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1e1491100126-0 | “Social anxiety and shyness can become so intense that they prevent people from en -
joying life. This book is ideal for anyone who wants to learn to be more comfortable
around other people. Drs. Antony and Swinson have taken proven treatments for social
anxiety and adapted them for a non-professional audience. The step-by-step strategies
described in this book have been shown to be effective, are easy to understand, and
are sure to help the reader cope better in social situations. Anyone who experiences
significant anxiety when performing or when interacting with other people should read
this book!”
— Aaron T. Beck, MD, university professor of psychiatry at the
University of Pennsylvania
“If you have trouble with social anxiety, you will find the book by Drs. Antony and
Swinson to be an excellent resource. This highly experienced duo has provided an excel -
lent road map to guide you through your efforts to overcome your anxiety and improve
the quality of your life. Based on the tried and true methods of cognitive-behavioral
therapy and on the results of many scientific studies, the techniques described in this
book will help you feel better when you are with other people or the center of atten -
tion. The only thing you have to do is work hard and apply them. Best wishes for your
journey along that road.”
— Richard Heimberg, Ph.D., director of the Adult Anxiety Clinic
of Temple University, Philadelphia
“Drs. Antony and Swinson provide practical advice in a highly readable format. This
book will be invaluable to people whose social anxiety prevents them from leading full
and happy lives.”
— Murray B. Stein, MD, professor of psychiatry and director of
anxiety and traumatic stress disorders program at the University | shyness_social.pdf |
1e1491100126-1 | anxiety and traumatic stress disorders program at the University
of California, San Diego | shyness_social.pdf |
7e3977fe64c0-0 | “This is an excellent resource written by world-renowned and skilled clinicians and
researchers in the area of anxiety disorders. Drs. Antony and Swinson present the most
up-to-date information about social anxiety and its treatment in a way that is clear and,
most importantly, that provides step-by-step tools for overcoming this disorder. This is
a must-read for persons suffering with social anxiety.”
— Michelle G. Craske, Ph.D., professor of psychology at the
University of California, Los Angeles
“This workbook by Antony and Swinson gives the millions of people whose lives are
limited by social fears the hope to control their future. The book is clear, practical, easy
to follow, and, above all, based on solid, scientific ground. The sections on troubleshoot -
ing are especially valuable to really help fine-tune the techniques. I would strongly rec -
ommend this book to anyone who is serious about overcoming their social fears.”
— Ronald M. Rapee, Ph.D., professor of psychology at Macquarie
University, Sydney, Australia, author of Overcoming Shyness and
Social Phobia
“This volume, written by a team composed of a psychologist and a psychiatrist, is an
outstanding workbook for any individual suffering from social anxiety or shyness and
wishing to undertake a structured self-help program to overcome it. The book can be
used alone or in conjunction with therapy. The authors are experts in their field and they
offer strategies that are solidly grounded in the latest research literature. The workbook
format provides readers with the exercises and worksheets they need to do the difficult
work required to overcome their shyness and social anxiety.”
— Jacqueline B. Persons, Ph.D., director of the San Francisco Bay | shyness_social.pdf |
7e3977fe64c0-1 | — Jacqueline B. Persons, Ph.D., director of the San Francisco Bay
Area Center for Cognitive Therapy and clinical professor in the
department of psychology at the University of California, Berkeley | shyness_social.pdf |
ada8c9337b94-0 | MARTIN M. ANTONY , PH.D.
RICHARD P . SWINSON, MD
New Harbinger Publications, Inc.PROVEN, STEP-BY-STEP TECHNIQUES
FOR OVERCOMING YOUR FEARTheShyness & Social Anxiety Workbook
SECOND EDITION | shyness_social.pdf |
a5db73e053bf-0 | Publisher’s Note
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and
publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express
or implied, with respect to the contents of the publication.
The authors, editors, and publisher have exerted every effort to ensure that any drug selection and dosage set forth in this text are in accordance
with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the
constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in
indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently
employed drug.
Some drugs and medical devices presented in this publication may have Food and Drug Administration (FDA) clearance for limited use in restricted
research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical
practice.
Distributed in Canada by Raincoast Books
Copyright © 2008 by Martin M. Antony and Richard P . Swinson
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
T ext design by Michele Waters
Acquired by Catharine Sutker
Edited by Carole Honeychurch
All Rights Reserved
Library of Congress Cataloging-in-Publication Data
Antony, Martin M. | shyness_social.pdf |
a5db73e053bf-1 | Library of Congress Cataloging-in-Publication Data
Antony, Martin M.
The shyness and social anxiety workbook : proven, step-by-step techniques for overcoming your fear / Martin M. Antony
and Richard P . Swinson. -- 2nd ed.
p. cm.
Rev. ed. of: The shyness & social anxiety workbook.
Includes bibliographical references (p. ).
ISBN-13: 978-1-57224-553-2 (pbk. : alk. paper)
ISBN-10: 1-57224-553-0 (pbk. : alk. paper) 1. Bashfulness--Problems, exercises, etc. 2. Social phobia--Problems,
exercises, etc. I. Swinson, Richard P . II. Antony, Martin M. Shyness & social anxiety workbook. III. Title.
BF575.B3A58 2008
158.2--dc22
2008016264 | shyness_social.pdf |
08395352697b-0 | For our students.
—MMA and RPS | shyness_social.pdf |
b52c096e8d23-0 | Contents
Acknowledgments vii
Introduction 1
Part 1 Understanding Your Social Anxiety
Chapter 1 Shyness and Social Anxiety 5
Chapter 2 Why Do You Have These Fears? 29
Chapter 3 Getting to Know Your Social Anxiety 39
Part 2 How to Overcome Social Anxiety and Enjoy Your Life
Chapter 4 Making a Plan for Change 65
Chapter 5 Medications for Social Anxiety and Social Anxiety Disorder 93
Chapter 6 Changing Your Anxious Thoughts and Expectations 107
Chapter 7 Confronting Your Fears Through Exposure 143
Chapter 8 Exposure to Social Situations 165
Chapter 9 Exposure to Uncomfortable Sensations 191
Chapter 10 Communicating More Effectively 203
Chapter 11 Maintaining Your Improvements and Planning for the Future 233 | shyness_social.pdf |
10685a3c9a76-0 | The Shyness & Social Anxiety Workbook
viRecommended Readings 239
National and International Associations Providing Referrals 245
Internet Resources 249
References 251 | shyness_social.pdf |
3c743c5d506a-0 | Acknowledgments
There are many people without whom this workbook would not have been possible.
First, we wish to acknowledge those who were instrumental in developing and investi -
gating the treatments described in this book. Dr. Aaron T. Beck pioneered many of the
cognitive strategies that are used throughout the world to treat anxiety, depression, and
many other conditions. We are also indebted to Drs. Isaac Marks, S. Rachman, Joseph
Wolpe, David Barlow, and others who helped to develop and study the exposure-based
strategies that are now commonplace for the treatment of anxiety. We also acknowledge
the important contributions of Drs. Richard Heimberg, Samuel Turner, Deborah Beidel,
David M. Clark, and others who adapted these cognitive and behavioral methods for the
treatment of social anxiety.
A special thank-you goes out to our colleagues, clients, and patients who provided
many helpful suggestions over the years that informed this second edition of The Shyness
and Social Anxiety Workbook . Finally, we wish to express our gratitude to the staff at New
Harbinger Publications (including Carole Honeychurch, Matthew McKay, Catharine
Sutker, Amy Shoup, Dorothy Smyk, and many others), who worked closely with us
through all stages of developing, editing, and marketing this book.
— Martin M. Antony, Ph.D.
Richard P. Swinson, M.D.
Toronto, Canada | shyness_social.pdf |
19c63baaf81e-0 | Introduction
Shyness and social anxiety are universal. From time to time, almost everyone has felt
nervous speaking in front of a group or anxious when interacting with another person.
We wonder if a presentation has gone well or whether we have made a good impression
on a first date or a job interview. In fact, even some celebrities, who make their living
in the public eye, have been described as excessively shy from time to time, including
Harrison Ford (actor), Mary Chapin Carpenter (singer), Michelle Pfeiffer (actor), David
Bowie (rock star), David Letterman (talk-show host), Nicole Kidman (actor), and Carrie
Underwood ( American Idol winner). There have also been reports in the media about
musical performers like Barbra Streisand, Carly Simon, and Donny Osmond suffering
from performance anxiety. Even radio “shock jock” Howard Stern has described himself
as being painfully shy when he is outside the safe confines of his on-air studio. (FYI,
details on other shy celebrities can be found at www.shakeyourshyness.com/shypeople
.htm.)
Shyness and social anxiety can range in intensity from being fairly mild to completely
incapacitating. In extreme cases, social anxiety may prevent an individual from develop -
ing friendships, working, or even standing in a public place. Regardless of whether your
fears are minor or completely overwhelming, the strategies described in this book will
help you to deal more effectively with social anxiety.
We recommend that you read this workbook in the order in which the chapters
appear. The initial chapters are designed to educate you about the nature of social
anxiety and to teach you how to evaluate the main features of your own social anxiety. | shyness_social.pdf |
19c63baaf81e-1 | anxiety and to teach you how to evaluate the main features of your own social anxiety.
Then we discuss the costs and benefits of different treatment approaches and help you to
select among available treatment options. Subsequent chapters provide detailed informa -
tion about particular treatment strategies including medications, cognitive therapy for
changing your anxious thoughts, using exposure to confront the situations you fear, and | shyness_social.pdf |
75f4a819d4cb-0 | The Shyness & Social Anxiety Workbook
2fine-tuning your communication and performance skills. The final chapter of the book
discusses strategies for maintaining your improvements.
This book is different from other self-help books in a number of ways. Of the many
books on social anxiety and shyness that you will find in your local bookstore, this was
the first to be written in a workbook format. It is filled with exercises and practices
designed to teach you basic strategies for overcoming shyness and social anxiety. We
encourage you to fill in the blank worksheets and forms located throughout the text. In
addition, we encourage you to make copies of the forms for your personal use so you
can continue to use them over the coming months.
This book also differs from many others because the strategies we recommend have
all been investigated extensively in well-designed clinical studies. In addition to specializ -
ing in helping people deal more effectively with their anxiety, we also are actively involved
in research on the nature and treatment of anxiety. It is a well-established fact that when
the techniques described in this book are used in a therapeutic setting, people generally
experience a significant decrease in their social and performance anxiety (Rodebaugh,
Holaway, and Heimberg 2004). Essentially, we have taken strategies that have proven
to be useful in therapy and adapted them into a self-help format. Recently, investigators
have also shown that our self-help approach (using the first edition of this book) can
also be effective for reducing social anxiety (Moore, Braddock, and Abramowitz 2007).
This workbook is designed so that it can be used alone or coupled with regular visits to | shyness_social.pdf |
75f4a819d4cb-1 | This workbook is designed so that it can be used alone or coupled with regular visits to
a professional therapist. In fact, a motive for writing this book was to have a good refer -
ence our own clients and patients can use as they progress through therapy.
This second edition has been thoroughly updated with the latest scientific knowl -
edge and references concerning the nature and treatment of social anxiety (for example,
the section on the genetic underpinnings of social anxiety now includes a discussion
of the Human Genome Project, which hadn’t been completed when the first edition
was published). The chapter on medications has also been revised to include the latest
information on medications that have only recently been studied for treatment of social
anxiety. Sections that were previously unclear or out of date have been completely
rewritten. We have added many new examples and several forms and diaries have been
updated and simplified. New sections have been added as well, including a discussion
of strategies for improving motivation for treatment and sections for family members
and friends of people who suffer from social anxiety. Finally, the lists of recommended
readings and Internet resources have been thoroughly updated.
The journey to overcoming your shyness and social anxiety may not be an easy one.
Some aspects of your fear will be easier and quicker to overcome than others. Also,
for every two or three steps forward, you may experience what feels like a step back.
