Social Anxiety: Alone With Witnesses

By The OCD Center of Los Angeles

Many people mistakenly think of Social Anxiety as nothing more than shyness.  In this two-part series, Jon Hershfield of the OCD Center of Los Angeles discusses Social Anxiety, its treatment with Cognitive Behavioral Therapy (CBT), and its relationship to other OC Spectrum Disorders.

Social Anxiety, also known as Social Phobia, is more than just shyness.

When I first began treating people with Social Anxiety Disorder (also known as Social Phobia), it seemed to me that this condition was primarily a problem of interesting people not realizing that they are interesting.

While this is a significant element of the disorder, there is more going on than one might initially expect.

In reality,  Social Anxiety and Social Phobia are terms used to describe a cluster of symptoms that center around the fear of being negatively evaluated by others.

This is often confused with being shy or introverted, or even schizoid.

An introvert may genuinely prefer the quiet solitude of turning inwards to the self rather than outwards to other people, while someone with schizoid personality disorder may simply not find the presence of other people to be pleasing.

In either of these cases, the experience of isolation from others is essentially rooted in ego-syntonic thoughts, which simply means that the thoughts are consistent with the individual’s true beliefs and values.

In other words, those who are truly introverted or schizoid genuinely prefer to be alone.

Conversely, a person suffering from Social Anxiety is burdened by unwanted intrusive thoughts about being judged, rejected, and/or and humiliated by others.

In some cases, these thoughts may be ego-syntonic, coinciding with the individual’s distorted core belief that they genuinely deserve negative judgment.

On the other hand, Social Anxiety may at times also be rooted in thoughts that are ego-dystonic, which simply means that the thoughts are inconsistent with the individual’s beliefs and values.

To these people, their thoughts about negative evaluation appear strange and irrational.  They don’t see themselves as being worthy of negative evaluation, yet the thought repeatedly pops up anyway.

Ironically most of the people I treat with Social Anxiety are anything but shy.  All it takes is a sense of safety and permission to be themselves and they are eager to be social.

It is worth noting that the term “social” here does not mean casual.  For many, the symptoms of Social Anxiety are equally troubling in the work environment, where fear of disapproval from someone in a position of authority or fear of disrespect from a subordinate can greatly impair functioning.

It may also be prevalent in the classroom where overvalued thoughts of rejection by peers can consume daily life.  So the term social applies to any environment that involves one or more other people.

Presentation Anxiety vs. Connection Anxiety

Social Anxiety seems to fall into two main categories, which I call Presentation Anxiety and Connection Anxiety.

Presentation Anxiety focuses on an intense fear of being judged negatively while engaging in some sort of solitary interaction with a group of people.  This often manifests as a fear of public speaking, but it is equally debilitating for the person who fears being negatively evaluated in a small social gathering such as a party.

Conversely, people who suffer from Connection Anxiety may or may not feel comfortable in the spotlight in a group setting, but experience far more intense discomfort in one-on-one interactions.

This has unfortunate implications for establishing relationships with people in an unstructured environment.

Connection Anxiety appears to be less talked about because it is common to see those with this type of  anxiety actively and comfortably engaged in large social environments.

But in my clinical experience, it is equally prevalent and every bit as debilitating.

Those with both forms of Social Anxiety may be adept at hiding their symptoms so long as they steer clear of their primary triggers.

For example, someone with Presentation Anxiety may be a social butterfly at parties but freeze in terror at the thought of giving a best man speech or asking a question in class.

Conversely, someone with Connection Anxiety may have no qualms about performing on stage, but may dread the interactions inherent in dating.

This may explain why some entertainers who have spent their careers on stage or on camera (Barbra Streisand [photo], Carly Simon, Donny Osmond, Kim Basinger), have reported having Social Anxiety, despite their careers in the public eye.

Both Presentation and Connection Anxiety may converge in the presence of small groups.

A small group has both the critical mass necessary for one to feel ganged up on or out of place, as well as the intimacy in which one might feel suffocated.

This, among other reasons, is why group treatment is particularly effective for the Social Anxiety.

> Continued in article [on the OCDLA site]: Social Anxiety / Social Phobia: Alone With Witnesses.

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Photo: Barbra Streisand on one of her CD covers. An article reports, “During a concert in New York’s Central Park in 1967, Barbra did what for her was unthinkable — forgot the lyrics to a song. Unable to shrug off the incident and carry on like many performers do, the consummate perfectionist found herself unable to perform in public for nearly another three decades.”

[Quoting Streisand:] “During my last tour, when I kicked off my shoes and said whatever I wanted, I actually enjoyed myself. Performing is not about perfection. I could never perform live if it were. For me, it’s about raising the money to do good in the world. It’s about self-acceptance. It’s about believing that I am enough.”

From article: Barbra Streisand, By Arlin Cuncic, About.com Guide for Social Anxiety

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Related articles:

Movie Characters With Social Anxiety, By Arlin Cuncic, About.com Guide.

Celebrities with anxiety and panic attacks

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