Tools for social anxiety
I started junior kindergarten in Bradford, Ontario. I spent senior kindergarten and grade one in Bowmanville. In grade two, I went to four different schools. Between my parents’ nasty need to keep up with socio-economic appearances and the family’s perpetual dodging of insurance surveillance (men with cameras who followed my stepdad around to ensure he wasn’t lying about his disability), I was always “the new kid,” scrambling to learn the social dynamics and hierarchies of whatever fresh environment I was dropped into. There were times it seemed pointless to even try to make friends.
All of these moves made for a socially anxious childhood. I regularly dampened the louder aspects of my budding personality to fit in, didn’t have the social networks or confidence to stand up to schoolyard bullies, and often felt a lot safer just playing on my own.
But I adapted. By the time I graduated high school, I had attended eight different schools. While I still suffered from the odd episode of social anxiety, between my constant moving, summer camp, and a year spent couch-surfing, I was confident in pretty much any social setting.
As I grew into adulthood, episodes of fear related to social concerns were ranked pretty low on my list of mental health concerns, which is why I was caught so off-guard when, a few weeks ago, I experienced it with an intensity I haven’t felt since childhood. I met up with a dear friend for a park beer. This is a person I’ve known for nearly a decade, who I respect, admire and trust deeply. We had a lovely afternoon gossiping, comparing notes about Mare of Easttown, and catching up on exciting personal developments in our lives. I left the encounter feeling rejuvenated and happy.
Back home, it took less than an hour for the nasty anxious thoughts to creep in: Did I overshare? Was that thing I said really dumb? Does my friend think I’m a moron, or worse, a terrible person?
Thoughts like these, triggered by social anxiety, are probably familiar to most (if not, hey, congratulations). The National Institute of Mental Health (NIMH) defines a social anxiety disorder as an intense and persistent fear of being watched or judged by others that affects a person’s day-today activities. Social phobias are one of the most common anxiety disorders, experienced by 8 to 13 per cent of Canadians. I have a feeling social anxiety is only going to become more widespread and acute as North America begins to emerge from COVID-19–related lockdowns—when we had well over a year to let our social skills rust. In this edition of the newsletter, I’ll share skills that have helped me cope with my recent increase in social anxiety.
Please note: If you’re experiencing social phobia so severe that you’re having panic attacks, I have a separate post dedicated to coping with them.
A great way to quiet a busy and anxious mind is through meditation. Meditation is a practice that focuses the mind to achieve a mentally clear and emotionally stable state. There are many different ways to practice meditation but, when it comes to social anxiety, I find being mindful of my thoughts is particularly helpful.
When social phobias are getting the better of me, I start by finding a quiet space where I can focus on my internal self. I envision the thoughts that are coming up as miniscule versions of myself circling around my shoulders talking to me about their concerns. Then, I come back to my breath. When I focus on breathing in and out (sometimes counting off the length of my in and out breaths), all those anxious little Mirandas disappear. If they start to reappear at any point, I just go back to focusing on my breath. As I become more mindful of my breath, I can start spreading my awareness out to the present moment. What do I hear? Smell? See behind my eyelids? The more I can pull myself into the present moment, the less intense my anxious feelings become. The great part about meditation is that I can practice it anywhere at any time, and the more I practice, the more effective I become at it.
Dialectical behavioural therapy (DBT) skills for reality acceptance are also helpful for addressing social anxiety. Checking the facts, as I’ve written about before, is a DBT skill that helps determine if an emotional reaction fits the facts of a situation. By identifying beliefs or assumptions surrounding an event, it’s possible to change an emotional response.