Nevertheless, the techniques described in this book have been shown to reduce social
and performance fears in most people who use them consistently. With hard work and
perseverance, these strategies will provide you with the opportunity to make big, posi -
tive changes in your life. | shyness_social.pdf |
e1da16cd3b7f-0 | PART 1
Understanding Your
Social Anxiety | shyness_social.pdf |
d5249b4bb142-0 | CHAPTER 1
Shyness and Social Anxiety
Rachel was a twenty-six-year-old woman who worked as an assistant manager of a small
bookstore. She was referred to our Anxiety Treatment and Research Centre to get help
for intense anxiety about her upcoming wedding. Rachel wasn’t afraid of being married;
in fact, she looked forward to spending years together with her husband. She was terri -
fied of the wedding itself. The idea of being on display in front of such a large audience
was almost unthinkable. In fact, she had postponed her wedding twice before because
of her fear of being the center of attention.
Rachel’s anxiety involved more than just a fear of her wedding. She reported that
she’d always been shy, even when she was very young. When she was in high school,
her anxiety around people had become so intense that it was affecting her school life.
She was convinced that her classmates would find her dull or boring, or that they would
notice her anxiety and assume that she was incompetent. Typically, Rachel avoided doing
oral reports at school and didn’t take any classes where she felt her performance might be
observed or judged by her classmates (such as physical education). On a few occasions,
she even asked for special permission to hand in a written essay instead of doing a pre -
sentation in front of the class. Despite being an excellent student, she generally tended
to be very quiet in class and rarely asked questions or participated in class discussions.
Throughout college, Rachel found it difficult to make new friends. Although people
enjoyed her company and often invited her to parties and other social events, she rarely
accepted the invitations. She had a long list of excuses to get out of socializing with | shyness_social.pdf |
d5249b4bb142-1 | accepted the invitations. She had a long list of excuses to get out of socializing with
other people. She was comfortable only with her family and a few longtime friends, but
aside from those, she usually avoided contact with other people.
After college, Rachel began working at a bookstore, and after a short time, she
was promoted to assistant manager. She was always comfortable dealing with custom -
ers at her store, and she gradually became more comfortable talking to her coworkers. | shyness_social.pdf |
e3959aec583a-0 | The Shyness & Social Anxiety Workbook
6However, she avoided eating lunch with other staff members, and she never attended
any social events, including the company’s annual holiday party.
Rachel lived with her social anxiety for years, despite how it interfered with her
education, work, and social life. It was not until the anxiety prevented her from having
the kind of wedding she and her fiancé wanted that she decided to seek help.
Rachel’s story is not that different from those of other people who experience
intense feelings of shyness, social anxiety, and performance-related fears. The types of
anxious beliefs and behaviors that she reported are similar to those that many socially
anxious people describe. After her evaluation at our center, Rachel began a twelve-
session course of cognitive behavioral therapy (CBT) and gradually learned to cope with
her anxiety more effectively. By the end of treatment, her avoidance of social situations
had decreased significantly, and Rachel was much more comfortable in situations that
previously made her very anxious.
CBT involves (1) identifying the thought patterns and behaviors that contribute to
people’s negative feelings, such as anxiety, and (2) teaching people new ways of thinking
and behaving to better manage their anxiety. This book will teach you the strategies
commonly used in CBT for social anxiety. Before exploring those strategies, however, we
will begin this chapter in the same way we usually begin treatment with the individuals
we see in our program—with an overview of the nature of fear and anxiety in general,
and of social anxiety in particular.
ANXIETY, WORRY, FEAR, AND PANIC
Everyone knows what it feels like to be afraid. Fear is a basic human emotion. In humans, | shyness_social.pdf |
e3959aec583a-1 | fear is controlled, in part, by an area of the brain called the limbic system. The limbic system
includes some of the deepest, most primitive structures of the brain—structures shared
by many less “evolved” animals. In fact, there is reason to believe that the emotion of fear
is present across most, if not all, animal species. Most organisms display specific patterns
of behavior when confronted with danger and often these “fearful” behaviors include
forms of aggression or escape. Therefore, the intense feelings we experience when we are
exposed to an immediate danger often are called the “fight-or-flight” response.
Although most people use the terms “anxiety” and “fear” interchangeably, behav -
ioral scientists who study emotions assign somewhat different meanings to these and
other related terms (Barlow 2002; Suárez et al., in press). Anxiety is a future-oriented
feeling of dread or apprehension associated with the sense that events are both uncon -
trollable and unpredictable. In other words, anxiety is a nagging feeling that occurs when
a person believes a negative event may occur in the future and that nothing can be done
to prevent it.
People who feel anxious tend to dwell upon and ruminate about the possibility of
danger. This tendency to dwell on future negative events is called worry. Anxiety is also
associated with uncomfortable physical feelings such as arousal (for example, sweatiness,
increased pulse), tension (for instance, tight muscles), and pain (like headaches). | shyness_social.pdf |
ac9f62b7144b-0 | Shyness and Social Anxiety
7There is no question that when anxiety is too intense it can interfere with perfor -
mance; however, mild to moderate amounts of anxiety are actually helpful. If you never
became even slightly anxious under any circumstances, you probably wouldn’t bother
doing the things that must be done. Why would you bother preparing an assignment on
time, dressing nicely for a date, or eating healthy food if you weren’t concerned about
the consequences of not doing these things? In part, it is anxiety that motivates us to
work hard, prepare for challenges, and protect ourselves from possible threats.
In contrast to anxiety, fear is a basic emotion that occurs when an individual is con -
fronted with an immediate real or imagined danger. Fear leads to a sudden, intense
physiological alarm reaction that essentially has one purpose—to get the person away
from the danger as quickly as possible. When people feel fearful, their bodies go into
overdrive to ensure that escape is fast and successful. Heart rate and blood pressure
increase to transfer blood to the large muscles. Breathing quickens to improve the flow
of oxygen throughout the body. People sweat to cool off the body and perform more
efficiently. In fact, all of these symptoms of arousal and fear are designed to make escape
easier, allowing for survival in the face of danger.
Panic attack is the clinical term used to describe the experience of intense fear that
takes place even though no realistic danger is actually present. Panic attacks can be trig -
gered by specific situations that people fear (for example, giving an oral presentation,
being in a high place, seeing a snake) or they sometimes occur out of the blue, without | shyness_social.pdf |
ac9f62b7144b-1 | any obvious trigger. Panic attacks are discussed in more detail later in this chapter.
To summarize, fear is an emotional reaction to an immediate danger, whereas anxiety
is a state of apprehension about some future threat. For example, worrying about giving
a presentation that is a week away is a reflection of anxiety, whereas experiencing an
adrenaline rush while in the midst of giving a presentation is usually an example of
fear.
Here are a few points to remember:
1. Anxiety and fear are normal emotions everyone experiences from time to
time.
2. Anxiety and fear are time-limited. Even though they feel as though they
may continue forever, they always decrease over time.
3. Anxiety and fear have a helpful function in that they prepare you for future
threats and protect you from danger. So, your goal should not be to rid
yourself of all fear and anxiety. Rather, your goal should be to reduce your
anxiety to a level that no longer interferes significantly with your life.
WHAT IS A SOCIAL SITUATION?
A social situation is any situation in which you and other people are present. Social situ -
ations can include those that involve interacting with others (these are often referred to | shyness_social.pdf |
b4196a3bab12-0 | The Shyness & Social Anxiety Workbook
8as interpersonal situations ) or situations in which you are the focus of attention or might be
noticed by others (these are often called performance situations ). Examples of interpersonal
situations and performance situations that may be feared by people with high levels of
social anxiety include:
Interpersonal Situations
UÊAsking someone out on a date
UÊTalking to someone in authority
UÊInitiating or maintaining a conversation
UÊGoing to a party
UÊHaving friends over for dinner
UÊMeeting new people
UÊTalking on the telephone
UÊExpressing a personal opinion
UÊHaving a job interview
UÊBeing assertive (for example, saying no when you don’t want to do
something)
UÊReturning an item to a store
UÊSending back food in a restaurant
UÊMaking eye contact
Performance Situations
UÊPublic speaking
UÊSpeaking in meetings
UÊPlaying sports or participating in aerobics
UÊPerforming a piano recital in front of others
UÊHaving others watch you work
UÊLeaving a recorded message on somebody’s voice mail
UÊGetting married | shyness_social.pdf |
28bf1cc7af76-0 | Shyness and Social Anxiety
9UÊActing on a stage
UÊReading out loud in front of others
UÊEating or drinking in front of others
UÊUsing public bathrooms with others in the room
UÊWriting with others watching (for example, completing a form in public)
UÊMaking a mistake in public (for example, falling down, dropping your keys,
and so on)
UÊWalking or jogging on a busy street or some other public place
UÊIntroducing yourself to a group of people
UÊShopping in a busy store
WHAT IS SOCIAL ANXIETY?
Social anxiety refers to nervousness or discomfort in social situations, usually because of
fear about doing something embarrassing or foolish, making a bad impression, or being
judged critically by others. For many people, social anxiety is limited to certain types
of social situations. For example, some people are very uncomfortable in formal work-
related situations, like presentations and meetings, but are quite comfortable in more
casual situations, like parties and socializing with friends. Others may show the exact
opposite pattern, with formal work situations being easier than unstructured social gath -
erings. In fact, it’s not unusual to hear of a celebrity who is quite comfortable performing
in front of large audiences but who otherwise feels shy and nervous when interacting
with people one-on-one or in small groups.
The intensity of social anxiety and the range of feared social situations vary from
person to person. For example, some people experience fear that is fairly manageable,
whereas others are completely overwhelmed by the intensity of their fear. For some people,
the fear is limited to a single social situation (for example, using public restrooms, public | shyness_social.pdf |
28bf1cc7af76-1 | speaking), whereas for others, the social anxiety occurs in almost all social situations.
The experience of social anxiety is related to a number of common personality
styles and traits including shyness , introversion , and perfectionism . People who are shy often
feel uncomfortable in certain social situations, particularly when they involve interact -
ing with others or meeting new people. People who are introverted tend to be quieter
and more withdrawn in social situations and may prefer being alone, compared with
people who are extroverted or outgoing. However, introverted people are not neces -
sarily anxious or fearful when socializing. Finally, the trait of perfectionism is associated
with a tendency to hold overly high standards for oneself that are difficult or impossible
to meet. Perfectionism can lead people to feel anxious in public for fear that other people | shyness_social.pdf |
fcf0df9ad1c0-0 | The Shyness & Social Anxiety Workbook
10will notice their “flaws” and judge them negatively. Perfectionism is discussed again later
in this chapter.
HOW COMMON IS SOCIAL ANXIETY?
It is difficult to obtain accurate estimates of the prevalence of social anxiety because
different studies have tended to define social anxiety differently and used different ques -
tions when interviewing people about their anxiety. Nevertheless, researchers have con -
sistently found that shyness and social anxiety are common experiences. For example, in
a survey of more than 1,000 people from across the United States and elsewhere, psy -
chologist Phillip Zimbardo and his colleagues (Carducci and Zimbardo 1995; Henderson
and Zimbardo 1999; Zimbardo, Pilkonis, and Norwood 1975) found that 40 percent of
those who were asked currently considered themselves to be chronically shy, to the point
of it being a problem. Another 40 percent reported that they had previously considered
themselves to be shy. Fifteen percent more considered themselves to be shy in some
situations and only 5 percent reported that they were never shy. More recent surveys
suggest that the prevalence of shyness may be even higher (for a review of studies on
the prevalence of shyness, see Henderson and Zimbardo 1999).
Researchers have also studied the prevalence of social anxiety disorder (a condition
associated with extreme social anxiety that will be described later in this chapter). In
a recently published survey of more than 9,000 Americans (Kessler et al. 2005), about
12 percent of people reported having the necessary symptoms to receive a diagnosis of | shyness_social.pdf |
fcf0df9ad1c0-1 | 12 percent of people reported having the necessary symptoms to receive a diagnosis of
social anxiety disorder at some point in their lives. In fact, social anxiety disorder was
found to be the fourth most prevalent psychological problem in this study, after depres -
sion, alcohol abuse, and specific phobias (for example, phobias of animals, blood, needles,
heights, flying, and so on). Other researchers have found the prevalence of social anxiety
disorder to be lower than 12 percent, but almost all studies have confirmed that social
anxiety disorder is a common problem (Kessler et al., in press).
