Coping with Shyness and Social Phobias

A Guide to Understanding and Overcoming Social Anxiety

Ray Crozier, Lynn E. Alden

• Publisher: Oneworld Publications
• Year: 2009
• eBook ISBN: 9781780740898
• Topic: Personal Development
• Subtopic: Abnormal Psychology

Often misunderstood and underappreciated, social anxiety is one of the most prevalent psychological problems in the West

Shyness and social phobia will affect one in twenty people and can prevent those suffering from leading their lives to the full. In this supportive and informative guide, psychologists Crozier and Alden explore the reason and meaning behind social anxiety and consider the various treatments on offer; including medication and cognitive-behavioural therapy.

Supported by case studies and the latest in psychological research and practice, the authors distinguish between shyness and the debilitating effects of social phobia in refreshingly relatable terms. Presenting up-to-date information on the methods people are using to overcome their difficulties and giving an objective appraisal of their effectiveness and limitations, this book is an invaluable resource for those trying to understand their own anxieties or the anxieties of others.

1

Is this book for you?

What is the book about?

Our starting point is that many of us feel extremely shy or anxious in social situations. We wish that we did not feel like this and we would like to change things so that we wouldn’t have to feel like this. We might have tried to change in the past but found that it was hard to do so – our fears and concerns seem so ingrained that they are resistant to change.

Perhaps you feel this way about yourself. Or perhaps you see these signs in your husband, wife or partner, your child, or a friend. You wish that you could help them in some way and sense that if you knew something more about these problems you would be better placed to do so. The aim of our book is to provide you with clear and up-to-date information about what is known about social anxieties.

Perhaps you have read about social phobia or social anxiety disorder and wonder what they refer to or how they are different from shyness or lack of self-confidence. Or you read or hear about strong claims being made about cognitive behaviour therapy and wonder if that would be helpful to you or to someone you know. What does it involve? How might it differ from other forms of treatment? Is there any evidence that it is more effective than other treatments?

Or you have followed recent debates in the media about the use of medication for the treatment of social phobia or social anxiety disorder (we will explain these terms shortly). Are drug treatments effective in treatment? Is their use appropriate? One form of medication that has attracted controversy recently is a class of drugs known as the SSRIs (Selective Serotonin Reuptake Inhibitors), which were developed for the treatment of depression but are now routinely prescribed for social anxiety disorder (we discuss this treatment in more detail in chapter 9). You might not be at all sure what these drugs are, how they work, or why they might be thought to have anything to do with, say, feeling nervous about going on a first date with someone you find attractive or worrying about having to persuade your colleagues at work to agree with your point of view.

Sometimes the media describe medication as a ‘pill for shyness’ or a ‘cure for shyness’ and this raises many questions in your mind. Is social phobia the same as shyness? How can a medical treatment change my everyday behaviour? And why should my nervousness about dating or my awkwardness in conversation be a medical matter at all? Isn’t it just me, the kind of person I am, my personality, not an illness that I suffer from and can get over if I take the medicine? Other newspaper reports have described a ‘breakthrough’ in science, where it is claimed that a gene for shyness has been discovered, and it is difficult to square the idea that shyness has a genetic basis with reports that it can be treated by drugs or by psychotherapy.

These are all good questions and probably you have many more good questions in mind. We – Lynn Alden and Ray Crozier – are psychologists and in this book we aim to tackle these questions from a psychological perspective. We don’t assume any prior knowledge of psychology and we will explain any technical terms that we introduce as we go along.

As psychologists we are committed to the essential role that objective evidence must play in deciding if and when treatments are appropriate and effective. Therefore we aim to support any claims we make by reference to well-executed clinical research studies and we will include enough information to enable you to check things out for yourself. We will have succeeded if we can provide you with sufficient information about shyness and social anxiety disorder that will help you to understand better problems of social anxiety – whether these are your problems or those of someone you know, or whether you have picked up this book simply because you have a general interest in this topic. If you want to seek professional help we should have pointed you in some directions that might be better for you to take than others would be.

What does the book cover?

Chapters 2, 3 and 4 of the book are concerned with the nature of social anxiety and shyness. We ask what these terms mean. Shyness is a common word in everyday language that conjures up a number of images. Perhaps you think of a shy child, bashful, tongue-tied, and awkward in the company of adults. Or a child who tends to play by herself, who is always at the edge of things, never quite joining in. Or you think of an adolescent, self-conscious, easily embarrassed, blushing when spoken to. Perhaps it is an adult, quiet, monosyllabic, can’t think what to say, never meets your eye, reluctant to join in social events. Or another adult, who looks forward to parties and meeting people, but is never at ease, perhaps talking too much or laughing too loudly, maybe drinking too much to keep confidence up. Whatever image you have conjured up, it will resemble the images that most other people have in mind: Shyness is to do with awkwardness and being ill at ease with other people. This raises a number of questions:

• Isn’t everybody shy?

