling strong and your counsellor will help you build up to this point at a comfortable pace, one step at a time. Furthermore, as with much change encouraged by counselling, you may not get it right first time. Therefore, a part of this process may be being knocked back and feeling as though you are failing. Once again, between you and your counsellor it will be critical at this point to keep trying through the support available in your sessions.

From my experience working with clients that are socially anxious, a key point in the therapy is when they are so fed up with living with the symptoms. At this time, challenging themselves presents itself as the better option. If you find yourself in this position, you will be preparing to avoid avoidance of the main issues. It is likely that your counsellor will be noticing a change in your relationship as well. Using the previous example of arriving late to sessions, you might explore, in a session, what this means to you. I would encourage you to engage in these discussions wholeheartedly and try to work out what is behind your behaviours.

Of course, and especially with social anxiety, the timing of these very open conversations is key. Trust must be present in your relationship with the therapist - you will both be feeling extremely comfortable with each other. Therefore, the early part of therapy will be spent building this trust and working ethically to avoid re-traumatisation. 

Openness

Once in a position that allows openness, this can facilitate great understanding of yourself. In some ways it can feel like a relief to be able to discuss the elephants in the counselling room or your wider world. It may be the first time that you have felt comfortable to share such personal thoughts. The reward is freedom from their restraint which can be a very empowering experience. Realising that you can choose to approach these challenges at any time is important. However, bear in mind that it can be a very emotional journey full of obstacles, so be careful with yourself.

To sum up

I am passionate about working with social anxiety sufferers and believe it is hard to quantify the extent to which this condition stretches into our population. I hope this article may encourage people to reach out for help and realise that it is possible to free themselves from their constraints. I have respect for Glasser (2000:xv) who states ‘that we choose essentially everything we do’.

The initial and important step of choosing counselling for your social anxiety is a sign of increasing awareness; awareness that you desire a change in your life and are asking for assistance. The counsellor will help further your awareness and facilitate your understanding of ways to challenge avoidance of distressing social situations. Once at a very trusting stage of therapy, openness allows sharing of things that might not have been said, and the true realisation that you can choose to change. You can choose to be whoever you want to be.

References

Glasser, W. (2000). Reality Therapy in Action. New York: HarperCollins Publishers.

Socialphobia.org. (2018). Social Anxiety Fact Sheet | Social Anxiety Association.  [online] Available at: http://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis [Accessed 29 Mar. 2018].

WHO. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organisation.