Social Anxiety: What is it, and how to deal with it

Social anxiety presents what I think is a perfect example of the intersection of anxiety and addictions. In my practice there is a story I hear repeated again and again: "I began drinking in my teens because I felt uncomfortable in my own skin, or couldn't talk to girls (or boys), and the moment I had a few drinks in me, I was able to cope and even to enjoy myself and perform quite well in those circumstances." In fact, the use of alcohol in social situations is not just tolerated, but is often encouraged, in peer groups or business dinners for example. How often have we heard the description of drinking as a "social lubricant", and to be honest, it actually works quite well for many people without adverse affect. There are many of us, though, who are not able to stop once we start, and for whom the solution can become very much part of the problem.

What is it?

Broadly speaking, social anxiety is the fear of being negatively evaluated by others. So this can include every scenario from public speaking (often topping the list of people's least sought-after activities), to adolescent insecurity, to the fear of public humiliation. To be clear, there is very much a spectrum of possible outcomes, and very few among us are genuinely immune to personal criticism (though we can claim so, to ourselves and others); however, it can become more of a problem for some of us, as described below. This is particularly true not just because it is an unpleasant experience, but - and what turns out to be more important - because of our response to this feeling, which is often avoidance, which leads to limiting our lives.

DSM diagnoses

The DSM is the official manual of the mental health profession, and while I don't put too much credence in the exactness of its anxiety definitions (there is often a lot of overlap), it can be a useful place to start our discussion. Social anxiety, as mentioned above, in the widest sense is simply the fear of someone else thinking negatively about us. This is not a diagnosis in itself, as we all feel this at one point or other.

Social phobia, on the other hand, is a more specific diagnosis, which involves a deeper and more persistent fear of disapproval of some kind, and it typically coupled with a degree of negative consequences for our life. Not going to a social event, for example, because we're afraid no-one will talk to us, and if someone does, that we'll be paralyzed in responding, not able to speak, or perhaps likely to embarrass ourselves if we do. Again, this is on a spectrum applied to individual cases, ranging from limited situations, like public speaking, to being anxious about most or even all social situations.

There is even an avoidant personality disorder, which represents a more comprehensive sensitivity, which can be thought of as constituting a part of one's personality, though the difference with other diagnoses is probably mostly a difference of degree, not of kind.

In any event, if we recognize ourselves in any of these descriptions, and would like to do something about it, what can be done? One piece of good news is that the answer is: quite a lot, and the approach is essentially the same whatever the degree of severity and avoidance.

Acceptance and Commitment

We start with a counterintuitive assertion, learning to accept our anxiety, by which we mean acknowledging it is here, without our usual judgement ("I hate feeling this way, what's wrong with me, I have to get rid of this feeling"). Note, acceptance does not mean approval, or being passive; on the contrary, once we're judging something, its already here, and resisting it simply sets us up for an internal struggle with ourselves that by definition we cannot win. It also makes us more preoccupied with these feelings, which can make them seem larger than they need be.

In fact, when we think about that social event or date this Friday night, and immediately feel overcome by anxiety, and decide not to go, or to pick up a drink instead, what we are actually avoiding is not so much the event itself as our feelings around it. If we are feeling bad contemplating the event, and decide not to go, and then feel some relief (which is often what happens in social anxiety, and acts as a kind of temporary reward), our avoidance is really about feelings now, or ones we imagine we will feel. We can call this experiential avoidance, and the main effect of it is that we might not engage with something that might bring connection and reward, i.e. going on a date or socializing with others. And after all, when we predict it is likely to go badly, do we really know this? How often have we gone to something like this and its turned out better than we thought?

So we miss not only the possibility of good experiences, but we end up alone, "safe" perhaps, but at the expense of a more engaged life, a potentially more fulfilled life. Social life is also, like so much in life, about practice and getting more comfortable and skilled at being with others, so we lose this opportunity too.

