Datasets:

vjain
/

shyness_social

Tags:

License:

Dataset card Viewer Files Files and versions Community

Dataset Viewer

Auto-converted to Parquet

View in Dataset Viewer

Viewer

Split (1)

train · 465 rows

id string	page_content string	source string
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

End of preview. Expand in Dataset Viewer.

README.md exists but content is empty. Use the Edit dataset card button to edit it.

Downloads last month: 0

Edit dataset card

Size of downloaded dataset files:

623 kB

Size of the auto-converted Parquet files:

310 kB

Number of rows:

465