Our understanding of social anxiety has developed a lot in recent years. The current paper presents a review of recent advances in the study of social anxiety and a model of how the disorder and its different features can be understood.
Model and Features of Social Anxiety
The most fundamental aspect of social anxiety is your perception of how you come across to others. This is formed as an image of how others perceive you, or an “image of other people’s image of you”. This image is based on prior experiences in social situations and is often highly negative. This means that people with high levels of social anxiety often picture themselves as coming across very badly- seeing themselves as awkward, nervous or boring and thinking that other people are constantly judging them and criticising their performance.
People with social anxiety see themselves as falling short of the required standard of social performance, and this leads to feelings of anxiety in any social situation.
Once a fear of social situations has formed in this way it is maintained through a process called attentional bias. This is where a person unconsciously focuses their attention on the frightening things around them and the potential for danger, rather than looking for the positive things in a given social situation. People with high levels of anxiety have a harder time controlling where there attention is focussed and are naturally drawn to things that frighten them. This means that they end up seeing more frightening things around them and their fears remain firmly fixed in place.
Social anxiety treatment can fix this bias by training people to focus their attention onto more positive things around them and pay less attention to the threats.
Another feature of social anxiety is the tendency to interpret information around you as negative. People with social anxiety will often interpret other people’s reactions to them as being negative even if they were not intended that way at all. Social anxiety can cause people to dismiss or discount times when they receive positive feedback in social situations and can also interfere with the way you process and interpret facial expressions.
The effect of interpretation bias has implications in understanding how to deal with social anxiety- treatment can help people learn to interpret ambiguous information more positively rather than filling the uncertainty with negative thoughts.
People with social anxiety will often have very negative images of themselves in their minds and will picture themselves as being judged and negatively evaluated when remembering or picturing social events. People with social anxiety also find it harder to hold positive self-images in their mind and generally find it harder to call to mind neutral or positive images than negatives images.
Self imagery can be corrected using a technique called video feedback, where patients are videoed in social situations and then watch their own interactions in order to see that they do not perform as badly as they imagined.
Self Focussed Attention
Self focussed attention refers to the extent to which people are aware of and focussed on their own sensations and experiences rather than being focussed on other people. High levels of self focussed attention can maintain social anxiety by making you increasingly aware of internal anxious feelings and using these to judge your performance in a social setting rather than the response you are getting from others.
New forms of social anxiety treatment can counter the effects of self focussed attention by training patients to focus their attention on the environment around them or on the task they are trying to accomplish rather than on their own thoughts and feelings.
Anxiety disorders often make it harder to regulate your emotions and can create an emotional “roller coaster” where your emotions jump from one extreme to another. Research shows that people with social anxiety disorder have a harder time describing and being attentive to their own emotions compared to those with general anxiety disorder and non-clinical control groups. People with social anxiety also display unhealthy levels of emotional suppression- they will try to keep their emotions hidden.
Social anxiety can also affect people’s capacity to feel certain emotions, with a reduced response to positive information being a common trait in those with social anxiety. Some research shows that social anxiety causes a reduction in positive emotions, which is a symptom not shared by other anxiety disorders.
Recent models of how to overcome social anxiety have included training on increasing positive emotions by asking patients to engage in kind, selfless acts for those around them, which was shown to increase feelings of positivity and improved satisfaction with their social relationships.
Research also shows that those with social anxiety often feel higher levels of anger in reaction to events around them, but that they also exhibit poor anger expression and have trouble regulating their feelings of anger. This can potentially hinder treatment and it has been shown that those who do not complete social anxiety treatment often have higher levels of anger compared to those who do.
Safety behaviours are those actions we take in order to protect ourselves from feeling high levels of anxiety. For people with social anxiety this often looks like avoiding eye contact, being reluctant to disclose much information about oneself and rehearsing what to say in advance. Socially anxious people believe that these actions are necessary to protect them from feeling anxious in social situations, but often they do not have the desired effect and only serve to keep their anxiety in place. Studies have often found that participants report feeling more anxious and less socially able when they are told to use lots of safety behaviours than when they are told not to use any.
Eliminating these safety behaviours is therefore an important part of overcoming social anxiety. Exposure to feared social situations without the use of safety behaviours has been shown to reduce anxiety symptoms significantly.
Post Event Processing
Another thought process which serves to maintain social anxiety is post event processing (PEP)- ruminating on your performance and other people’s reaction to you after a social interaction. People with social anxiety often show high levels of negative post event processing, often dwelling on how badly they think an event went after it is over.
Whether your evaluation of an event is positive or negative often depends on the self image you have in your head during the event. Focussing inwardly on your own emotions and thoughts during a task also leads to higher levels of negative PEP after the event. This relationship between PEP and self-focussed attention means that PEP can be reduced by training patients in mindfulness techniques which help them disengage from their excessive thoughts about themselves and become more focussed on others.
Social anxiety is caused and maintained by a complex set of thought processes and biases in attention and interpretation. Recent research has made significant advances in tackling each of these issues and overcoming social anxiety in a range of patients. Future research can continue to refine treatment processes, with particular focus on the relatively unexplored issue of positive emotion impairment, in order to help those with social anxiety experience more positive emotions in their lives.