But what is so awful about feeling uncomfortable? I think a lot of it is our self-blame, that we judge ourselves for not feeling confident and think less of ourselves, that we shouldn't feel this way. But what if we allowed ourselves to feel whatever we are feeling, with some kindness, just realizing that we are feeling very uncomfortable, but that this is quite common and more than likely to be temporary. This is what we mean by acceptance, allowing our feelings as unpleasant, but normal and tolerable, and that needn't prevent us going ahead and facing the feelings and continuing with what is important to us, accepting the invitation and attending the event, in whatever form it takes.

Which brings me to commitment, by which I mean deciding to go ahead with what we value, even when we don't feel like it, and in the face of difficult thoughts and feelings. When considering something we might want to do, we may decide not to get involved until we feel better about ourselves, or motivation arrives to do so. In other words, we will wait until we feel less anxious or more confident before we get involved socially. But what if this is back to front, that feeling better being in social situations starts with going to something we may not feel like going to? That we begin to feel some motivation when we take action, even when we're not feeling it to begin with, rather than waiting for inspiration to strike.

Addressing this problem thus becomes less about trying to "figure out" or "solve" this dilemma - which leads to inner struggle and paralysis - than accepting our thoughts and feelings as part of us, seeing them as just thoughts and feelings and not absolute reality, not struggling with them, and instead turning our attention to taking some action? And once we have done so, then we may start to feel better about ourselves, which in turn naturally encourages us to reach out some more, in a kind of virtuous cycle.

In short, we are moving from primarily trying to manage fear, to taking action toward meaningful human connection.

Practical Steps

It is vital though, to clearly identify what is important to you, socially and otherwise, and to understand that this process of taking on temporary discomfort is in the service of an important value for you, rather than just gratuitously putting ourselves into difficult situations.

So, reflect on this for yourself, it is the most important step of all, actually. Do you want more friends, a romantic partner, to play a team sport that you have been avoiding? Be aware that sometimes we can tell ourselves "I don't care" about all this; if so, that is fine, but let us be honest, are we really avoiding something important to us because we think we won't succeed, or because we fear it will be unpleasant?

Compassionate (non-judgemental) acceptance will make committed action less fraught, and the key is to start small, plan easier steps to begin with, and build on that. By non-judgemental, we mean noticing the judgemental thoughts, but allowing them to come and go, not seizing on them and trying to change them, which has the paradoxical effect of making them more solid and believable.

It is helpful here to distinguish values and goals. Values are fundamental ideas about how you wish your life be - freely chosen, lifelong guiding principles that describe how you want to treat yourself, others, and the world, which can't be completed, as they are part of your ongoing life. An example would be: I want to live a healthy life, which we never get to the end of, but to which we can attach goals, such as I want to exercise twice this week and go and see my doctor for my annual checkup.

For our purposes, the kind of values we would probably be talking about in the social arena would be ones like developing more authenticity in relationships that matter to us or finding and developing a loving relationship. If you're having trouble identifying values to commit to, ask yourself this: if you had a magic wand and could act any way you wished with others with no negative consequences, what would that look like?

Values can last a lifetime, though of course we can and do change them over time, but once we are clear about what is important to us, we can develop more concrete goals which can be accomplished, such as signing up for a dating app or reaching out by starting to attend church or joining a meditation group (which in both cases will likely fulfill the two values of spirituality as well as socializing). We might or might not succeed at a particular goal, but this doesn't change our values, which we can never be "wrong" about, and which we can never "fail" at, though putting values into effect does mean taking some action.

So ask yourself where you are right now in your relationships with others, where do things strand now, what is important to you, where would you like to go? Once you're clear about this, it is fairly straightforward to establish some goals to pursue gradually, and remember the saying "progress not perfection" applies here as elsewhere; there will likely be disappointments and discomfort, but our values make it worthwhile persevering, and acceptance can make it just that much simpler. As a meditation teacher once said to me, "the obstacle is the path."

Mindfulness and Acceptance for Social Anxiety