Differences Between Men and Women
Shyness and social anxiety are common across both sexes, although most studies
have found that social anxiety disorder is slightly more prevalent in women than in men
(Somers et al. 2006). There are a number of possible explanations for why women are
more likely than men to report fearing social situations. First, it’s possible that men are
actually more anxious in social situations than they are willing to admit. For example,
there is evidence from studies of other phobias that men underestimate their levels of
fear (Pierce and Kirkpatrick 1992). Also, in Western societies, women are often expected
to be more socially active than men. Therefore, men may be able to avoid certain types
of social situations more easily than women, without being harassed about their absence
and without experiencing as much social pressure from others in their day-to-day lives. | shyness_social.pdf |
b5b26d45f5be-0 | Shyness and Social Anxiety
11There also may be differences in the types of social situations that men and women
fear. One study found that men with social anxiety disorder were more fearful than
women of urinating in public bathrooms and returning items to stores, whereas women
with social anxiety disorder were more fearful than men of situations such as talking to
people in authority, public speaking, being the center of attention, expressing disagree -
ment, and throwing a party (Turk et al. 1998).
Cultural Differences
It is challenging to measure social anxiety across cultures because signs of social
anxiety in one culture may have a very different meaning in another culture. For example,
whereas some cultures may view poor eye contact as a sign of shyness or social anxiety,
other cultures often avert their eyes from contact with another as an appropriate sign
of respect. Cultures also differ with respect to their use of pauses and silence during
conversation, the preferred physical distance from others, and the appropriate tone of
voice (Sue 1990).
Despite the difficulties in measuring social anxiety across cultures, studies gener -
ally suggest that social anxiety and shyness are common across different ethnic groups.
However, it should be noted that in the United States and Canada, the majority of
people who seek treatment for social anxiety disorder tend to be white and have a
European background. Although people from nonwhite, non-European backgrounds are
just as likely to experience problems with social anxiety, they are less likely to seek help
from a mental health professional.
HOW DOES SOCIAL ANXIETY AFFECT
PEOPLE’S LIVES?
In this section, we will discuss how a person’s social anxiety can affect relationships, | shyness_social.pdf |
b5b26d45f5be-1 | In this section, we will discuss how a person’s social anxiety can affect relationships,
work and school, and other day-to-day activities. After reading each section, take a few
moments to consider how your social anxiety affects each of these areas of your life, and
then describe this in the space provided.
Relationships
Social anxiety can make it difficult for people to establish and maintain healthy rela -
tionships. It can affect all levels of relationships, from those with strangers and casual
acquaintances to those with family and significant others. For many people, even the
most basic forms of social interaction (such as making small talk, asking other people
for directions, saying hello to a neighbor) are very difficult. For such a person, dating | shyness_social.pdf |
c330020c55b8-0 | The Shyness & Social Anxiety Workbook
12may be completely out of the question. Social anxiety may be more manageable around
more familiar people, such as close friends and family—but not always. For some people,
anxiety may actually increase as a relationship becomes more intimate. Also, social anxiety
can interfere with existing relationships, particularly if a socially anxious person’s partner
wants to socialize with others on a more regular basis. The following case examples illus -
trate how social anxiety can have a negative impact on a person’s relationships.
UÊWilliam has never been in a romantic relationship. Although others have
expressed interest in dating him, he always makes excuses not to go out and
usually doesn’t return their phone calls. William desperately wants to be in a
relationship, but he just can’t find the courage to take the initial steps.
UÊCindy is generally comfortable with her male colleagues at work, and she
has several male friends with whom she socializes occasionally. However, as
her relationships with men become closer, she is increasingly fearful that the
other person will discover the “real” Cindy and reject her. She has ended
several relationships with men just as they were becoming close.
UÊJerry frequently argues with his girlfriend about his unwillingness to spend
time with her friends. Although he was quite shy and anxious when they
first started dating, recently his social anxiety has put more of a strain on
their relationship. Because of his anxiety, they have been spending a lot of
time alone while she has wanted to socialize as a couple with other people.
UÊNorm has gradually lost many of his friends over the years. For a while after
finishing high school, he kept in touch with his closest friends. However, | shyness_social.pdf |
c330020c55b8-1 | finishing high school, he kept in touch with his closest friends. However,
because of his anxiety, he often dreaded returning their calls and almost
never accepted their invitations to get together. Eventually, his friends
stopped calling him.
UÊAlison’s roommate consistently plays loud music after midnight, making it
impossible for her to sleep. Despite feeling very frustrated and angry, Alison
avoids asking her roommate to turn down her music for fear that her words
won’t come out right or that her roommate will think she is an idiot.
UÊWhen talking to people whom she doesn’t know well, Julia tends to speak very
quietly, keep her distance, and avoid eye contact. As a result, people at work
have started to leave her alone and they rarely invite her to lunch anymore.
In the space below, record the ways in which social anxiety has affected your friendships
and relationships. | shyness_social.pdf |
06980e21692d-0 | Shyness and Social Anxiety
13Education and Career
Significant social anxiety can have an impact on a person’s education and career.
It can affect the types of courses you take in school and the types of jobs you might
accept. It can also affect job performance as well as your enjoyment of school or work.
Consider the following case examples:
UÊNaveen turned down a promotion at work that involved significant super -
visory responsibilities, including chairing a weekly staff meeting and train -
ing groups of staff. Although the promotion would have provided him with
a significant increase in salary, Naveen was terrified of speaking in front
of groups, and he couldn’t even imagine being able to lead the weekly
meetings.
UÊRuth dropped out of college partway through her third year. As a fresh -
man and sophomore, Ruth had been able to be anonymous in her large
classes. However, when her classes became smaller in her junior year, she
felt increased pressure to participate in class. She began avoiding her lec -
tures and eventually left school.
UÊLen dreads going into work each day. He is terrified to speak to his cowork -
ers and avoids speaking to his boss at all costs. Although he never misses
work, Len keeps the time he must talk to others at a minimum. He rarely
takes a break for fear that others will ask him to have lunch or to spend their
breaks with him.
UÊCheryl has been out of work for two years. Although she often hears of jobs
that might be interesting, the thought of having to go through a formal inter -
view is completely overwhelming. On several occasions she has arranged for | shyness_social.pdf |
06980e21692d-1 | view is completely overwhelming. On several occasions she has arranged for
job interviews and then failed to show up because of her social anxiety.
UÊPeople at work think that Jason is a snob. He tends to be very serious, and
he speaks very little to others. Even when someone asks him a question, he
tends to answer with only one or two words. In reality, he isn’t a snob; he is
just very shy and anxious around people at work.
In the space below, record the ways in which social anxiety has affected your work or
education. | shyness_social.pdf |
7cd305b75006-0 | The Shyness & Social Anxiety Workbook
14Other Day-to-Day Activities
Just about any activity that involves contact with other people can be affected by
social anxiety. The following examples illustrate the range of situations and activities that
are often difficult for people who are socially anxious.
UÊSita avoids going shopping on Saturdays because the stores are so crowded
and she is fearful of having other people watch her. In fact, just walking
down a busy street is sometimes difficult for her.
UÊMichael screens all of his phone calls. He is very anxious when speaking to
people on the phone because he finds it is more difficult to know how they
are reacting to what he says as compared to speaking in person.
UÊKalinda has stopped going to the gym. She was finding that exercising in
front of other people was causing her too much anxiety. Instead she exer -
cises at home, where no one can see her.
UÊReid noticed a small hole in a sweater that he had just purchased. Although
he had not worn the sweater and it still had all the original tags, he was
unable to return the sweater for fear of looking foolish in front of the
salesperson.
In the space below, record the ways in which social anxiety has affected your day-to-day
functioning.
SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)
When social anxiety becomes particularly severe, it may develop into a condition known
as social anxiety disorder. Social anxiety disorder (also called social phobia ) is one of several
anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, | shyness_social.pdf |
7cd305b75006-1 | anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
Text Revision (DSM-IV-TR; American Psychiatric Association 2000). The DSM-IV-TR is
the guide used by mental health practitioners to identify and diagnose various types of
psychological problems. DSM-IV-TR diagnoses don’t tell us much about the causes of
the disorder. Instead, the disorders listed in the DSM-IV-TR are simply descriptions of
behaviors and experiences that cause interference or distress in a person’s life. In short,
they are a way of classifying emotional and psychological problems. | shyness_social.pdf |
34e4bab31fdc-0 | Shyness and Social Anxiety
15Although there is strong evidence that some of the DSM-IV-TR disorders (for
example, schizophrenia, Alzheimer’s disease) are associated with a biological dysfunc -
tion, the evidence is much less clear for other disorders. The problems listed in the
DSM-IV-TR range from severe mental illnesses to disorders that most people would
consider “bad habits.” In fact, the DSM-IV-TR even includes such problems as nicotine
dependence and impaired sleep resulting from jet lag or shift work.
If your anxiety symptoms meet the diagnostic criteria for social anxiety disorder,
that does not mean that you are sick, have a disease, or are mentally ill. What it does
mean is that you are experiencing social anxiety at a level that bothers you or interferes
with aspects of your functioning. Remember that almost everyone experiences social
anxiety, shyness, or performance anxiety from time to time. The social anxiety experi -
enced by people with social anxiety disorder is associated with the same types of anxious
thoughts and behaviors that most people experience. The difference is that people with
social anxiety disorder experience social anxiety at a more intense level, more frequently,
and often in a wider range of situations than people without social anxiety disorder.
Fortunately, social anxiety disorder responds extremely well to the types of treatment
discussed throughout this book.
Diagnostic Criteria for Social Anxiety Disorder
A diagnosis of social anxiety disorder requires that a person have an intense and
persistent fear of one or more social or performance situations. Typically, the fear is
related to anxiety over being scrutinized by others or doing something embarrassing or
humiliating. In addition, the fear must bother the individual or cause significant interfer -
ence in his or her life. In other words, a person would not receive a diagnosis of social | shyness_social.pdf |
34e4bab31fdc-1 | anxiety disorder if he or she had a strong fear of public speaking but didn’t need to speak
in front of groups and didn’t care about having the fear. On the other hand, a person
who fears public speaking and needs to speak in front of groups (for example, a school -
teacher) might be considered to have social anxiety disorder if the criteria are all met.
Social anxiety is often a feature of other problems. For example, people with eating
disorders may be nervous about having other people notice their unusual eating habits.
People who wash their hands excessively due to obsessive-compulsive disorder (OCD)
may avoid people either for fear of being contaminated by others or for fear of having
other people notice their OCD symptoms (such as frequent washing, red hands from
washing, and so on). In these examples, the social anxiety would be viewed as part of
the other problem, rather than as social anxiety disorder per se. For social anxiety dis -
order to be diagnosed as a separate problem, there must also be extreme social anxiety
that is unrelated to any other problems that are present. For example, the person might
have a general fear of looking stupid, appearing boring to others, or making mistakes in
front of other people—over and above the anxiety about having others notice his or her
compulsive washing or unusual eating habits. | shyness_social.pdf |
ee4a12bf8d0c-0 | The Shyness & Social Anxiety Workbook
16Diagnosing social anxiety disorder is a complicated task. The information outlined
in this section gives you an idea of how mental health professionals distinguish different
types of problems from social anxiety disorder. However, this overview will probably not
be enough for the purpose of self-diagnosis. If you want to be sure about whether your
symptoms meet the diagnostic criteria for social anxiety disorder, we recommend that
you see a psychiatrist or psychologist who has experience and expertise in the assess -
ment of anxiety disorders.
Unfortunately, even professionals sometimes have difficulty agreeing about whether
the diagnostic criteria for a particular disorder are met. For many people, the criteria
outlined in the DSM-IV-TR don’t fit as neatly as we might like, which makes diagnosis
especially challenging. Fortunately, the exact diagnosis isn’t always necessary for select -
ing an effective treatment. The strategies described in this book will be useful for over -
coming shyness and performance anxiety regardless of whether the full criteria for social
anxiety disorder are met.
One final note about the diagnosis of social anxiety disorder: if all of the criteria for
social anxiety disorder are met and the person is fearful of almost all social situations, the
person is said to have generalized social anxiety disorder.
THREE COMPONENTS OF SOCIAL ANXIETY
In an effort to define shyness, Cheek and Watson (1989) surveyed 180 shy individu -
als about the types of experiences that are associated with shyness and social anxiety.
Eighty-four percent of the participants’ responses to the survey fell into one of three
categories: the physical aspects of social anxiety (uncomfortable feelings and sensations),
the cognitive aspects of social anxiety (anxious thoughts, expectations, predictions), and | shyness_social.pdf |
ee4a12bf8d0c-1 | the cognitive aspects of social anxiety (anxious thoughts, expectations, predictions), and
the behavioral aspects of social anxiety (for example, avoidance of social situations).