• What is the difference between shyness and that other common type of uneasiness – embarrassment?

• Isn’t shyness an attractive characteristic?

• Am I shy? Is my shyness the same as that of other people?

• Is shyness a part of my personality?

• Can I become less shy even if I have a shy personality?

• Is shyness an illness?

• Is shyness different from social phobia?

• Can shyness be overcome?

If these questions are of interest to you, then we hope that this is the book for you and that these opening chapters will provide you with helpful answers to your questions.

These questions might be of more than interest to you. You might be desperate to find out more about the anxiety – perhaps the panic – that you feel in particular kinds of situations. These situations aren’t rare, like encountering a bear in the woods: they are everyday, routine. The thought of eating in public terrifies you. You couldn’t cope with an argument at work; or with being criticized – you would brood on it forever. You have never had a boyfriend or a girlfriend because you can’t bring yourself to ask anyone out.

It could be someone else’s shyness that makes you anxious, your child’s perhaps. You look on helplessly as he or she goes through the agonies of shyness, perhaps becoming lonely or depressed.

For some people, shyness is something they rarely think about as being of much relevance to them. Most of us are shy on at least some occasions: we know this and can cope with it. For others, shyness is something that they would change if they could. For yet others, shyness is ‘crippling’, it prevents them from living the life they want to. When your anxieties are intense and they impede social functioning and reduce the quality of your life, you may well meet the diagnostic criteria for social phobia or social anxiety disorder. This is a recognized psychiatric disorder. Twenty or so years ago it wouldn’t have been recognized as such. It might have been regarded as symptomatic of something else, for example, of panic attacks or agoraphobia, but it wouldn’t have been thought of as a condition in its own right. No specific treatments were available at that time.

Chapter 5 examines the concept of social anxiety disorder. It explains how the concept has changed over the years. It sets out the diagnostic criteria that have been agreed upon in psychiatry. It reports findings on how common it is in the population. We see that it is one of the most common disorders along with depression and alcohol problems.

The next four chapters deal in more detail with the nature of social anxiety disorder and its treatment. Chapter 6 examines the issue of diagnosis in greater detail. It begins by posing the question: How do you know if you need treatment? It examines some of the factors to take into account when deciding whether treatment for social anxiety would be valuable for the individual: impairment of effective social functioning; extreme discomfort during social events; lack of satisfaction with life; reduced opportunities for enjoyment and happiness. The chapter introduces some of the forms of psychological and pharmacological treatments that have proved to be effective. It gives advice on how you might contact sources of treatment. It discusses factors to bear in mind when choosing a form of treatment or a therapist.

Cognitive behaviour therapy has become established as the principal psychological form of therapy for a range of mental health problems including anxiety. Carefully designed clinical studies have demonstrated its effectiveness. What are cognitive processes and what role do they play in social anxiety? These questions are the focus of chapter 7. This chapter places cognitive behaviour therapy in the context of the identification of the factors that maintain anxiety. It explains that cognitive behaviour therapy places particular emphasis on the ways that socially anxious people think about themselves and social events. The chapter draws upon research and clinical observation to discuss what we know about how thinking helps to maintain anxiety symptoms and behaviours. This information helps us understand how the therapy works.

Chapter 8 describes in more detail the procedures of cognitive behaviour therapy. It emphasizes that it is a therapy based on doing as opposed to talking or thinking: it is based on practice and experimenting. A key element is that of changing safety behaviours. These behaviours are ways of coping with anxiety which we have developed that seem to us to be helpful but which are counter-productive in the long term. I am silent because I don’t want to reveal my inadequacies. This seems to work because I am never challenged and never show myself up. But at what cost? Not only am I denying myself the satisfactions that are to be found in social relationships, I am also forgoing opportunities to learn how to deal more effectively with social situations so that I never have the chance to develop confidence in myself. Also, my belief that I have inadequacies is never put to the test. What if I have been adequate all along? What if people do like and respect me for the person I am? There are similar costs whenever I avoid social situations: evasion only removes problems in the short term and is worth little in the longer term. We trust that this chapter will give you insight into cognitive behaviour therapy and enable you to make an informed choice about whether it would be the best treatment for you if you do decide to seek to overcome social anxiety or to give helpful advice to someone you know who wishes to do so.

