Anxiety: Friend or Foe? Part 2

Beyond Shyness : How to Conquer Social Anxieties
by Jonathan Berent, A.C.S.W., Amy Lemley

(Page 2 of 3)

Alan, a young man of twenty-two, is typical of the people who have come to me for treatment. Outwardly, he seemed well adjusted and likable. His sense of humor added fun to our sessions, and he was an active conversationalist who was well liked by his peers. If you met him in an informal setting, you would have no idea that an attractive, articulate person like Alan could get nervous or anxious about any social situation. But Alan suffered from the most common social anxiety today: fear of public speaking. He was afraid to stand up in front of a group and talk. For almost four years, he put off taking the public-speaking class that was required for college graduation. By his last semester, however, he knew there was no more avoiding it. He had to take the class or miss out on receiving his degree. Although he was scared, he was also highly motivated to confront his fear and finish his course load.

At first, Alan experienced a typical anxiety reaction or panic response: His hands got clammy, his heart raced, and he experienced every stutter, every verbal misstep as a huge blunder that no one would ever forget. He would blush, or imagine he was blushing, and then worry about what his classmates thought of him. Sometimes, he would feel a little short of breath and then worry that he would hyperventilate and need to rush from the room. He was intensely aware of all these symptoms of nervousness, though his audience of classmates thought little of it — they too were nervous about their speaking assignments, and were sympathetic. Alan's symptoms diminished as he gave more speeches, and watched others make the same mistakes without losing face.

The sensations that troubled Alan are typical of anxiety sufferers. Also typical is the tendency to avoid what you fear. The possibility of blushing or hyperventilating had become as scary to Alan as giving a speech, and in putting off the class, he was avoiding all these things.

Alan was not alone. Far from it: Millions of people feel some panic or anxiety symptoms regularly. Sometimes they are mild reactions that are easily connected to a particular situation or event. But in other instances they are more pervasive and more debilitating. The physical sensations may even be severe enough to warrant a visit to the emergency room, where a frustrated anxiety sufferer may be told that there is nothing wrong but stress. But panic symptoms are indeed real. Their cause? An internal mishandling of stress or emotions. What occurs with a panic or anxiety attack is a psychophysiological reaction: a mind-body response. While the body is preparing itself to confront the stressor, the mind is filled with fear and apprehension, with thoughts like "I'm losing control" or "I know I'm going to fail." Together, the body and mind are overreacting to their own fight-or-flight instincts.

Let's consider situations you may be avoiding because they cause a fight-or-flight anxiety reaction. Below are some possibilities:

Interaction with an authority figure
Giving a presentation at work
Eating in public
Speaking in front of a group
Taking interactive responsibility at work
Signing a check or other document in front of someone
Talking on the telephone
Talking to someone you don't know
Talking to someone you do know (outside the family)
Making social plans with someone (outside the family)
Going on a date
Using a public bathroom
Going to a party
Going to a singles-oriented event or program
Interacting with people at work
Waiting in line
Sitting in a doctor's or dentist's waiting room
Being examined by a doctor or dentist
Going to the theater
Going to a restaurant
Maintaining eye contact when talking to someone
Going to any public place
Taking public transportation
Other

Are some of these situations stressful for you? Go back over the list, checking off the ones that apply to you. As you check them off, think about the degree to which your fear hampers your social life. And if you recognize a situation that you actively avoid because you find it too stressful — say, you never use a public bathroom at all because you're "too shy" or it makes you anxious — make note of that, too.

Now that you've given some thought to the situations that cause anxiety, let's examine the particular symptoms of your anxiety. We will look at physical symptoms — what your body does when you feel anxious — and thought patterns — what thoughts bother you when you feel anxious. Use Charts 1 and 2 (pp. 23 and 24) to rank these symptoms in terms of frequency (whether they occur twice a month or as often as once a day), severity (whether they cause you minor discomfort or absolute panic), and the degree to which they interfere with your social life (not at all or significantly). The last category is very important, since it will help you to determine to just what extent your social anxiety disables you. The rankings in that category should be interpreted as follows:

1. Not at all. If you choose this answer, you usually experience no discomfort whatsoever when the thought or feeling in question arises. You may experience the symptom, but you are fully able to continue what you are doing (talking to an acquaintance, addressing a group, working with your supervisor, and so on) without becoming distracted or trying to leave the situation.

2. A little. If a symptom interferes a little, it may occasionally cause you to lose your train of thought, or to falter or hesitate during conversation. Still, you find ways to compensate, and your interaction is not inhibited to a noticeable extent. You continue to interact with others on a regular basis, and none of your symptoms causes you to avoid interacting completely.

3. Moderately. A symptom that moderately interferes with interaction would be one that occasionally keeps you from doing something you would like to do (such as approach and speak to a stranger at a party) or are required to do (make a cold sales call on a prospective client). You are uncomfortable enough with the symptom at least to consider whether encountering it is worth the anxiety involved.

4. Significantly. For social anxiety symptoms to affect significantly the degree to which you interact, they must have caused you to develop the habit of avoiding the situations that cause them, whether by procrastination or merely by passive participation (such as attending a meeting without contributing anything). While you don't avoid all interaction, you probably try to stay out of it when you can, and spend a great deal of time negatively evaluating those interactions you do have. This may cause others to view you as aloof or distracted in conversation.