To check the facts when I’m experiencing social anxiety, I start by identifying the emotion I want to change: shame. I focus on the event prompting my shame and challenge any judgements or black-and-white thinking patterns that arise. I’m mindful of my own interpretations, thoughts, and assumptions around the prompting event and try to see all possible sides of the situation. From there, I can label the threat. In the case of social anxiety, the threat is that someone might think less of me. The catastrophic consequences of the threat would be losing a friend or rejection. When I put my social anxiety in terms like that, I often find the emotional intensity of my anxiety doesn’t fit the facts of the situation. Even if I did say something stupid, I surround myself with supportive and nonjudgmental people who would never bail on me because of something so small.
When my feelings of shame aren’t justified, which I find is the case with most of my experiences with social anxiety, I use opposite action. In the case of my friend from the park, I told her about the feelings of shame I was experiencing (knowing I could trust her not to reject me). She assured me I had nothing to worry about and that she’d always support me, which alleviated the anxiety I was experiencing. If I do find myself in a social situation where my shame feels justified, depending on the circumstances, I either try to appease those I have offended or avoid groups or individuals that disapprove of me.
Anxiety doesn’t just exist in the mind; it lives in the body. Somatic experiencing, which I’ve written about before, is a body-oriented therapeutic model developed by Peter A. Levine to treat post-traumatic stress disorder (PTSD). Somatic experiencing can be very effective in relieving symptoms associated with trauma, like fear and anxiety.
To practice identifying and releasing anxiety in my body, I begin in a comfortable seated position with my feet on the ground, my back supported by a chair, and my shoulders relaxed. I breathe normally and focus on where I feel the anxiety in my body. Sometimes, it’s like a stone in the bottom of my stomach. Other times, it’s like there’s a bird caught in my chest. I bring my breath and focus on where I feel a physical sensation. With a moment or two of deep focus, the sensation starts to loosen or dissipate. Occasionally, images or scenes from my childhood might arise that link the sensation to a specific event. When that happens, I can explore re-negotiating traumatic memories.
Internal Family Systems (IFS)
Social anxiety, rooted in shame, has a tendency to provoke self-criticism. When I find myself in a shame spiral and am really beating myself up, I turn to Internal Family Systems (IFS), developed by Richard Schwartz, to help me practice self-compassion.
I’ve gone in-depth on IFS before, but, as a refresher, fundamental to IFS is the understanding that our personality as a whole is made up of sub-personalities or “parts.” As we go through life acquiring trauma and attachment injuries, our parts can shift from valuable states into roles that, though necessary to survive our experiences, can be destructive to us in the long-term when these “parts” become frozen in survival mode. These “parts” tend to take the following forms:
Exiles: Our most powerful of parts, exiles are young, vulnerable parts we learned to bury a long time ago because our vulnerability or vitality bothered our caretakers or peers (for a multitude of reasons). Exiles are the parts of us that tend to carry extreme beliefs, hold fears of being worthless or unlovable, and influence our ability to be intimate. Exiles also have the power to pull us into their despair, until we become their pain.
Managers: Managers are our preemptive protectors. They govern the way we interact with the world around us to try to prevent the exiles from flooding our awareness with painful and traumatic feelings.
Firefighters: These parts rush in to protect us when our exiles try to break through. They do so by distracting us with impulsive behaviours such as drug use, promiscuity, overeating, or violence.
The goal of IFS is to help these parts transform through “unburdening” or a renegotiation of extreme beliefs that came into a person’s system as a result of trauma. When a part is unburdened, it transforms back into its naturally valuable state.
Like Somatic Experiencing, IFS starts with bodily sensations. Where am I holding this shame and self-criticism? When I bring focus to the area of my body where I’m experiencing sensation, I can start to tune into my “parts” that are responsible for my social anxiety. Often there’s a manager part involved—a preemptive protector part that governs the way I interact with the world to prevent my exiled parts from flooding my feelings.The manager part is the one responsible for the self-criticism. Through its criticism, it attempts to keep me safe but it can often overdo it, which leads to social isolation. When I’m in tune with the manager part, I thank it for all the work it does to keep me safe and emotionally secure, but I ask it to step back for a moment as I would like to engage with the exiled part it’s protecting me from. I pause to take in any resistance. If I feel some, I continue to reassure the part that I’m in a state where I’m ready and capable to interact with the exile. I can even allow the manager part to watch the encounter from a distant room if that will help it feel more comfortable.