Cognitive behavioral treatments for social anxiety encourage people to think of
their social anxiety in terms of these three components. In other words, when you feel
anxious, you should pay attention to what you feel, think, and do. Breaking down your
social anxiety into these components will help to make the problem feel less overwhelm -
ing and will set the stage for using the strategies outlined in this book.
Social Anxiety and Physical Feelings
Anxiety in social situations is often associated with a long list of physical arousal
symptoms, and some of these feelings may themselves be sources of fear and anxiety.
For example, people with elevated social anxiety are often especially fearful of symp -
toms that may be noticeable to other people, such as shaky hands, sweating, blushing,
and a trembling voice. Examples of feelings that you may experience in social situations
include: | shyness_social.pdf |
8f8d65eca45f-0 | Shyness and Social Anxiety
17UÊRacing or pounding heart
UÊBreathlessness or smothering feelings
UÊDizziness or lightheadedness
UÊDifficulty swallowing, choking feelings, or a “lump” in the throat
UÊQuivering or shakiness (for example, in the hands, knees, lips, or whole
body)
UÊBlushing
UÊNausea, diarrhea, or “butterflies” in the stomach
UÊExcessive sweating
UÊShaky voice
UÊTearfulness, crying
UÊPoor concentration or forgetting what you were trying to say
UÊBlurred vision
UÊNumbness and tingling sensations
UÊFeelings of unreality or being detached
UÊTightness or weakness in the muscles (for example, wobbly legs, sore neck)
UÊChest pain or tightness in chest muscles
UÊDry mouth
UÊHot flushes or chills
People who are socially anxious differ from one another with respect to the ways in
which they experience these feelings when they are anxious. Some people report many
different physical symptoms. Others report only a few of these feelings. In fact, some
people are not aware of any physical sensations when they are anxious.
There is also evidence that people are often unable to accurately report the inten -
sity of these sensations. People who are socially anxious often report that their physi -
cal symptoms are very intense, particularly those symptoms that might be visible to
other people. This is, however, often not the case. For the majority of people who are | shyness_social.pdf |
8f8d65eca45f-1 | socially anxious, their symptoms are much less noticeable than they think. For example,
a study by Mulkens, de Jong, Dobbelaar, and Bögels (1999) found that when socially
anxious individuals are exposed to a stressful social situation, they are more likely than
nonanxious individuals to believe that they are blushing. However, the study also found | shyness_social.pdf |
d8e32885d349-0 | The Shyness & Social Anxiety Workbook
18that there were no differences between socially anxious and nonanxious people with
respect to the actual intensity of blushing.
Although in most cases people’s anxiety symptoms are less noticeable than they
think, there is no question that a small number of individuals have a tendency to blush,
shake, or sweat that is clearly excessive and may actually be quite noticeable to other
people. In other words, some people blush easily and others don’t. Some people have
shakier hands than others, and some people perspire more than others. However, not
everyone who blushes, sweats, and shakes excessively also experiences intense fear when
around other people. In fact, many people are not terribly concerned about experiencing
these symptoms in front of other people.
In other words, experiencing these symptoms is not the problem. Rather, it is your
beliefs about the meaning and possible consequences of these symptoms that contributes
to your social anxiety. If you didn’t care whether other people noticed your physical
anxiety symptoms you would probably be much less anxious in social and performance
situations. Furthermore, you would probably experience fewer of these uncomfortable
symptoms.
Not surprisingly, the physical sensations that you experience when you are anxious
or fearful are similar to those that you experience during any intense emotion, including
excitement and anger. The differences between fear, excitement, and anger manifest not
so much in the way they feel physically, but rather in the types of thoughts and behav -
iors associated with each of these emotions. It is to these aspects of social anxiety that
we now turn our attention.
Social Anxiety and Thinking
Strictly speaking, people don’t react emotionally to the situations and events in their | shyness_social.pdf |
d8e32885d349-1 | Strictly speaking, people don’t react emotionally to the situations and events in their
lives. Rather, they react to their beliefs and interpretations concerning these events and
situations. In other words, given an identical situation, different people might have com -
pletely different emotional responses, depending on their beliefs about the situation.
Consider the following example. Imagine that you have interviewed for a job and are
waiting to hear about the outcome of the interview. You were told that you would hear
within a week. Two weeks have passed, and you still haven’t heard from anyone about
whether you were selected for the position. How would you feel? What emotions would
you be experiencing? Well, you might be nervous if you thought the lack of a call was a
sign that you didn’t get the job. On the other hand, if you thought no call was a sign that
decisions had not yet been made, you might feel more optimistic. You might be angry if
you believed that the interviewer was treating you disrespectfully by not calling.
Often our beliefs are accurate; however, sometimes our beliefs are exaggerated or
incorrect. For example, some people who are socially anxious are quick to assume that
another person doesn’t like them just because he or she seems uninterested during a
conversation. In reality, there are many reasons why a person might look uninterested
when talking to you. Some of these include: | shyness_social.pdf |
7fbf9f2a02f4-0 | Shyness and Social Anxiety
19UÊThe other person is not interested in the topic of the conversation but still
likes you as an individual.
UÊThe other person is hungry.
UÊThe other person is in a hurry (for example, he or she is late for an
appointment).
UÊThe other person is tired.
UÊThe other person is feeling sick or unwell.
UÊThe other person is shy or socially anxious.
UÊThe other person is thinking about something stressful that happened earlier
in the day.
UÊThe other person is worrying about something that is coming up.
UÊThe other person is someone who generally doesn’t enjoy conversations.
UÊThe other person is someone who always looks somewhat uninterested,
even when he or she is having a good time.
UÊYou are incorrectly assuming that the other person is uninterested even
though he or she is showing all the usual signs of interest.
If you are anxious in social situations, the chances are that you are either interpret -
ing the situations as threatening in some way or are predicting that something negative
is likely to occur. The more often you experience social or performance anxiety, the
more often you probably engage in this style of anxious thinking. We will provide a more
detailed discussion of the role of thoughts in social anxiety in chapter 6. For now, here
are common beliefs held by people who are socially anxious:
UÊIt’s essential that everyone likes me.
UÊIf someone doesn’t like me, it means I am unlikable.
UÊIf someone rejects me, I deserve it.
UÊPeople should always be interested in what I am saying. | shyness_social.pdf |
7fbf9f2a02f4-1 | UÊPeople should always be interested in what I am saying.
UÊPeople should never have a disapproving or bored look on their face when
I am talking.
UÊPeople should never talk about me behind my back.
UÊIf I make a mistake at work, I’ll get fired. | shyness_social.pdf |
002445c6c20a-0 | The Shyness & Social Anxiety Workbook
20UÊPeople will be angry with me if I make a mistake.
UÊI’ll make a fool of myself if I give a presentation.
UÊPeople can tell when I’m nervous.
UÊPeople find me unattractive, boring, stupid, lazy, incompetent, weird, weak,
and so on.
UÊPeople are untrustworthy, judgmental, and nasty.
UÊI should be able to hide my anxiety symptoms.
UÊIt’s awful to blush, shake, or sweat in front of others.
UÊIf my hands shake at work, it will be a disaster.
UÊAnxiety is a sign of weakness.
UÊI should not appear anxious in front of others.
UÊI won’t be able to speak if I’m too anxious.
Social Anxiety and Behavior
The most common behavioral response to feeling anxious or frightened is to either
avoid the anxiety-provoking situation completely or to do something else to reduce the
anxiety as quickly as possible. The reason people engage in these behaviors is because
they are very effective at reducing discomfort— in the short term . However, in the long
term, these behaviors have the effect of maintaining fear and anxiety in social situations
because they prevent people from learning that their anxiety-provoking predictions are
unlikely to come true. Following are some examples of behaviors that people often use to
reduce their anxiety in social situations. Notice that some of these are examples involv -
ing complete escape or avoidance. However, other examples involve partial avoidance,
efforts to reduce anxiety, or attempts to protect oneself in the situation. These behaviors
are often called safety behaviors , because they are carried out in an effort to feel safer in
the feared situation: | shyness_social.pdf |
002445c6c20a-1 | the feared situation:
UÊTurning down an invitation to a party
UÊMaking an excuse not to have dinner with a friend
UÊNever answering questions in class
UÊAlways arriving late for meetings and leaving early in order to avoid making
small talk | shyness_social.pdf |
3da2a91bd7f9-0 | Shyness and Social Anxiety
21UÊOffering to help with the dishes at a party in order to avoid talking to the
guests
UÊMaking an excuse to get off the telephone with a friend or coworker
UÊDistracting yourself from your anxious thoughts
UÊHaving the room dark during your presentation in order to keep the audi -
ence focused on the slides rather than on you
UÊFilling out a check before arriving at a store in order to avoid having to write
in front of others
UÊAvoiding eye contact and talking very quietly during conversations with
others
UÊWearing makeup and a turtleneck sweater to hide your blushing
UÊAlways attending the office holiday party with a close friend, spouse, or
other safe person, even though other guests usually attend alone
UÊAlways arriving for meetings early to ensure that it will not be necessary to
enter the room after everyone else is already seated
UÊHaving a couple of glasses of wine before meeting another person for a
date
Interactions Among the Three Components
The cycle of fear and anxiety can begin with any of the three components we’ve
just discussed. For example, you may be talking to a colleague at work when you notice
yourself perspiring slightly (physical component). That may lead to anxious thoughts
about whether your colleague is noticing your sweaty brow and wondering if there is
something wrong with you (cognitive component). As your anxiety increases, the inten -
sity of your physical sensations increases and you continue to think anxious thoughts.
Eventually, you may make an excuse to leave the situation (behavioral component).
Alternatively, the cycle may begin with the cognitive component. For example, | shyness_social.pdf |
3da2a91bd7f9-1 | Alternatively, the cycle may begin with the cognitive component. For example,
before giving a presentation, you may tell yourself that you are going to lose your train
of thought and that others will notice how uncomfortable you are. You imagine that the
others will interpret your discomfort as a sign of weakness (cognitive component). As
you continue to dwell on these anxious thoughts, you notice your face beginning to feel
flushed and your heart rate increasing (physical component). Finally, you make a decision
to read your presentation word for word to be sure that your anxiety doesn’t cause you
to lose your place during the presentation (behavioral component). | shyness_social.pdf |
d2ad18327977-0 | The Shyness & Social Anxiety Workbook
22Finally, the cycle may start with the behavioral component, namely avoidance and
safety behaviors. By putting off getting together with friends for a long time (behavioral
component), you are more likely to experience anxious thoughts (cognitive component)
about what might happen when you do see them, as well as uncomfortable physical
feelings when you are actually in the situation (physical component). Although avoiding
anxiety-provoking situations can be comforting in the short term, it also can have the
effect of making the situation even more uncomfortable when you finally confront it.
The longer you put off an unpleasant task, the harder it is to start the task when you
finally decide to do it.
Exercise: Components of Social Anxiety
Over the next week or so, photocopy and use the Three Components of Social Anxiety
Monitoring Form (found at the end of this chapter) to record your anxiety in terms
of the three components of fear. Try to complete the form each time you encounter
a feared social situation (if possible, at least three times in the next week). In the first
column, record the situation (including time and place). In the second column, record
the intensity of your fear using a scale from 0 (no fear) to 100 (maximum fear). In the
third column, record the physical sensations that you experienced in the situation. In the
fourth column, record any anxiety-provoking thoughts or predictions that you are aware
of regarding the situation. Finally, in the fifth column, record any avoidance behaviors or
any other anxious behaviors used to reduce your anxiety. In addition to the blank form,
a sample completed form is included.
OTHER PROBLEMS AND FEATURES | shyness_social.pdf |
d2ad18327977-1 | a sample completed form is included.
OTHER PROBLEMS AND FEATURES
Social anxiety is often associated with other problems. These may include panic attacks
in social situations, excessively high standards and perfectionism, depressed mood, a
negative body image, substance abuse, or difficulty trusting others. We will now discuss
each of these associated difficulties.
