Anxiety: Friend or Foe? Part 3

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

(Page 3 of 3)

Adam: Adam was a young man whose anxiety turned into a monster. Where Shelly had a very mild case of social anxiety, Adam's case could only be called severe. Over a period of several years, his underlying social fears developed into a full-blown school phobia. A quiet, unassuming person, Adam had never stood out in the classroom. Through elementary school and on into high school, he neither excelled nor failed his subjects. By no means a discipline problem, the "shy" Adam kept to himself and seldom talked in class, whether to answer a teacher's question or chat with his buddies. In fact, he really had no friends, and the only peers he socialized with were his cousins, whom he saw at weekly family gatherings.

Though he watched the other kids working together on projects or playing sports together, Adam never approached them to join in. Maybe they wouldn't let him, he thought. Maybe he wasn't good enough. Being rejected was not a chance he was willing to take.

Adam never tried hard in school either. If he didn't understand something, he kept quiet, fearful that raising his hand would bring ridicule. When he did poorly on an exam or paper, it only confirmed to him what he was sure was true: He didn't measure up. He became so apprehensive about his tests that he began to feel physically ill at the thought of each approaching reminder of his inadequacy. Even though he had studied hard for a math test, for example, he could barely bring himself to get out of bed on the morning it was to take place. His parents, who thought of their child as a reserved but obedient boy who would eventually grow out of this awkward adolescent stage, did not pressure him. Adam was defensive and withdrawn, overwrought by the looming possibility that he would fail.

For the two class periods preceding the math test, Adam's mind was awash with geometry theorems, and his stomach churning. As waves of nausea washed over him, he began to salivate and swallowed hard. His eyes burned and he closed them, wishing he could block the test from his mind. When his head started to feel heavy and he became short of breath, he asked for a hall pass and headed for the bathroom.

Alone, he let his anxiety overtake him as he stared into the mirror, letting the cool water flow from the faucet and onto his sweaty palms. He would feel better, he thought, if he could just throw up. But even when he forced his finger down his throat, there was no relief. His dry heaves made him feel even weaker. He slumped to the cold tile and began to cry. Adam never went back to math class that day; instead, he got a pass from the nurse and went straight home.

Of course, the pressure Adam was feeling was not just related to the math test. The roots of his anxiety went much deeper. Still, the physical symptoms of anxiety became so debilitating that he eventually quit going to school altogether. Naturally, his parents were extremely concerned but also uncertain what to do. It took almost a year before Adam was sufficiently in control of his symptoms to return to school.

Clearly, he was working to avoid the pain of any kind of interaction, because he was so afraid of rejection or humiliation. His social anxiety became so extreme that he feared the symptoms as much as the stressor itself; in fact, his fear of interaction developed into a full-blown phobia. Adam's anxiety profile obviously featured all the physical symptoms on the list (especially shortness of breath, accelerated heartbeat, dizziness, and depersonalization). They surfaced almost daily and were extremely incapacitating, affecting him to a high degree whenever he was actually in the situation that caused them. Of course, when Adam avoided these situations, their frequency and severity diminished, but their degree of interactive interference increased until it was at level 5. The symptoms were so bad that they were preventing him from interacting, all the way to the point of incapacity. Obsessive thought patterns were a contributing factor as well: "Am I good enough?" "Will they like me?" Adam even had these recurring thoughts when he was alone in his room, looking out on the street at the neighborhood kids playing below.

To gauge the median, let's look again at Alan's situation. His physical symptoms, though fairly noticeable, were limited to specific situations in which he had to address a group; these symptoms included a lump in the throat, difficulty concentrating, accelerated heartbeat, a quavering voice, sweaty palms. But they only appeared during public-speaking situations. Otherwise, Alan handled himself with relative ease. The same was true of the obsessive thought patterns, which were limited to a specific situation: "I'm going to embarrass myself," "People can tell I'm nervous," "I'm going to lose control." The frequency was isolated, and therefore low, but the severity when the situation did arise was moderate. As for interactive interference, Alan places in the moderate range: He was high-functioning, but he did in fact actively avoid the stressor for a time.

Identifying your symptoms is the first step in creating a map for change. In order for change to occur, you need specific information to work from. This anxiety profile provides those specifics. Knowing what you're afraid of means you know why your pulse is racing, and that knowledge provides you with a choice: Handle the anxiety in a healthy way by identifying the cause and managing the symptoms, or handle it in an unhealthy way by running from the situation you fear.

