Shy No Longer

Module 1

Overview of Social Anxiety
What is Social Anxiety?

2

Understanding Anxiety

2

What Causes Social Anxiety

6

How is Social Anxiety Maintained

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What Can Be Done About Social Anxiety

7

Module Summary

9

About this Module

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What is Social Anxiety?
Many people experiencing the symptoms of anxiety can begin to wonder whether there is something reallywrong with them and comments from other people such as, ‘Just get yourself together’, “There’s nothing
to be frightened of”, are not very helpful.
Although you might feel alone in your struggle against anxiety, the reality is that many people experience
these emotions either from time to time, or on a more regular basis. In fact, it is estimated that 1 in every
5 people experience significant anxiety at some time in their life.
Anxiety can affect any kind of person at any stage of their life, whether they are an introvert or an
extrovert, youthful or elderly, male or female, wealthy or poor. Whatever your distinction, you can
become anxious. So remember, you are not alone.
Social anxiety is used to describe anxiety that occurs in response to social situations, whether you are in
the situation or thinking about the situation. Of course, many people do feel anxious about some social
situations, such as public speaking. Worrying about whether the speech will go well, or what other people
will think is quite common. Many of these people go on to give the speech and might feel relieved when it isover. For some people, however, the anxiety may be so distressing that they avoid the situation at all costs.
In clinical practice, the term “Social Anxiety Disorder” or “Social Phobia” is used to describe thisintense and longstanding fear of social situations, which often results in the person avoiding the situation.
Often the person is worried that they will be embarrassed or humiliated in some way and that they will be
evaluated negatively or criticised by other people. Even if your fear is not so intense that it would be called
Social Anxiety Disorder or Social Phobia, this package may give you some helpful suggestions for easing theanxiety that you experience in social situations.

Understanding anxiety
Feeling afraid is very much a part of the experience of being human. You might think of it as a survival
instinct where fear occurs in response to a realistically dangerous situation. Think about how you might
react if a dangerous animal approached you. Most likely you would respond with fear. In fact, it is often
helpful to respond with fear at times like this because when we become afraid, our body goes through awhole series of changes that ultimately serve to protect us. This fear response would probably lead us toeither run for our lives or become sufficiently ‘pumped up’ to physically defend ourselves. As you can see
from this example, the experience of fear is part of the process of survival.
There are other times when real physical danger isn’t there. Think about a person walking through a poorly
lit alley at night. They might feel anxious because they are worried that something dangerous may happen.
Now, there may or may not be anything dangerous in the alleyway, but what is important, is that they
believe there is something dangerous. It is this belief that causes the anxiety.

FIGHT/FLIGHT RESPONSE
The response that occurs when a person is in danger, or believes that they are in danger, has been called
the fight/flight response. It helps us to respond to real physical threat. When we are confronted withdanger, such as that dangerous animal we spoke of earlier, we might typically run away from the situation,or stand and fight. This allows us to protect ourselves. So anxiety is not, in itself, harmful. It can be quite
adaptive in certain circumstances.
When a person’s fight/flight response is activated, three major types of responses occur. These include
body responses, acting responses, and thinking responses.
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Body Responses or Physiology
When we become anxious, be it in response to physical threat or social situations, our bodies experience
several changes. Think of the common fear of public speaking. People often say that, before they are about
to speak, they notice their heart pounding, they start to breathe more quickly, they might get sweaty palms,
and might even feel a little lightheaded. These are common reactions that occur when we become anxious.
Think about some of your own physical responses in social situations - what do you notice?