5. Severe to the point of incapacity. This is where social phobia comes in. We'll talk more about that in Chapter 4, but for now, understand that for social anxiety to become a phobia, must be so severe that you avoid the situation that causes the anxiety whenever possible, even when it means forgoing a promotion or spending all your free time in total solitude. At this stage, you fear your symptoms just as much as you fear the interaction.

Now take several minutes to go through each list of symptoms, using the rankings to determine how much each plays a role in your current daily life.

Remember, there is a wide range of what is considered normal, and even feeling slightly nervous or keyed up is within that normal range. The goal is not avoiding anxiety but managing it, getting it under control. Whatever your anxiety level, by following the steps in this self-help plan and adapting them to your needs, you can empower yourself to interact more effectively. Later, you will do these indexes again. It is important to realize that your progress will be based on relativity. As you compare previous indexes to the most current one, look not only at totals but also at the individual categories and their frequency, severity, and degree of interactive interference.

To help you make general sense of your ratings, let me use as examples two people who have come to me for treatment. Each experienced different extremes of anxiety — Shelly was highly functioning but unfulfilled professionally, while Adam was incapacitated by fear on all fronts. Whereas Alan, our earlier example, a relatively high-functioning person with severe anxiety about a specific situation (public speaking), was somewhere in the middle, the two people introduced here were at opposite poles when compared to the norm: Shelly was high-functioning, and Adam was low-functioning. Understanding their perspectives may help you to gauge your own level of anxiety.

Shelly: At thirty-five, Shelly was an associate with a small law firm. She and her husband enjoyed socializing with friends and neighbors in the suburb where they lived, and often entertained at home. Shelly was not anxious or inhibited in purely social situations, and often hosted gatherings herself. At work, however, she did experience a slight degree of anxiety when it came to initiating projects or accepting responsibility. Her interactive inhibition — resistance to asking for help or doing things on her own — was preventing her from being made partner. How did social anxiety interfere with productivity at work? For Shelly, the safety of her position, with its predictable duties and conservative style of dress, was reassuring when she joined the firm right out of law school. But in order to get ahead at the firm, Shelly needed to do more than conform to the social system that existed at work. She had to go beyond meeting assignments and seek out new solutions and challenges.

Instead, though, Shelly waited for her supervisor to give his opinion on the cases assigned to her. Usually, her hesitancy to make decisions or take action on her own caused her to procrastinate — a bad habit that was hard to conceal as deadlines came and went. She didn't realize that action relieves anxiety. Instead, she feared the outcome of the risks she had to take in speaking her mind. She was unwilling to endure the pain of anxiety these risks would entail. Even when she had ideas of her own, she was extremely hesitant to express them, assuming that they were off-base or, as she said, "Somebody else would have made the same points already." Shelly's thinking was skewed: The firm hired her because they recognized capability and potential. Her training and experience were valuable to them, so some more initiative on her part would only have increased her value and could have netted her the partnership she hardly dared dream about. Perhaps more important, even if her ideas were rejected, the outcome would not have been devastating. No one is right 100 percent of the time or always says or does exactly the right thing. Shelly would not have been fired for thinking aloud as part of a problem-solving team.

Shelly's interactive inhibition had another cost as well. In performing the same duties the same way, without the experience of taking a risk that might pay off, of following a case start to finish, of meeting new challenges, she had dug herself into a rut. Her limited self-esteem was self-perpetuating, and the result was a lack of fulfillment. It's true she was successful in many ways, but without the confidence to move forward without being anxious about interacting, she did not feel successful.

How did Shelly score on the anxiety profile? The types of situations that caused Shelly anxiety were not that easy to identify — and after all, she did manage to get through the day with no physical symptoms of anxiety. At home, when she thought about work, she did tend to go over and over the same situations again, wondering what would have happened if she had done things differently. Occasionally, this led to a tension headache. Shelly did well in most situations, and she usually was willing to attend social events. But when she thought she must measure up by being assertive, she felt pressured and feared humiliating herself. Shelly's physical symptoms registered as minimal because none inhibited her interaction on a daily basis. She may have experienced minor symptoms such as cold hands or sweating, but she was not aware of them and they had no effect on her ability to interact. If she got a headache, it occurred at home — not during an interaction — and therefore it did not interfere with social interchange.

For thought patterns, Shelly's overall score was in the moderate range — not surprising, since it was her thought patterns that made her uncomfortable enough to clam up, taking direction instead of initiative. Recurring thoughts, such as "Am I good enough?," "I don't have anything to add," and "I don't know what to say," had a moderately inhibiting effect on Shelly's interactions, particularly on the job. These recurring thoughts, by reinforcing her low self-esteem, played a role in keeping her from advancing up the career ladder.

About the Author

Jonathan Berent, A.C.S.W., lives in East Hampton, and practices in Great Neck, N.Y. A certified psychotherapist, he has worked with thousands of individuals of all ages in individual, group, and family psychotherapy. He has appeared on "The Oprah Winfrey Show," "Sally Jessy Raphael," "Joan Rivers," "CNN Medical News" and many other TV and radio shows.