Changing your responses may sound like a tall order, but it gets easier step by step. You can monitor your progress by referring back to these indexes, gauging once again the frequency and severity of your symptoms and considering the degree to which the various situations are still inhibiting your social life. Keep your initial responses handy (and leave room in the margin for later retesting) so that you can chart your progress from beginning to end.

As you work through this self-help program, you will teach yourself a new attitude and a new way to recognize and respond to anxiety. I've often heard it said that everything new starts with a thought. Here is yours: My social anxiety symptoms are temporary and eventually they will diminish significantly and may well disappear altogether. This sentence must become part of your daily routine. To ensure progress, you have to develop what I call PMA — Positive Mental Attitude. A positive outlook is one of the strongest and most powerful strategies of this self-help program. What you are doing is self-coaching, and a vital part of being a good coach is boosting morale. How? Through PMA, of course!

A negative mental attitude has no doubt been a contributing factor to your social anxiety. Here is a diagram of the sequence in which social anxiety develops:

The individual makes mistakes

• This causes feelings of confusion
• Which cause feelings of rejection
• Fear builds
• Which leads to avoidance of the threatening situation
• Which lowers self-confidence
• Which decreases the chances of success
• Which in turn creates more potential for confusion, rejection
• And brings on anxiety, lack of fulfillment, and possibly depression

I have found this cause-and-effect sequence to apply to most people who call themselves "shy." The key element, of course, is the degree of avoidance. In looking at social anxiety as a series of events — essentially social failure leading to a fear of rejection leading to avoidance of the situation that causes the bad feelings — a simple premise presents itself: Social anxiety syndrome is learned.

This is good news. Why? What is learned can be unlearned, relearned, or reprogrammed. It may be true that people are genetically predisposed to certain characteristics, but the bottom line is that the problems discussed here can be controlled, reduced, or even eliminated. If your NMA (Negative Mental Attitude) is winning out right now, you may be saying that it's too late for you, that old habits die hard. But try to turn your thinking around — use that PMA. Yes, it is true that the earlier in life you interrupt this anxiety cycle, the better your chance of controlling the problem. But no matter how old you are, if you allow yourself to step in as coach and work your way through your symptoms and fears, you'll meet with success.

During a recent radio program I took a call from the mother of an eleven-year-old girl who told me her daughter was having trouble with some girls who teased her on the playground at school. When her class played open games such as kickball outside, she was almost always chosen last. And on field trips, while other kids would partner up as instructed, this girl was usually left to be "partners" with the teacher or teacher's aide. This child was obviously upset, so much so in fact that she was faking illness in order to stay home from school. The mother told me that she had allowed her daughter to talk about her feelings, but insisted that she go to school anyway, and tried to find other ways in the community for her daughter to make friends, such as afterschool classes and a church youth group. I told this mother she was right on: She supported her daughter by letting her express how she felt and tell what she was afraid of, but she also gave her the message that it is unhealthy to simply avoid the situations you find unpleasant. The little girl had to learn to deal with her problem by identifying her fears, expressing them, and then confronting the situation that caused them. This mother did the right thing.

As an adult, you can do this for yourself. Be your own coach, using PMA to boost "team spirit." Let the coaching part of you be the part that develops the objective perspective of your situation. Do not deny the reality of your current outlook. Be honest with yourself as you examine and reexamine the indexes in this chapter and subsequent ones. And keep in mind that your success graph will not be a straight line headed up and off the page: There will be ups and downs, many successes but some failures too.

Use a graph to gauge your own experience. There is no such thing as straight-up progress. There is no success without failure. And it has to be a step at a time. The key is not to let the little downs become one big down that leads to an extreme degree of avoidance. When setbacks occur, don't be discouraged. Remind yourself of your long-term goals. There is a path to follow. Think of it as your map for change:

1. Develop PMA — Positive Mental Attitude.
2. Identify your symptoms.
3. Set realistic goals.
4. Learn to control your anxiety and its symptoms.
5. Refine your social skills.
6. Apply what you know.
7. Keep applying it!

As you master each component, you will be able to see your progress by looking back at the charts in this chapter. This is an ongoing process — once you attain one goal, you must maintain it: Continue trying to understand your symptoms, to work on making PMA a part of your personality. I am hopeful that you've already come that far in this chapter alone. Keep at it! Ultimately, you will be moving forward — an occasional backstep is merely part of the overall advancement to a new level of sociability. Give yourself credit for meeting little goals, and don't be threatened by your long-term ones. It has taken a long time to develop your social responses — and it will take some time to relearn them. But with the right attitude — and adhering carefully to the steps of this program — you can get beyond "shyness."

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.