Panic Attacks
If you experience intense social anxiety, the chances are good that you have had
panic attacks in social and performance situations. As discussed at the beginning of
this chapter, a panic attack is a rush of fear that occurs in the absence of any realistic
danger. According to the definition of a panic attack, the fear must peak within ten | shyness_social.pdf |
840e8bf29048-0 | Shyness and Social Anxiety
23minutes, although it usually peaks immediately or within a few seconds. Also, to meet
the full criteria for a panic attack, there must be at least four symptoms from a list
of thirteen, including racing heart, chest discomfort, dizziness, breathlessness, shaking,
stomach discomfort, sweating, choking feelings, hot flashes or chills, feelings of unreality
or detachment, numbness or tingling, and fears of dying, going crazy, or losing control.
For those who suffer from social anxiety, panic attacks tend to be triggered by
exposure to feared social situations or even just thinking about being in a feared situa -
tion. In addition, people who are socially anxious are often fearful of experiencing panic
symptoms. Because panic-attack symptoms are often incorrectly viewed as a sign that
one is about to lose control, it’s no wonder that people who are socially anxious would
want to avoid having panic attacks in front of others. Even though people who experi -
ence panic attacks often are afraid of losing control, going crazy, fainting, having a heart
attack, or experiencing some other physical or social catastrophe, such consequences
are extremely unlikely. In other words, panic attacks are uncomfortable, but they aren’t
dangerous. In fact, the symptoms often are not even noticeable to other people.
Perfectionism
Research from our organization (Antony et al. 1998) and elsewhere has found that
social anxiety is associated with elevated levels of perfectionism. Perfectionists hold
standards that are unrealistically high and overly rigid. They may have exaggerated con -
cerns about making mistakes and often go out of their way to ensure that mistakes are
avoided.
In social anxiety, people tend to place too much importance on making a perfect | shyness_social.pdf |
840e8bf29048-1 | In social anxiety, people tend to place too much importance on making a perfect
impression on others. If they are not guaranteed to be approved of by others, they may
feel very anxious in social situations or avoid socializing altogether. Perfectionism is
different from simply having high standards. High standards are often useful because
they motivate us to work hard and succeed. In the case of perfectionism, however, the
standards are so high and so inflexible that they actually interfere with performance by
causing a person to overprepare for tasks (for instance, spending hours rehearsing a pre -
sentation), procrastinate (such as putting off preparing for a presentation), or be overly
critical of his or her own performance.
Depression
Given the impact of social anxiety on a person’s functioning, it is no wonder that
a substantial number of people with social anxiety disorder also experience depression.
Severe social anxiety can lead to isolation, loneliness, and deep sadness. Social anxiety
disorder can prevent a person from living up to his or her potential, which, in turn, can
lead to feelings of hopelessness and depression. Depression can also increase the severity
of social anxiety. | shyness_social.pdf |
a06616b87cc2-0 | The Shyness & Social Anxiety Workbook
24People who are depressed are often embarrassed about feeling down, may assume
that others don’t want to be around them, and may avoid being around other people.
Social anxiety and depression are associated with similar thought patterns as well—
specifically, negative thoughts about oneself and about one’s relationships. Finally, there
is reason to think that social anxiety disorder and depression may be related to similar
biological processes in the brain. In fact, the treatments discussed in this book (including
both psychological treatments and medications) have been shown to be useful for both
anxiety and depression.
Body Image Problems
People who are unhappy with their physical appearance may feel anxious when
socializing or being watched by others. For example, people with eating disorders such
as anorexia nervosa and bulimia nervosa may avoid activities that involve eating in front
of others or showing their bodies (such as wearing shorts, swimming, or exercising in
public). People who are overweight may also be concerned about having their physical
appearance judged negatively by others. In fact, dissatisfaction with any aspect of one’s
physical appearance (for example, losing your hair, not liking your nose, and so on) can
lead some people to experience social anxiety.
Substance Abuse
Some people who experience excessive levels of social anxiety use alcohol or other
drugs to help cope with social situations. In most cases, this may involve only having an
extra glass of wine at a party or having a beer when eating out with friends. However,
for some people, using alcohol or drugs to manage anxiety can become a problem if
the drug or alcohol use becomes excessive. If you frequently use excessive amounts of
alcohol or other drugs to feel more comfortable in social situations, it may be important | shyness_social.pdf |
a06616b87cc2-1 | alcohol or other drugs to feel more comfortable in social situations, it may be important
to address this issue at the same time that you are working on your social anxiety.
Anger and Mistrust of Others
In addition to fearing negative judgment from others, some people with high levels
of social anxiety may also have difficulty trusting others. They may avoid confiding
in others, not only for fear of being judged, but also because they’re afraid that other
people will not be able to keep a secret. Social anxiety is also sometimes associated with
elevated levels of anger and irritability. For example, some people with social anxiety
disorder may become very angry or hostile when being looked at by others. They may
also become angry at perceived rejections by other people. | shyness_social.pdf |
7cea094fbb54-0 | Shyness and Social Anxiety
25OVERCOMING SOCIAL ANXIETY
Two general approaches have been shown to be useful for overcoming social anxiety:
psychological strategies and medications. We’ll discuss each of these briefly.
Psychological Strategies
Although there are many different types of psychotherapy practiced by mental
health professionals, there are only a small number of strategies that have been shown to
be effective for reducing social anxiety in a relatively brief amount of time. The chapters
in this book discuss three general approaches that repeatedly have been shown to be
effective for treating social anxiety disorder:
1. Exposure-based strategies will teach you to approach feared situations grad -
ually, over and over again, until they no longer provoke fear.
2. Cognitive strategies will be used to help you to identify your anxiety- provoking
thoughts and to replace them with more realistic ways of thinking.
3. Instruction in basic communication skills will teach you to communicate
more assertively, meet people more easily, give effective presentations, and
use nonverbal communication appropriately.
Medications
There are a number of medications that have been shown to be effective for decreas -
ing social anxiety. These include a range of antidepressants as well as certain tranquil -
izers. As long as the person continues to take the medication, these treatments are about
as effective as the psychological strategies discussed in this book. For some people, the
combination of medication and psychological treatment is the most effective approach.
In chapter 5 we will discuss the benefits and costs of using particular medications for
treating your social anxiety. | shyness_social.pdf |
c96aa2c8e14f-0 | The Shyness & Social Anxiety Workbook
26
Three Components of Social Anxiety Monitoring Form
Place/Situation/TimeFear
(0–00)Physical Feelings Anxiety-Provoking Thoughts Anxious Behaviors | shyness_social.pdf |
2ced573ae374-0 | Shyness and Social Anxiety
27Three Components of Social Anxiety Monitoring Form—Completed Sample
Place/Situation/TimeFear
(0–100)Physical Feelings Anxiety-Provoking Thoughts Anxious Behaviors
At a party on Tuesday night;
I said to Mike, “It’s been ages
since I saw you last,” and he
responded by reminding me
that I just saw him last week!90 Heart racing, sweating,
shaking, short of breathI can’t believe I said that! Mike must
think I’m an idiot for forgetting that I
just saw him. Maybe he thinks I don’t
care enough to remember him. He must
notice that I am a nervous wreck!Apologized to Mike about 5 times, and
then went to the bathroom to get away
from him. After about 10 minutes, I
made an excuse and left the party.
Wednesday evening. Preparing
for a brief
presentation on Friday.70 Heart racing, muscle tightness I will lose my train of thought. People
will think I am incompetent. I will lose
my job if I blow this presentation.
Had two glasses of wine to calm down.
Rehearsed my presentation about 20
times. Asked a coworker to present with
me.
Saturday afternoon. Walking
through the mall.50 Feeling flushed, palms are
sweaty, heart is racingPeople are staring at me. They can tell
I’m anxious. They are probably think -
ing I look funny or that I walk funny.
I avoided eye contact with other people.
After about 5 minutes, left the mall,
even though I hadn’t finished my
shopping! | shyness_social.pdf |
069e88fda38e-0 | CHAPTER 2
Why Do You Have
These Fears?
BIOLOGICAL FACTORS
As with any emotion or personality trait, our biology affects the tendency to experience
anxiety in social situations (Mathew and Ho 2006). Biological processes such as natural
selection or evolution, genetics, brain activity, and alterations in the levels of certain
neurotransmitters in the brain may all contribute to social anxiety. We’ll discuss each of
these in this section.
Natural Selection: The Evolutionary Function of
Social Anxiety
Natural selection is the process by which members of a species who are best able
to adapt to their environments are the most likely to reproduce successfully, thereby
causing the species to evolve gradually and to survive over a long period of time. It
makes sense that through natural selection, those among us who are most fit and healthy
might be more likely to survive and to reproduce than those who are less so. However,
several authors have argued that many of the illnesses from which humans suffer may also | shyness_social.pdf |
9551c461b8f3-0 | The Shyness & Social Anxiety Workbook
30have developed according to the same laws of natural selection that are thought to have
guided the more “positive” aspects of human evolution (Moalem and Prince 2007; Nesse
and Williams 1994).
For example, in their book, Why We Get Sick: The New Science of Darwinian Medicine , Drs.
Randolph Nesse and George Williams discuss how a number of uncomfortable condi -
tions such as sneezing from allergies, suffering from colds or fevers, and experiencing
pain from injuries all serve to protect us from potential dangers. The same processes that
lead to allergies, colds, and fever also help the body to rid itself of potentially danger -
ous toxins and parasitic viruses. Likewise, pain following an injury is a warning sign that
prevents us from moving our bodies in ways that could worsen the injury.
Might anxiety also improve our chances of survival? As we mentioned in chapter
1, the fight-or-flight response associated with fear and panic protects us from potential
danger. When we are afraid, our bodies quickly become mobilized either to meet the
danger head on or to escape from the danger as quickly as possible. All of the sensations
that we experience when we are frightened (for instance, increased pulse, faster breath -
ing, sweating, hyperventilation, and so on) are designed to help us meet the physical
demands of confronting the threat (fighting) or escaping to safety (flight).
From an evolutionary perspective, it makes sense that we humans would develop
a propensity for experiencing social anxiety. We are social beings, and as such, we are
very much dependent on those around us. None of us could survive without the help of | shyness_social.pdf |
9551c461b8f3-1 | very much dependent on those around us. None of us could survive without the help of
others. As infants and children, we are completely dependent on our parents for food,
shelter, comfort, and education. As we grow up, we continue to depend on other people.
We depend on our employers to provide us with money for food and shelter. We depend
on other people to build our homes, grow our food, heal our injuries, entertain us,
and to help us meet most of our day-to-day needs. Because of our dependence on one
another, we learn at a very young age that it is important to get along well with people.
Essentially, we want other people to like us. After all, consistently making a bad impres -
sion on other people might lead to isolation, unemployment, and many other negative
consequences.
Feeling anxious in social situations serves to remind each of us to pay attention to
the effects our behavior has on those around us. If we didn’t think about the impact of
our behavior on others, we would probably get into trouble more often than not. We
wouldn’t bother dressing nicely or being polite. We might always say exactly what’s on
our mind without considering whether it might be hurtful. Feeling anxious in social
situations protects us from offending other people and from doing things that might
lead others to judge us in negative ways. So, not only is it normal to feel shy or socially
anxious from time to time, it is also helpful.
Of course, social anxiety and shyness are not always helpful. Extreme social anxiety
may lead to impaired concentration, which, in turn, can cause a person to make more
errors at work or school. In addition, socially anxious people often avoid taking social | shyness_social.pdf |
9551c461b8f3-2 | errors at work or school. In addition, socially anxious people often avoid taking social
risks and may therefore find it difficult to make friends or to find work. Whereas mild to
moderate levels of social anxiety are completely normal and potentially helpful, extreme
social anxiety can interfere with a person’s functioning. | shyness_social.pdf |
df83b63cb48f-0 | Why Do You Have These Fears?
31So, from an evolutionary perspective, people with social anxiety disorder do not
have an illness, per se. Rather, they have too much of a good thing . Social anxiety is helpful in
small doses, but when it is too intense, it can make life more difficult.
Genetics and Social Anxiety
Social anxiety disorder appears to run in families. For example, a study by Stein,
Chartier, Hazen, Kozak, et al. (1998) found that having a close relative (for example, a
parent, sibling, or child) with generalized social anxiety disorder (extreme anxiety in most
social situations) made an individual ten times as likely to have social anxiety disorder,
compared with individuals who didn’t have a socially anxious relative. In contrast, more
narrowly focused social fears (for example, a fear of public speaking only) were less likely
to run in families.