You might think you are alone in reacting this way, but really, we all experience these types of reactions
when we experience fear and anxiety. Basically, our bodies are designed to release certain chemicals when
we believe a threat exists, in case we need to either run away, or stand and be ready to fight. There areimportant reasons why these reactions occur.
An increase in heart rate and strength of heart beat enables blood and oxygen to be pumped
around the body faster so you might feel like you heart is ‘pounding’.
An increase in the rate and depth of breathing means more oxygen, which is necessary for fight or
flight, is taken into the body. You may start to sigh, to yawn, or notice breathlessness, choking or
smothering feelings, tightness and pain in the chest. This response also reduces the blood supply to thehead, and while not dangerous, you might feel dizziness, light-headedness, blurred vision, confusion, feelingsof unreality and hot flushes.
A redistribution of blood from areas that aren’t as vital to those that are, such as away fromskin, fingers and toes towards large vital organs. Your skin might look pale or you might feel cold, or there
might be a feeling of numbness and tingling in your fingers and toes.
An increase in sweating causes the body to become more slippery, making it harder for a predator tograb, and also cooling the body, preventing it from overheating.
Widening of the pupils of the eyes lets in more light and enables you to better scan the environment
for danger. You may notice blurred vision, spots before the eyes, or just a sense that the light is too bright.
Decreased activity of the digestive system allows more energy to be diverted to fight/flightsystems. A decrease in salivation may leave you with a dry mouth and decreased activity in the digestivesystem may lead to feelings of nausea or a heavy stomach.
Muscle tension in preparation for fight/flight and results in subjective feelings of tension, sometimes
resulting in aches and pains and trembling and shaking. The whole physical process is a comprehensive onethat often leaves the individual feeling quite exhausted.
As you can see, these physical responses are important when facing danger, but mostsocial situations are not physically dangerous! Your body has just become used tosetting off your physical alarm system in these situations.
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Action Responses or Behaviours
When we feel anxious or expect to feel anxious, we often act in some way to control our anxiety. One
way you may do this is by keeping away from social situations. This is called avoidance.

Think about the kinds of situations that you don’t like to go into. What do you avoid?

Avoiding situations may reduce the anxiety you feel in the short term, but it is likely to have some lesshelpful long-term effects. Sometimes it stops people from doing things they would like to do, or achievecertain goals. For example, you might have good ideas about work projects, but if you don’t share them atteam meetings because you are worried about negative evaluation, you might not get the recognition andpromotion that you’d like.

What about you? What effect does avoiding social situations have on you?


I don’t get to do things that I would like to do, or that are important to meI feel relieved in the short term, but I feel even less confident the next time

I don’t get to overcome my fear of those situations



I end up regretting that I missed out on certain things
A second action response may be to behave differently. For example, you may say nothing because yourmind has ‘gone blank’, you may keep your head down because you think your face is red, or you may
shuffle around in your chair because you feel uneasy.
How do you behave differently when you are anxious in social situations?

These action responses may have been used so often that they have become a familiar way of life to you, a
habit that you don’t really think about. However, you can unlearn the “anxiety habit” and build new habits
for feeling more comfortable in social situations.
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Thinking Responses or Cognitions
There are a number of thinking responses or cognitive changes that are associated with social anxiey.
Firstly, as a normal part of the fight/flight response, we begin to shift our attention to our surroundings andsearch for potential threat. This is a helpful response in physically dangerous situations, but it is not so
helpful in social situations.
Secondly, some types of thoughts are often associated with social anxiety
1.

Over-estimating the chance that negative things will happen in social situations (eg “I’ll make a
mistake when I’m talking to people”)

2.

Over-estimating the cost of negative events in social situations (eg “If I make a mistake, everyone
will think I’m useless)

People with social anxiety might think thay they have to behave a certain way in social situations, and if they
don’t they will be seen as stupid, incompetent, and feel embarrassed.
Let’s put these two changes together. If you were worried about people evaluating you negatively, you
might start to scan the social environment for signs of threat, in this case, signs that other people thinkpoorly of you. Have you ever been talking in a group of people and seen someone yawning? You might
instantly think, “I must be boring them”. However, they may have been up all night with a sick child.
You might also be scanning within yourself to find evidence of threat, such as focusing on bodily sensations
like a pounding heart or sweating, and then thinking that everyone will notice. As a result, people withsocial anxiety tend to be very self-conscious and have a negative view of the way they are coming across toother people.