Once my manager has stepped back, I can get in touch with my exile. My exiled part responsible for my fear of rejection and shame around social settings is a child, as most exiled parts are. When I realize this, I can comfort the part in the way I would a child and hold compassionate space for the feelings the exile is experiencing. I can remove this exile to a safe and comfortable space where I can check in with it whenever my social anxiety is triggered until the exile feels it no longer has to carry the burden by itself.
I’m sure I’ll have many moments of social anxiety on the horizon as I get back to seeing friends, travelling, and reintegrating into social settings. Knowing I have the tools to navigate these situations makes the prospect of socializing far less daunting and gives me the strength I need to avoid isolating. Hopefully, these tools will be useful to others who are struggling with social anxiety as society reopens.
This issue: The Rest Cure and the West Cure
I lie down ever so much now. John says it is good for me, and to sleep all I can.
Indeed, he started the habit by making me lie down for an hour after each meal.
It is a very bad habit, I am convinced, for, you see, I don’t sleep.
And that cultivates deceit, for I don’t tell them I’m awake,—oh, no!
The fact is, I am getting a little afraid of John.
He seems very queer sometimes, and even Jennie has an inexplicable look.
The excerpt above is from Charlotte Perkins Gilman’s, “The Yellow Wallpaper,” (1892), a short story in which the female narrator slowly goes insane while enduring the “Rest Cure.” Perkins Gilman was a patient of Silas Weir Mitchell, originator of the Rest Cure, an enforced regimen of bed rest, seclusion, massage and overfeeding (his treatment was also prescribed to Virginia Woolf, who satirized it in Mrs. Dalloway). Though anyone could suffer from a diagnosis of “neurasthenia,” an ill-defined medical condition characterized by lassitude, fatigue, headache, and irritability associated with emotional disturbances, the Rest Cure was primarily prescribed to upper class white women who displayed symptoms of anxiety, postpartum depression, anorexia or could generally be regarded as “nervous.” While Mitchell made note of a patient’s short-term improvement in his book, Fat and Blood, the cure worsened the mental and physical condition of other women who received the treatment. (Studies would later show long-term bed rest has no benefits for numerous health conditions.)
Notable nervous men of the time; however, were prescribed the “West Cure '' by Mitchell, a trip out to the Western US to cattle rope, hunt, and bond with other men (notable recipients of the treatment included Walt Whitman, Owen Wister, and Theodore Roosevelt). Unlike the Rest Cure, West Cure patients typically emerged from the experience refreshed and reinvigorated. Mitchell’s treatments served to reinforce patriarchal attitudes of the time—that women belonged in the domestic sphere while men were encouraged to foster their masculinity.
Though the late 1800s may seem like ancient history, outdated societal attitudes still bleed into our present-day understanding of anxiety. Men are still less likely to seek help for anxiety, likely reinforced by stereotypical notions of masculinity. Women, though more likely to seek treatment for anxiety, are less likely than men to receive mental health services, again likely to do with preconceived gender roles.
The DBT Skills Workbook for Anxiety: Breaking Free from Worry, Panic, PTSD, and Other Anxiety Symptoms
By: Alexander L. Chapman and Kim L. Gratz
Alexander Chapman and Kim Gratz are excellent at adapting DBT skills to a range of trauma-related symptoms, and The DBT Skills Workbook for Anxiety is no exception. The workbook covers using DBT skills to cope with panic attacks, nightmares and PTSD flashbacks, obsessive-compulsive disorder, worry, and includes an entire chapter dedicated to social anxiety. Chapman and Gratz focus on accessibility, easing readers step-by-step through skills to help reduce anxiety.