Of course, the existence of social anxiety disorder in multiple family members does
not necessarily mean that the social anxiety is transmitted by genes. Environmental
factors (for example, learning from one’s parents and siblings) can also contribute to
the family members sharing certain behaviors and tendencies. To tease out the effects
of genetic influences from the effects of environment and learning, scientists have relied
on three main types of studies:
1. Twin studies. Twin studies examine the frequency of a problem across pairs
of identical twins (twins who are 100 percent genetically identical) vs. pairs of
fraternal twins (twins who share, on average, 50 percent of their genetic mate -
rial). Because twin pairs tend to be raised in similar environments regardless | shyness_social.pdf |
df83b63cb48f-1 | rial). Because twin pairs tend to be raised in similar environments regardless
of whether they are identical twins or fraternal twins, a higher social anxiety
concordance rate in identical twins than in fraternal twins is thought to be
evidence that genetics may have played a larger role in the development of
the social anxiety (the term concordance rate refers to the probability of one
person having a particular problem if his or her twin also has the problem).
2. Adoption studies . In adoption studies, scientists interview both the bio -
logical parents and the adoptive parents of people who were adopted as
children and who also have the particular problem being studied. If the
researcher finds that social anxiety disorder occurs much more frequently in
the biological parents of the socially anxious adoptees than in the adoptive
parents, it suggests that genetics may be more important than environment.
Although adoption studies have been used to study the role of genetics
in various disorders and illnesses, this approach has not yet been used in
research on social anxiety disorder.
3. Molecular genetics studies . In 2003, scientists completed the Human
Genome Project, which involved mapping all of the genes in human DNA
and determining the sequences of the 3 billion chemical base pairs that | shyness_social.pdf |
85ff3e5e111b-0 | The Shyness & Social Anxiety Workbook
32make up human DNA. This work has made it possible for scientists to study
particular genes that may be involved in the development of social anxiety
disorder and many other conditions, using research methods known as
linkage studies and association studies .
So, what do we know about the role of genetics in social anxiety disorder? Most of
the studies to date on genetics and social anxiety disorder have been twin studies (for
instance, Kendler, Karkowski, and Prescott 1999; Kendler et al. 2001; Stein, Jang, and
Livesley 2002), and there has also been a small number of molecular genetics studies (for
example, Lochner et al. 2007). Generally, twin studies have found modest to moderate
levels of heritability for social anxiety disorder, suggesting that although genetics plays a
role, other factors such as a person’s environment and experiences are also very impor -
tant. Molecular genetics studies are just beginning in the area of social anxiety, and over
time they should help to uncover which genes are most important in the development
of this problem.
Two personality traits closely related to social anxiety appear to be heritable as well,
with heritability estimates (the extent to which the transmission of a trait across generations is
due to genetics) being close to 50 percent across a wide range of studies (Plomin 1989).
One of these traits, called neuroticism , is a general tendency to feel distressed, anxious,
nervous, and worried. The other trait, called introversion , is a tendency to be inwardly
focused and socially withdrawn. Not surprisingly, shyness and social anxiety tend to be | shyness_social.pdf |
85ff3e5e111b-1 | focused and socially withdrawn. Not surprisingly, shyness and social anxiety tend to be
associated with both of these personality styles (Briggs 1988). Recently, researchers have
started to use molecular genetics studies to identify specific genes that may contribute
to traits such as introversion (Stein, Schork, and Gelernter 2004).
If genetics does play a role in causing social anxiety, does that mean that social
anxiety cannot be changed? Not at all. Our genetic makeup affects just about every
aspect of who we are, including physical fitness, academic ability, depression, weight,
personality, and even our interests and hobbies. Yet we all know that our behavior and
experiences still play an important role in determining our behavior and performance in
these various domains.
For example, regardless of whether you are genetically predisposed to be athletic,
training hard will improve your athletic ability. Furthermore, the environment (for
example, the exercise habits that you learn while growing up) may have a profound effect
on whether you exercise regularly as an adult. Still, there are differences between people
with respect to how hard they must train to become physically fit. For some people, it
comes easier than for others—in part, because of their genetic makeup.
The same reasoning holds true for social anxiety. A genetic predisposition to have
high levels of social anxiety and shyness simply means that you may have to work harder
at overcoming the problem than someone who doesn’t have such a tendency. | shyness_social.pdf |
ae30197789a4-0 | Why Do You Have These Fears?
33Effects of the Brain and Neurotransmitters
Compared with other psychological problems, including other anxiety disorders,
studies examining the biological factors underlying social anxiety often have failed to
obtain significant findings. For example, research examining hormonal factors, sleep pat -
terns, and heart functioning has often failed to find differences between people with
social anxiety disorder and people without significant social anxiety.
However, a number of studies have found increased levels of activity in particular
parts of the brain during periods of social anxiety. For example, scientists have found
that people with social anxiety disorder experience increased activity in a part of the
brain called the amygdala when looking at pictures of harsh faces (Phan et al. 2006; Stein
et al. 2002; Straube et al. 2004). The amygdala is part of the limbic system and is activated
when we experience the emotion of fear. During public speaking, there also appears
to be more activation in the amygdala among people with social anxiety disorder than
among people without this problem (Phan et al. 2006).
As reviewed by Britton and Rauch (in press), other areas of the brain that have been
found to be activated during social anxiety include the anterior cingulate cortex (an area that
is involved in controlling emotions, thought, and heart rate, among other functions), the
medial prefrontal cortex (a section of the brain that is involved in complex cognition, per -
sonality expression, and social behavior), the insular cortex (a section of the limbic system
that is involved in the experience of basic emotions, including fear), and the hippocampus | shyness_social.pdf |
ae30197789a4-1 | that is involved in the experience of basic emotions, including fear), and the hippocampus
(a part of the limbic system that controls memory and spatial abilities). Furthermore,
treatment of social anxiety with either cognitive behavioral therapy or medication leads
to reductions in activity in the amygdala and hippocampus (Furmark et al. 2002).
Studies examining the role of neurotransmitters (the chemicals responsible for
transmitting information throughout the brain) in social anxiety have yielded mixed
results (McCabe and Antony, in press). Some studies suggest that the neurotransmitter
dopamine may be involved in social anxiety, whereas other studies have failed to replicate
these findings. Studies regarding the role of serotonin (another neurotransmitter) have
also yielded mixed findings. However, medications that work on the serotonin system
have consistently been found to be helpful for decreasing the symptoms of social anxiety
disorder (more on this in chapter 5).
PSYCHOLOGICAL FACTORS
In addition to biology, people’s experiences and beliefs also contribute to whether they
develop difficulties with social anxiety and shyness. The ways in which learning and
beliefs contribute to social anxiety are discussed in this section. | shyness_social.pdf |
0f57cdc9cfaa-0 | The Shyness & Social Anxiety Workbook
34How Learning Contributes to Social Anxiety
A large number of studies suggests that learning plays an important role in the
development of fear. We learn to fear objects and situations through three main routes
(Rachman 1976). First, directly experiencing a trauma or some negative consequence in
a particular situation can lead to fear. For example, being bitten by a dog can teach a
person to be afraid of dogs. Second, observing other people who are afraid of a situation
can teach a person to be nervous. So, people may be more nervous behind the wheel
of a car if they grew up with a parent who was an anxious driver. Finally, hearing or
reading about the dangers of a particular situation can help to cause or maintain a per -
son’s fear. For instance, reading about airline crashes can help to strengthen a person’s
fear of flying.
LEARNING BY DIRECT EXPERIENCE
A history of negative experiences in social situations can increase a person’s shyness
and social anxiety. For example, in a study from our center, people with social anxiety
disorder were more likely to describe a history of severe teasing in childhood than were
people with other anxiety problems (McCabe et al. 2003). In addition to teasing, other
examples of social traumas include:
UÊBeing bullied by other children while growing up
UÊHaving parents, friends, teachers, or employers who are overly critical
UÊDoing something embarrassing in a social situation (such as making an
obvious mistake, vomiting, having a panic attack, and so on)
In the space below, list examples of negative consequences that you have experi -
enced in social situations that may have contributed to or helped to maintain your social
anxiety. | shyness_social.pdf |
0f57cdc9cfaa-1 | anxiety.
Examples of Negative or “Traumatic” Experiences That May Have Contributed to
My Social Anxiety | shyness_social.pdf |
9daf18b63412-0 | Why Do You Have These Fears?
35LEARNING BY OBSERVING OTHERS
Observation is a powerful way of learning to fear specific objects and situations. This
form of learning (also called vicarious learning ) includes developing a fear by observing role
models who themselves are anxious in social situations. Another form of observational
learning involves witnessing another person experience a trauma in a social situation.
Examples of observational learning experiences that could lead to the development of
social anxiety include:
UÊGrowing up with family members who are very shy and who rarely
socialize
UÊWatching a classmate be severely criticized by a teacher following a
presentation
UÊSeeing coworkers become very anxious while giving presentations
UÊWitnessing a friend being teased by other students at school
In the space below, list examples of observational learning experiences that may have
contributed to or helped to maintain your social anxiety.
Examples of Observational Learning Experiences That May Have Contributed to
My Social Anxiety
LEARNING THROUGH INFORMATION AND INDIRECT MEANS
People can learn to fear social situations by reading about or being warned about the
dangers of making a bad impression on others. Examples of situations that could lead to
developing social anxiety through the transmission of information include:
UÊBeing repeatedly told by parents that it is very important to always make a
good impression
UÊBeing exposed to messages in magazines and on television that your image
is the most important thing about you, and that you are only as attractive
as other people think you are | shyness_social.pdf |
4c6b1b735879-0 | The Shyness & Social Anxiety Workbook
36In the space below, list examples of informational learning experiences that may have
contributed to, or helped to maintain, your social anxiety.
Examples of Indirect or Informational Learning Experiences That May Have
Contributed to My Social Anxiety
Why Only Some People Develop Extreme Social Anxiety
Although negative experiences, observational learning, and informational learning
are common routes by which people develop fears, they are not enough to explain why
some people develop social anxiety and others don’t. Almost everyone is exposed to
negative experiences in social situations. At one time or another most of us are teased.
We are all exposed to anxiety-provoking messages at home, as well as through the media.
And yet, not everyone develops a problem with social anxiety. Why is this so?
Most likely, there are other factors that influence whether a particular person devel -
ops problems with social anxiety following a history of negative social experiences. These
can include biological factors, such as a person’s genetic makeup. Previous learning expe -
riences and the ways in which someone deals with his or her negative social experiences
may also influence the development of fear. For example, a person who is ridiculed the
first time he or she gives a presentation may be more likely to develop a fear of public
speaking than someone who is ridiculed on a single occasion after having given many
successful presentations previously. Similarly, someone who is severely teased at school
may be protected from developing problems with social anxiety if he or she receives
support from close friends after the episode.
Finally, avoiding a social situation following a traumatic experience may increase the
chances of developing social anxiety. You have probably heard that the best thing to do | shyness_social.pdf |
4c6b1b735879-1 | chances of developing social anxiety. You have probably heard that the best thing to do
after falling off a horse is to get back on as soon as possible to avoid developing a fear of
horses. The same is true of social anxiety. If you avoid a social situation following a trau -
matic experience, you may increase your chances of developing a fear of that situation. | shyness_social.pdf |
0c1ea0a41749-0 | Why Do You Have These Fears?
37HOW BELIEFS CONTRIBUTE TO
SOCIAL ANXIETY
As discussed in chapters 1 and 6, people with elevated social anxiety tend to think about
social situations in a more negative way than do those people who are less anxious.
Anxiety-provoking thoughts, interpretations, and predictions can lead someone to feel
fear and anxiety in social situations.
There are numerous studies investigating the role of thinking in social anxiety. There
is also evidence that helping people to change their anxious beliefs is an effective way
of decreasing their social anxiety. Research on thinking and social anxiety is reviewed
elsewhere (Antony and Swinson 2000; Hirsch and Clark 2004). Some of the highlights
of this research include the following findings:
UÊPeople who experience high social anxiety rate negative social events as
more likely to occur and more costly (in terms of their consequences), in
comparison with people who don’t have significant social anxiety.
UÊThese people tend to interpret their own performance (such as during a
conversation or a speech) more critically than do people who are lower in
social anxiety.