When you are in anxious social situations, what kinds of thoughts do you have?

These three types of reactions: body, action, and thinking responses, all combine to form the experience ofsocial anxiety. Some reactions may be more noticeable than others may, but they are all importantcomponents and will be addressed throughout the modules.

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What causes social anxiety?
You have probably asked yourself what causes anxiety and social anxiety. There’s no simple answer, ofcourse, as everyone is different. However, there are some important factors that have been identified.
These factors can generally be divided into biological and psychological causes.

BIOLOGICAL FACTORSNo single gene has been associated with social anxiety, although based on twin studies and family studies, itdoes seem that individuals may inherit a vulnerability to developing an anxiety disorder.

PSYCHOLOGICAL FACTORS
Having this vulnerability does not necessarily mean that someone will develop an anxiety disorder. A great
deal depends on the lifestyle of that person, the types of life stressors they have encountered and theirearly learning. For example, if we were taught to fear certain neutral situations as a child, such as social
situations, and we have not had the opportunity to unlearn these patterns of behaviour, we may havecontinued to develop certain patterns of thinking and behaving which contribute to the development of ananxiety disorder.

How is social anxiety maintained?
Anxiety becomes a problem when a person cannot manage to function adequately in their daily life due tothe frequency and severity of symptoms of anxiety. Whatever the causes, there are a number of factorsthat maintain or perpetuate the problem of frequent and severe symptoms of anxiety.

FOCUSING ATTENTION ON NEGATIVE THINGS
People with social anxiety pay attention to cues that may be perceived as socially andpersonally threatening, which often means focusing intensely on negative things. Do you
focus on other people’s reactions, wondering what others think or how you look toothers? Perhaps you become focused on your own body reactions, such as sweating or shaking. By focusing
mainly on these cues, it’s easy to find reasons for staying afraid.

THINKING STYLE
As mentioned earlier, people with social anxiety are often particularly afraid that they will be evaluatednegatively. They think that other people will think poorly of them, laugh at them, or think they are
incompetent. They may believe they are worthless if others think badly of them, which leads to greater
anxiety about such social situations in the future.

AVOIDANCE
Avoidance of social situations may reduce anxious feelings in the short term, but this also reduces
opportunities to prove to yourself that social situations can be positive experiences. There is no chance tofind out that others can enjoy your company or that they value the things you have to say. Avoidance
prevents people from disconfirming their fears. The more we don’t do something, the more we tellourselves we can’t do something.
Do you recognise any of these factors in how your own anxiety has developed?

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What can be done about social anxiety?
MEDICATION
Medication has been used to reduce anxiety symptoms in social situations. While there are a number ofdifferent medications that may help to reduce anxiety symptoms, it is often difficult to know which one will
work the best. You should always speak to your doctor if you have any queries about medication, and if
your doctor prescribes them, make sure you follow all the instructions, and report any side effects.

COGNITIVE-BEHAVIOURAL STRATEGIESAnother powerful treatment option for reducing social anxiety is Cognitive-Behavioural Therapy (CBT).
Cognitive and behavioural strategies address the three components that specifically contribute to anxiety insocial situations. You may recall that these components include body responses, thinking responses andaction responses. In this way, cognitive-behavioural strategies seek to change the anxiety habits that may
have developed in response to social situations.

Physical or Body Responses
Remember the physical symptoms that our bodies experience in reaction to anxiety-provoking events?
These include rapid breathing, pounding heart, sweating, clammy palms, and muscle tension. One strategy
to help reduce the physical symptoms of anxiety is relaxation. In these modules, we will look at how to use
calming techniques and relaxation strategies to help reduce the intensity of your anxiety.