Chapter 9 examines pharmacological treatments for social anxiety disorder. No new treatments have been developed specifically for social anxiety. Medications that have been developed for the treatment of depression have been successfully applied to the treatment of social anxiety disorder. The SSRIs are the principal class of drug that has been investigated. Treatments to reduce anxiety including beta blockers and benzodiazepines have proved less effective although they are used for the treatment of short-term anxieties about specific events, for example anxiety about giving a speech. The chapter discusses the benefits and limitations of these classes of drugs. It draws attention to any problems with their use including potential side effects. There is increasing public concern over what is regarded as the over-prescription of antidepressant drugs and their extension to social anxiety disorder; we discuss these important issues.

Chapter 10 focuses on anxiety about blushing. We don’t devote a separate chapter to this topic because we believe that it is of special significance or because it is very different from shyness or social anxiety. We do so for three reasons: (1) many people regard their blushing as a problem in its own right and believe that they would not be anxious if only they did not blush as much as they do; (2) we hope to show that the issues raised by fear of blushing are similar to those raised by social anxiety disorder, for example, safety behaviours play a prominent part in the maintenance of anxiety in both; (3) there has been growing interest in treating anxiety about blushing through the use of surgery to prevent facial reddening from taking place. We discuss the issues raised by surgical intervention.

An overview

You will see that we cover a lot of ground in this short book. We hope that it will be relevant to your concerns and that it will help you to cope with your shyness and social anxiety by:

• providing you with information on what we know about these conditions;

• allowing you to learn about the experiences of people who are shy or who suffer from social anxiety disorder;

• drawing your attention to the forms of treatment that are available, whether psychological or pharmacological;

• discussing the benefits and disadvantages of the various treatment options;

• giving information on how to contact sources of help and support.

2

What is social anxiety?

The situations that elicit anxiety

Very many people, perhaps all of us, feel uncomfortable in at least some of our interactions with other people, attendance at social gatherings, or participation in public events. Most of us would probably agree on a list of the kinds of situations that cause us the most difficulties – when we meet new people, ask someone for a date, attend social get-togethers where we don’t know anyone, speak up in front of a group by, say, giving a speech at a wedding or making a presentation at work to customers or colleagues, attend a job interview, speak to our manager in the office, complain about faulty work, or return unwanted goods to a shop.

These can be difficult situations for many, perhaps most of us. We are nervous about having to do what needs to be done, perhaps we dread these occasions when they come round and we may put off confronting them for as long as we can. So we hang around outside the boss’s door, postponing knocking on it as long as we can, or we take advantage of every opportunity to delay the meeting. We chat about the weather and everything else rather than draw the decorator’s attention to the quality of work we are not happy with; we go to other shops before we can face entering the one where we want to return the garment that doesn’t fit or the DVD player that we found to be scratched when we opened the box at home. The anticipation of these encounters can give rise to unpleasant physical sensations and we might spend a lot of time and energy rehearsing what we are going to say, practising our opening lines, thinking what to say if the decorator tells us that the work is exactly what was asked for, or the shop assistant implies that it was us who scratched the DVD player.

When we’re actually in the situation, it might be an unpleasant experience as long as it lasts. We notice ourselves sweating or trembling or we have that horrible sensation of ‘butterflies’ in our stomach. We find it difficult to find the right words to say, although lots of things we might say race through our mind. Will it sound stupid? Will I reveal my ignorance? By the time we have summoned the courage to utter a remark, the conversation has moved on. We feel ill-at-ease, self-conscious, out of place.

We experience a sense of relief when it is over. Perhaps we are disappointed that we did not stand up for ourselves better or make the points we wanted to make. Into our mind come all the clever things we should have said. We wish we had spoken up more clearly and mumbled less. What did everyone think of us? We imagine that those who were present must regard us as shy or think that we have little to contribute; for whatever reason we believe that we haven’t made a good impression and this may make it harder for us to act effectively the next time we meet them.

On the other hand, sometimes, perhaps usually, the situation turns out not to be as awful as we had feared and we overcome our initial nerves and perhaps even enjoy the experience. Yet this might not necessarily help us the next time we encounter a similar challenging situation. We will approach it again with little confidence that we will be able to cope with it and achieve what we want to. This is an experience that is common for public speakers, lecturers, or performers of different kinds. Th...

Table of contents

• Cover
• Title page
• Copyright page
• Contents
• Acknowledgements
• Series Foreword
• 1 Is this book for you?
• 2 What is social anxiety?
• 3 What is shyness?
• 4 The experience of shyness
• 5 What is social anxiety disorder?
• 6 Is treatment for you?
• 7 Psychological therapy
• 8 Overcoming social anxiety: strategies for change
• 9 Medication
• 10 Fear of blushing
• 11 Rounding things up
• Notes
• Appendix: List of websites and their contact addresses
• Index