UÊThey tend to overestimate the extent to which their physical symptoms
(such as blushing) are visible to others.
UÊThey are more likely than less anxious people to assume that others will
interpret their physical symptoms (shaking, sweating, and so on) as a sign
of a serious problem with anxiety or some mental illness. In contrast, people
who are not socially anxious are less concerned about others noticing their
physical arousal symptoms. Instead, people without significant social anxiety
assume that others will interpret their physical symptoms as normal (perhaps | shyness_social.pdf |
0c1ea0a41749-1 | assume that others will interpret their physical symptoms as normal (perhaps
a sign of feeling hot, being hungry, and so on).
UÊWhen presented with an ambiguous social situation (for example, a stare
from someone else or a phone call that isn’t returned), people with ele -
vated social anxiety have a heightened tendency to interpret the situation
negatively.
UÊSocial anxiety is associated with a tendency to rate ambiguous or neutral
faces as having a more negative expression.
UÊCompared with people who are less anxious, people with social anxiety dis -
order tend to pay more attention to information that represents social threat
than to nonthreatening information. For example, when asked to look at lists
of words, people who are socially anxious spend more time looking at words | shyness_social.pdf |
4df0073d10ce-0 | The Shyness & Social Anxiety Workbook
38that are related to social anxiety (words such as “blush” or “party”) than do
those who are less anxious.
UÊSocial anxiety is associated with a tendency to have a better memory and
recognition for other people’s faces, particularly if the expression on the
face appears to be negative or critical.
Taken together, these studies suggest that social anxiety and social anxiety disorder
are associated with thinking styles that may actually make the problem worse. In chapter
6, we’ll discuss ways to change your anxious thoughts and replace them with less anxious
and more realistic ways of thinking. A number of studies investigating the effects of
cognitive behavioral therapy on the negative thinking styles often associated with social
anxiety have found that treatment leads to a reduction in negative thinking (Hirsch and
Clark 2004).
HOW BEHAVIORS CONTRIBUTE TO
SOCIAL ANXIETY
As discussed in chapter 1, avoidance of social situations can have the effect of increas -
ing social anxiety over the long term. In other words, the strategy that people who
are socially anxious use most frequently to cope with their fear may actually make the
problem worse .
In addition, some behaviors that people use to protect themselves in social situa -
tions can actually lead to the very outcome that people with social anxiety disorder fear
most—a negative reaction from others. For example, if when talking to other people at
a party, you speak very quietly, avoid eye contact, and avoid expressing your views and
opinions, people may choose to talk to someone else. They may interpret your behavior
as a sign that you’re not interested in talking or that you are a difficult person to get | shyness_social.pdf |
4df0073d10ce-1 | to know. See chapters 7 through 9 for a discussion of strategies for confronting feared
situations instead of avoiding them and for stopping the safety behaviors that help to
maintain your fear over time. And, in chapter 10, we’ll discuss strategies for improving
communication and social skills. | shyness_social.pdf |
f42f76bab7bd-0 | CHAPTER 3
Getting to Know Your
Social Anxiety
WHY CONDUCT A SELF-ASSESSMENT?
The initial step that a psychologist, psychiatrist, or other mental health professional
takes in beginning to help an individual with a particular problem is a period of evalua -
tion and assessment. This evaluation process involves collecting information needed to
better understand the nature and extent of the problem so that the best possible treat -
ment plan can be formulated. This initial assessment almost always involves an interview
and may also include various questionnaires and standard tests. Sometimes, the therapist
may ask the person to start keeping a diary to monitor specific thoughts or behaviors.
In the case of social anxiety, a clinician might spend the first session (or even the
first few sessions) asking questions about the client’s social anxiety, about other difficul -
ties he or she might be experiencing, and about the person’s general background and
life experiences. The individual also may be asked to answer a series of questionnaires
that measure social anxiety and related problems. In addition, the client is often asked
to complete diary entries between sessions to measure the person’s anxiety in social
situations, his or her feelings of depression, and any other aspects of the problem. The
assessment process helps the clinician to understand the person’s problems and is useful
for choosing an appropriate course of treatment. In addition, repeating certain assess -
ments from time to time allows the clinician to measure whether treatment is working
(Antony and Rowa 2005). | shyness_social.pdf |
533ed3e5dabe-0 | The Shyness & Social Anxiety Workbook
40In the same way, a detailed self-assessment will help you to understand and address
your difficulties with social anxiety. We strongly recommend that, before you begin
working on changing your own social anxiety, you carry out a careful self-assessment.
This assessment process will have the following four main benefits. It will:
1. Allow you to measure the severity of your social anxiety
2. Help you to identify key problem areas
3. Make it easier to choose the most appropriate treatment strategies
4. Provide you with an opportunity to measure your improvement as you use
the strategies described in this book
Now we will discuss each of these issues in greater detail.
MEASURING THE SEVERITY OF YOUR
SOCIAL ANXIETY
The term “severity” takes into account such variables as (1) the intensity of your fear in
social and performance situations, (2) the range of different situations that precipitate
your social anxiety, (3) the frequency with which you experience intense social anxiety,
(4) the effect of your social anxiety on your day-to-day life, career, and relationships,
and (5) the extent to which being socially anxious bothers you. Generally, as the sever -
ity of social anxiety increases, typically, so does the intensity of the fear, the number of
situations that are affected, the frequency with which anxiety is experienced, the level of
interference with day-to-day functioning, and the extent to which a person is bothered
by having the fear.
IDENTIFYING WHICH PROBLEMS TO WORK ON
If you’re like many people, you probably experience anxiety in a number of different
social situations. A comprehensive self-assessment will help you to decide which fears | shyness_social.pdf |
533ed3e5dabe-1 | social situations. A comprehensive self-assessment will help you to decide which fears
to work on first. First, it will be important to identify which situations you fear and
avoid. Next, you will need to identify your priorities—that is, which aspects of the
problem you want to begin to address first. When choosing your priorities, here are
some suggestions to keep in mind:
UÊBegin working on problems for which you are likely to see quick changes.
Early improvements will help to motivate you to work on more difficult
situations. | shyness_social.pdf |
ad27c0773af8-0 | Getting to Know Your Social Anxiety
41UÊTry to work on fears that interfere the most with your day-to-day life. Being
able to confront the most disabling fears will have a much bigger impact on
your life than working on fears that are less important to you.
UÊIf one of your treatment aims is very important to you but is just too over -
whelming to deal with, divide that goal into smaller, more manageable
objectives. For example, if you are afraid of dating, you could work on your
fear by breaking the situation down into steps such as saying hello to an
attractive classmate, sitting beside the classmate for several weeks in a row,
speaking with the classmate after class, offering to study with the classmate,
and asking the classmate to have dinner with you after class.
CHOOSING THE BEST STRATEGIES FOR CHANGE
A self-assessment also can help you to decide which treatment strategies to use. In many
cases, the specific treatment approaches you select will be directly related to factors you
identify in your self-assessment. Consider the following examples of how an assessment
can help you to select the best approaches for treatment:
UÊIdentifying which situations you fear and avoid will help you to choose
which situations to select for exposure practices (as described in chapters
7 and 8).
UÊIdentifying the extent to which you are fearful of the physical feelings that
you experience when you are anxious will help determine whether you
should practice exposure to uncomfortable physical sensations (as described
in chapter 9).
UÊAssessing those areas in which your social skills can be improved will help
you to decide whether to spend time working on the skills involved in asser - | shyness_social.pdf |
ad27c0773af8-1 | you to decide whether to spend time working on the skills involved in asser -
tiveness, public speaking, dating, or general communication. (See chapter
10 for strategies for improving various types of social and communication
skills.)
UÊIf you decide to take medications for your social anxiety, the choice of
which medication to try will depend on your previous response to medica -
tions, possible interactions with other medications you take, medical condi -
tions you may have, side effects that you are willing to tolerate, as well as a
number of other factors. If you are considering using medications, thinking
about these issues should be part of your self-assessment (see chapter 5). | shyness_social.pdf |
b80ae84be335-0 | The Shyness & Social Anxiety Workbook
42MEASURING YOUR IMPROVEMENT
Assessment is not only for the initial phase of your treatment. Rather, the process of
assessment should continue throughout treatment and even after treatment has ended.
Continuing the assessment process throughout treatment will provide you with a way of
measuring how much your social anxiety has improved as a result of using the strategies
described in this book. Also, conducting occasional self-assessments after treatment has
ended will let you know whether your treatment gains have continued over time.
STEP-BY-STEP GUIDE FOR CONDUCTING
A SELF-ASSESSMENT
Therapists and clinicians who treat social anxiety use a number of tools to assess clients
and patients. The most common of these include the following.
Clinical Interviews
Interviews involve asking a person specific questions about his or her background,
anxiety symptoms, and related problems. It is an easy way of getting to know someone
and learning about his or her difficulties simply by talking.
Questionnaires
Questionnaires include paper-and-pencil tests that a person completes before begin -
ning treatment, and perhaps again during treatment and after treatment ends. They are
used to provide additional information not covered in the interview, as well as to confirm
and expand upon the information provided in the interview.
Diaries
Diaries are completed on a day-to-day basis between therapy sessions. They are
useful because they provide the individual with an opportunity to record his or her
thoughts and feelings as they occur, rather than having to remember all of the details of
a complex event later.
Behavioral Assessment
A behavioral assessment involves directly observing a person’s behavior or asking | shyness_social.pdf |
b80ae84be335-1 | Behavioral Assessment
A behavioral assessment involves directly observing a person’s behavior or asking
the person to perform a specific behavior and then measuring the thoughts and feelings
that arise in that situation. The most common types of behavioral assessment for social | shyness_social.pdf |
9b67c694857e-0 | Getting to Know Your Social Anxiety
43anxiety are the behavioral approach test and behavioral role-play . These involve having a person
enter a feared social situation (behavioral approach test) or act out a feared situation
in a role-play (behavioral role-play) and having the person report his or her fear level,
anxious thoughts, and other experiences.
Although these assessments are usually conducted by a psychologist, psychia -
trist, or other professional, each can be adapted to be part of your self-assessment. We
recommend that your assessment include the following three steps:
UÊConduct a self-interview. For example, answer important questions about
your anxiety and related problems.
UÊComplete anxiety diaries. An example is the Three Components of Social
Anxiety Monitoring Form included in chapter 1.
UÊComplete a behavioral approach test or role-play.
Conducting a Self-Interview
Any professional contact with a psychologist, psychiatrist, or other mental health
professional typically begins with a clinical interview, during which the clinician asks the
client or patient questions about his or her problems. The interview helps the clinician to
identify the most important features of the problem and is a first step toward developing
an effective treatment plan. To be consistent with this goal, we suggest that you conduct
a self-interview , in which you answer important questions about your problem.
To help you with this process, we have identified ten basic questions you should try
to answer at the start of your self-assessment. The answers to these questions will help
you to do the following: decide whether social anxiety is in fact a problem for you; iden -
tify the factors that contribute to your social anxiety; and choose the specific situations | shyness_social.pdf |
9b67c694857e-1 | that you need to work on most. At the beginning of chapter 4, we will suggest additional
questions that will help you to develop a treatment plan.
WHICH SOCIAL SITUATIONS DO YOU FEAR AND AVOID?