Cognitive or Thinking Responses
For people with social anxiety, thinking reactions can occur in the ‘here-and-now’ of the social situation,and may include focusing on negative cues. Importantly, it is our perception of particular cues as negative,
which contributes to anxiety. Thinking reactions can also occur when we’re worrying about a future eventor when we’re worrying about what we did or said at a past event. Have you ever noticed that, sometimes,
just thinking about something is enough to make you feel a little hot and flustered?
These thinking reactions are also part of a bigger picture of thinking processes. People with social anxiety
are very concerned about what other people think about them. It is this concern about negative evaluationthat starts the feelings of anxiety, which then prompts the search for threatening information in social
situations. In these modules, we will take a closer look at the thinking responses that contribute to social
anxiety and how they can be changed.

Behavioural or Action Responses
One of the most important factors that needs to be addressed when overcoming anxiety is the avoidanceof social situations. These modules will suggest some ways to gently confront those social situations so thatyou can feel less anxious when you are in them. After all, if you didn’t want to feel less anxious when insocial situations, chances are you wouldn’t be reading this information!

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Anxiety Symptoms Worksheet
Anxiety symptoms can often be grouped into 3 categories. Some symptoms are of thephysical or body type, for example, shortness of breath, tightness in the chest,
lightheadedness, etc. Some symptoms are of the cognitive type which may include thought
responses such as, “People will notice that I am anxious”, “People will think that I am
stupid”, etc. The third category of symptoms is to do with your behaviours or actions,
how you act and behave, for example: not going out, avoiding people, going out only with people to whom
you are close, etc.
Throughout this module, you have been asked about some of your body responses, thought responses andphysical/body responses. You can summarise your responses on this sheet.
PHYSICAL/ BODY

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COGNITIVE/
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Module 1: Overview of Social Anxiety

BEHAVIOURAL/
ACTIONS

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Module Summary•

Social anxiety is used to describe feelings of anxiety that occur in response to social
situations. This may be with a large group of people or just a few individuals, it may be in aparticular situation, or it may be generally in response to many types of situations.

•

For some people this anxiety may be so distressing that they feel like they can’t even go
into such social situations, or they may spend much time before and after worrying
intensely about it. The terms social anxiety disorder or social phobia are used to describe
this intense fear of social situations, which often results in the person avoiding thesituation.

•

The fight/flight response is a normal human reaction that occurs in response to fear whena person is in physical danger. It is also activated when a person believes that there isdanger or threat. This includes three major types of reactions:•

Body responses such as increased heart rate, increased breathing, increasing blood
towards muscles and important organs, sweating, and muscle tension.

•

Action responses such as avoidance of feared situations or changing your behaviourin those situations.

•Thinking responses such as searching for threatening information in anxious
situations, which reinforces the general belief that you will be negatively evaluated byother people.

•

The causes of social anxiety include both biological and psychological factors. Social anxiety
is maintained by an individual’s focus on negative things, by their thinking style, and by theiravoidance of feared social situations.

•

Some medication is available to help reduce the symptoms of social anxiety. In thefollowing modules, we will look at cognitive-behavioural strategies that address thephysical/body responses, behavioural responses, and thinking/cognitive reactions that are apart of social anxiety.

In the next module we will
be looking at the role ofbreathing in anxiety and how
you can change yourbreathing to reduce yourgeneral anxiety levels

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About This Module
BACKGROUNDThis module was created in 2003 by Patrick Kingsep at the Centre for Clinical Interventions, under thesupervision of the Centre’s Founding Director, Paula Nathan.
The concepts and strategies in these modules have been developed from evidence-based psychologicalpractice, primarily Cognitive-Behaviour Therapy (CBT). CBT for social anxiety is based on the approachthat anxiety is a result of problematic cognitions (thoughts) and behaviours.

REFERENCES
These are some of the professional references used to create the modules in this information package.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D.
A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69–93). New
York: Guilford Press.
Heimberg, R. G. & Becker, R. E. (2002). Cognitive-behavioral group therapy for social phobia. New York: Guilford
Press.
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research
and Therapy, 35, 741–756.

“SHY NO LONGER”
This module forms part of:Kingsep, P., & Nathan, P. (2003). Shy No Longer. Perth, Western Australia: Centre for ClinicalInterventions.

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