For each of the following situations (divided into interpersonal situations and per -
formance situations, as defined in chapter 1), record a number ranging from 0 to 100 to
rate (1) the extent to which you fear the situation during a typical or average encounter
and (2) the extent to which you typically avoid the situation. For example, if you have an
intense fear of making presentations but you avoid the situation only about half the time,
your fear rating might be an 80 and your avoidance rating might be a 50. If the situation
is one that you never encounter, base your ratings on how fearful you imagine you would
be in the situation and how much you would avoid the situation if it did come up from
time to time. Use the following scales to rate your fear and avoidance levels. | shyness_social.pdf |
2007d9a644e4-0 | The Shyness & Social Anxiety Workbook
44Fear Scale
0 10 20 30 40 50 60 70 80 90 100
None Mild Moderate Extreme Very
Extreme
Avoidance Scale
0 10 20 30 40 50 60 70 80 90 100
Never
AvoidRarely
AvoidSometimes
AvoidOften
AvoidAlways
Avoid
Feared Social Situations Worksheet
Interpersonal Situations (interacting with others)
Fear Avoidance Item
Asking someone out on a date
Starting a conversation with a classmate or coworker
Going to a party
Having friends over for dinner
Being introduced to new people
Talking on the telephone with a friend
Talking on the telephone with a stranger
Expressing a personal opinion (for instance, expressing
your views about a movie that you saw recently or a book
that you’ve read)
Being interviewed for a job
Being assertive (such as refusing an unreasonable request)
Returning an item to a store
Sending back food in a restaurant
Making eye contact
Other (specify)
Other (specify)
Other (specify) | shyness_social.pdf |
e77521cbbdc7-0 | Getting to Know Your Social Anxiety
45Performance Situations (being observed by others)
Fear Avoidance Item
Giving a presentation at work
Making a toast at a party or family gathering
Speaking in meetings at work or school
Playing sports or participating in aerobics in front of
others
Standing in a wedding party at someone else’s wedding
Singing or performing music in front of others
Eating or drinking in front of others
Using public bathrooms with others in the room
Writing with others watching (such as signing a check)
Making a mistake in public (for instance, mispronouncing a
word)
Walking or jogging in a busy public place
Introducing yourself in front of a group
Shopping in a busy store
Other (specify)
Other (specify)
Other (specify)
WHICH VARIABLES MAKE YOUR ANXIETY BETTER OR WORSE?
An important step in your self-assessment is to become aware of the variables that
make your fear better or worse in a given situation. For example, if you are fearful
of eating with other people, there are many factors that could influence your fear in
this situation, including who you’re eating with, where you’re eating, and what you’re
eating. Identifying the variables that affect your level of fear in a particular situation
will help you to set up appropriate practices when you begin to use the exposure-based
techniques discussed later in this book.
Following is a list of variables that sometimes affect a person’s fear and anxiety
in social situations. For each item, record a number ranging from 0 to 100 to rate the
extent to which the variable listed affects your level of fear or discomfort in the types of | shyness_social.pdf |
e77521cbbdc7-1 | extent to which the variable listed affects your level of fear or discomfort in the types of
social situations that you fear. For example, if you are much more anxious when talking
to a woman than when talking to a man, you might rate the effect of the other person’s
sex on your anxiety at about a 75 or 80. Use the following scale to obtain your rating. | shyness_social.pdf |
8ae34523abdd-0 | The Shyness & Social Anxiety Workbook
46Effect on Your Discomfort Scale
0 10 20 30 40 50 60 70 80 90 100
No
EffectSmall
EffectModerate
EffectLarge
EffectVery
Large
Effect
Your Anxiety Variables
Aspects of the Other Person and their Effect on Your Discomfort
Effect
on Your
DiscomfortItem
Age (whether the other person is older, younger, or the same age as
you)
Sex of the other person (same sex, opposite sex)
Relationship status of the other person (married, dating someone,
single)
Physical attractiveness of the other person
Nationality or ethnic background of the other person
How confident the other person seems
How aggressive or pushy the other person seems
How interesting the other person appears to be
Whether the person appears to have a good sense of humor
How financially successful the other person seems to be
How well dressed the other person appears to be
Other (specify)
Other (specify) | shyness_social.pdf |
91674073dff1-0 | Getting to Know Your Social Anxiety
47My Relationship with the Other Person and Its Effect on Your Discomfort
Effect
on Your
DiscomfortItem
How well you know the other person (family member, close friend,
acquaintance, stranger, and so on)
How intimate and close you are to the other person
Whether there is a history of conflict between yourself and the other
person
The type of relationship between you and the other person (for
example, supervisor, coworker, employee)
Other (specify)
Other (specify)
Aspects of How You Are Feeling and Its Effect on Your Discomfort
Effect
on Your
DiscomfortItem
How tired you are overall
General level of stress in your life at the time
How familiar you are with the topic being discussed
How prepared you are before entering the situation (for example,
whether you have had a chance to rehearse your presentation)
Other (specify)
Other (specify) | shyness_social.pdf |
a320a6bcf0a3-0 | The Shyness & Social Anxiety Workbook
48Aspects of the Situation and Their Effect on Your Discomfort
Effect
on Your
DiscomfortItem
Lighting (for instance, the light level is so high that you feel that any
sign of anxiety will be visible)
How formal the situation is (for example, eating at a wedding reception
vs. a casual dinner with friends)
Number of people involved (such as presenting to a few coworkers vs.
presenting to a filled auditorium)
Activity involved (eating, speaking, writing, and so on)
Your physical position (seated, standing, and so on)
Whether you can use alcohol or drugs to feel more comfortable
How long you’re stuck in the situation for
Other (specify)
Other (specify)
WHAT ARE YOUR FEELINGS AND HOW DO YOU FEEL
ABOUT THEM?
Following is a list of physical feelings that people sometimes experience when they
are feeling anxious, worried, or frightened. For each item, you should first record a
number (from 0 to 100) that reflects the intensity of the feeling during a typical expo -
sure to an anxiety-provoking social situation. A rating of 0 means that, typically, you do
not experience the sensation at all, and a rating of 100 means that the sensation typically
is extremely intense when you encounter social situations that are a problem for you.
Next, using a scale from 0 to 100, rate the extent to which you are fearful of experi -
encing the sensation in front of other people. A rating of 0 means that you are not at all
concerned about experiencing the sensation in front of others and a rating of 100 means
that you are extremely fearful of experiencing the sensation in front of others. | shyness_social.pdf |
a320a6bcf0a3-1 | that you are extremely fearful of experiencing the sensation in front of others.
Intensity of the Physical Sensations Scale
0 10 20 30 40 50 60 70 80 90 100
Not
at AllMild Moderate Extreme Very
Extreme | shyness_social.pdf |
1c9a17e9fa1f-0 | Getting to Know Your Social Anxiety
49Fear of Having the Physical Sensations in Front of Others Scale
0 10 20 30 40 50 60 70 80 90 100
No
FearMild
FearModerate
FearExtreme
FearVery
Extreme
Fear
Intensity of
SensationYour
Fear of
SensationSensation
Racing or pounding heart
Breathlessness or smothering feelings
Dizziness or lightheadedness
Difficulty swallowing, choking feelings, or a “lump” in the
throat
Quivering or shakiness (in the hands, knees, lips, or
whole body)
Blushing
Nausea, diarrhea, or “butterflies” in the stomach
Excessive sweating
Shaky voice
Tearfulness, crying
Poor concentration (forgetting what you’re trying to say)
Blurred vision
Numbness and tingling sensations
Feelings of unreality or being detached from your body
or from things around you
Tightness, soreness, or weakness in the muscles
Chest pain or tightness in chest muscles
Dry mouth
Hot flushes or chills
Other (specify)
Other (specify) | shyness_social.pdf |
b5d02ed5bf6d-0 | The Shyness & Social Anxiety Workbook
50 WHAT ARE YOUR ANXIETY-PROVOKING BELIEFS, PREDICTIONS,
AND EXPECTATIONS?
As discussed in chapter 1, your beliefs have a big impact on how you feel in social
situations. For example, if you expect that others will think you are stupid, weak, or
unattractive, you are very likely to feel anxious around other people. On the other hand,
if you are not especially concerned about what others think about you in a particular
situation, you’re much more likely to feel comfortable. Often, our beliefs and predic -
tions are not based on reality. For people who experience elevated anxiety in social and
performance situations, beliefs and expectations about these situations are often nega -
tive. These thoughts tend to exaggerate the likelihood of danger and lead the person to
expect the worst, even when there is no reason to do so.
Cognitive therapy involves teaching people to identify and change their anxious
beliefs, predictions, and expectations by considering more realistic alternative beliefs.
Before you can change your thoughts, however, you need to be able to observe them
and to decide whether they are unrealistic and whether they are contributing to your
anxiety.
Chapter 1 lists examples of thoughts and expectations that contribute to social
anxiety. Some of these include basic assumptions, such as, “It is important that every -
one likes me” and “Nobody will ever think I am interesting.” Other anxiety-provoking
thoughts may be more focused on a particular situation, such as, “If I arrive at class early,
I won’t be able to think of anything to say” and “People will think I am weird if they
notice my hands shaking.” | shyness_social.pdf |
b5d02ed5bf6d-1 | notice my hands shaking.”
To identify your own anxiety-provoking thoughts, we recommend the following
steps. First, review some of the examples of anxiety-provoking thoughts listed in chapter
1. These will give you an idea of the types of thoughts that are often associated with
social anxiety. Next, think of social situations that you find particularly difficult (for
example, talking to strangers, eating with other people, speaking at meetings) and try to
answer the following questions. Your answers to these questions will give you an idea of
the types of thoughts, predictions, and expectations that help to maintain your anxiety. | shyness_social.pdf |
f4f60f9793bc-0 | Getting to Know Your Social Anxiety
51Your Anxiety-Provoking Beliefs
What am I afraid will happen in the situation?
What might people think about me in the situation?
Is it almost always important that I make a good impression? Why?
How will I react in the situation (what symptoms will I exhibit)?
What if my expectations come true? What might that lead to?
Am I aware of any other beliefs or predictions that contribute to my anxiety? | shyness_social.pdf |
577fde92a8ad-0 | The Shyness & Social Anxiety Workbook
52WHAT ARE YOUR ANXIOUS BEHAVIORS?
Anxiety and fear are usually accompanied by a strong urge to do something to
reduce these uncomfortable feelings. Are there behaviors that you use to reduce your
anxiety? Here are some examples.
Avoidance of social situations. Are there situations that you refuse to enter? For example,
do you avoid going to parties, particularly when you won’t know people there? When
the telephone rings, do you avoid answering it? Do you turn down opportunities to do
presentations even when they are important? Avoidance is one of the most common
behaviors that helps to maintain your fear and anxiety. Earlier in this chapter you rated
the extent to which you fear and avoid various social situations. As part of this review
of your anxious behaviors, look over that list again and note which situations you tend
to avoid at least some of the time. If there are any other situations that come to mind,
list them below.
Overcompensating for perceived deficits. Are there ways in which you try extra hard
in social situations to compensate for flaws or faults that you perceive yourself to have?
For example, do you overprepare for presentations by putting together too much mate -
rial, memorizing the presentation, or reading the presentation word for word from your
notes? Do you rehearse everything that you are going to say before meeting a friend
for dinner, just in case you become overly anxious and lose your train of thought? Do
you go out of your way to talk a lot to appear outgoing, just so people won’t notice that
you’re anxious? Each of these is an example of how people sometimes overcompensate | shyness_social.pdf |
577fde92a8ad-1 | you’re anxious? Each of these is an example of how people sometimes overcompensate
to cover up what they perceive to be flaws. If you can think of examples of times when
you have overcompensated in social situations for what you thought were flaws or faults,
list them below.
Excessive checking and reassurance seeking. Social anxiety, shyness, and performance
anxiety sometimes can lead people to engage in frequent checking and reassurance
seeking behaviors. Examples include frequently looking in the mirror to make sure that | shyness_social.pdf |
6be1ba85d55e-0 | Getting to Know Your Social Anxiety
53your hair is perfect and continually asking your friends to reassure you that you are
interesting or smart.
Although it is helpful to seek reassurance from time to time, constant reassurance
seeking can have a negative impact by helping to maintain your fear. By asking for reas -
surance over and over again, you may strengthen the belief that there is something
wrong with you. (Why else would you need to check so often?). Also, you run the risk
of never learning to provide yourself with the reassurance that you may need. Finally,
constantly asking others for reassurance may cause some of your greatest fears to come
true by negatively affecting how others view you. Other people may get tired of always
having to provide you with reassurance. Also, if you constantly ask others to make judg -
ments about you (for instance, to tell you how smart, attractive, or interesting you are),
you may actually be training them to be more observant and scrutinizing of you than
they might otherwise be.
In the space below, list some examples of times when you have engaged in excessive
checking or reassurance seeking.
Other subtle avoidance and safety behaviors. Overcompensating for perceived deficits
and excessive checking are both examples of safety behaviors because they are used to
help you feel safer in social situations. Unlike complete avoidance of feared situations,
these are more subtle avoidance behaviors, and they can be more difficult to notice. Are
there other subtle ways in which you avoid situations or safety behaviors that you use to
protect yourself from feeling anxious in social situations?
For example, if you have to give a presentation, do you stand in a particular place? | shyness_social.pdf |
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