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Social Anxiety and Mindfulness
According to the DSM IV, Social Phobia (Renamed Social Anxiety Disorder in the DSM V to better differentiate itself from other phobias that have little relationship to Social Anxiety) is characterized by a persistent fear of being judged and scrutinized in social situations. It can involve fear of having visible anxiety responses (such as blushing, shaking, rapid heartbeat) or fear of having a panic attack when in a social situation. Individuals with this disorder know that their fear is abnormal and they often avoid situations or tolerate social events with extreme anxiety, which can create disruption in the individual's life (loss of jobs, dropping out of school, and isolation from former friends and family can all be a result of social anxiety) and feelings of worthlessness or helplessness. Social anxiety is so crippling for sufferers because it affects one of the most important ways a person can receive support, acceptance, and health; through relationship with others. Since anxiety in general, and social anxiety in particular, seems to include an acute awareness not only of one's own physical sensations but also of thoughts, it might on the surface seem that people suffering from anxiety are acutely mindful; after all, anxiety is so painful because the sufferer is highly aware of their own physical reactions and the subtle actions, movements, or words of others. Hyper awareness, though, is not the same thing as mindfulness and even works at counter purposes. Mindfulness from a therapeutic perspective includes an element that research has found to help alleviate social anxiety; a nonjudgmental, acceptance-based awareness of anxiety symptoms. Through mindfulness with a focus on nonjugment, individuals suffering from Social Anxiety Disorder can alleviate suffering due to obsessive thoughts, negative self evaluation, and uncomfortable somatic experiences.
What is Mindfulness and How can Mindfulness Help?
John Kabat-Zinn defines therapeutic mindfulness as "the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment to moment." For clients with social anxiety, a large part of the distress comes from an "inability to adequately monitor, control, regulate, or resolve fears of being negatively evaluated or rejected" (Kashdan & Steger, 2006), an inability that creates a the tendency to avoid or tolerate, in misery, many social situations. These thoughts of being judged negatively are like a chorus in the mind of the SAD sufferer, constantly reminding them that they are not acceptable and that he world is not safe. The specifically nonjudgmental aspect of mindfulness seems key to how mindfulness can work with social anxiety. Since so much of social anxiety is about one's own reactions to anxiety symptoms and fear of those symptoms being visible to others, a nonjudgmental stance toward those symptoms can help to alleviate some of the avoidance behaviors associated with social anxiety. The kind of attention to internal experience that individual with SAD experience is not really mindfulness (it is not simply observation with non-judgment); it is coupled with negative self evaluation and distress at perceived negative evaluation by others. Brady and Whitman describe this as a kind of loop, in which attention to internal anxiety symptoms heighten as awareness of external stimuli decreases (2011). In other words, the more an individual suffering from SAD becomes aware of their symptoms, the less ability they have to verify their own discomfort and fears against what is really happening in the outside world, furthering their isolation from immediate experience beyond their internal sensations, thoughts, and emotions. It follows, then, that if individuals can learn to tolerate their own internal discomfort and anxiety symptoms through nonjudgmental observation, while remaining aware that their thoughts are only thoughts and do not have to be believed, they can better prepare themselves to exposure to social situations. Burton, Schmertz, Price, Masuda, and Anderson (2013) found that mindfulness is negatively related to fear of negative evaluation, while Goldin and Gross (2010) find that mindfulness increases a person's ability to emotionally regulate when in a triggering situation. When triggered, Social Anxiety sends one into a tailspin of introspection, judgment, and somatic discomfort. If individuals can become aware of negative evaluations but step away from identifying with them, they can better assess the present-moment reality of a situation and bring in emotional regulation skills.
Specifically among the negative thoughts common with individuals with SAD is the tendency for frequent negative self-evaluations, a factor related to low self-esteem. According to the American Psychiatric Association, low self-esteem is an associated symptom of social anxiety (Rasmussen & Pigeon, 2011). This low self-esteem is partly due to the looping, obsessive thoughts described above, in which an individual believes that their own negative self evaluation is shared by others, which in turn increases negative self evaluation. This belief can cause avoidance or silence, which in turn can exacerbate discomfort in social situations and more feelings of failure and negative evaluations by others. Social rejction strongly correlates with low self-esteem, and individuals with SAD both perceive themselves to be socially rejected and perhaps even bring about their exclusion through avoidance, awkwardness, and perceived disinterest or lack of engagement (Rasmussen & Pigeon, 2011). The low self-esteem and negative evaluation aspect of Social Anxiety disorder is related to self-referential processing, the process by which one evaluates one's own behavior, thoughts, and identity and comes to judgements or conclusions about that behavior. Individuals suffering from SAD are preoccupied with evaluating themselves, generally in a negative way. Through mindfulness, a practice that allows for one to experience their thoughts as not the "truth," but as just one aspect of experience that arises and falls away, clients can create some distance between thoughts and immediate actions or beliefs, as discussed briefly above. To put it simply, mindfulness teachers a practitioner to not take their thoughts so seriously, but to also know, and accept, those thoughts as present in the moment. This is an important distinction; while socially anxious people might be well aware of their self evaluation and thoughts, they might harshly evaluate these thoughts and try to push them away or repress them. Mindfulness seeks to bring greater awareness to thoughts and the cycle of thoughts, emotions, and somatic responses. Instead of pushing away these seemingly negative thoughts, indivudlas can instead fully realize those thoughts. Often, so many negative self evaluations go under the radar and set off a series of emotions and physical sensations that an individual scarcely realizes before they set off a chain of responses. Awareness of thoughts, and some skills around dealing with obsessive negative thoughts, can help to alleviate some of the cognitive elements that lead to low self-esteem in SAD sufferers.
Woman with a tension headache
Another common element of Social Anxiety Disorder comes through somatic symptoms. The somatic symptoms, such as blushing, sweating, shaking, and rapid heartbeat, can be highly embarrassing, and often can contribute to negative self evaluations and avoidance of social situations; simply the fear of having these symptoms can mean that SAD sufferers avoid situations that might potentially trigger these reactions. As with other Social Anxiety Disorder symptoms, mindfulness can be brought to bear on somatic elements, too. Although there are few studies related to the specifics of somatic elements as they relate to mindfulness treatments, many of the points above also come into play when thinking about how mindfulness can be helpful in treating these symptoms. As with the Buddhist concept of "first dart" and "second dart", the somatic elements of social anxiety have two sources of pain for sufferers. The "first dart" in this case is the pain of the actual physical reaction, such as blushing, shaking, racing heart, etc. These elements alone can be physically uncomfortable. The second dart, though, is particularly painful for the social anxiety sufferer; the embarrassment, shame, and fear of other people noticing the symptoms, and the frustration of losing control over one's own physical experience, is as painful for people with SAD as the actual symptoms themselves. If clients can learn to fully experience these sensations, without judgment and without negative evaluation, then they can better tolerate the physical symptoms that come up in uncomfortable social situations. While mindfulness does not claim to "fix" symptoms or make a client magically symptom-free, it is a mechanism by which a person can come to not only an overall acceptance of symptoms, but also better understand when those symptoms are triggered, the thoughts that accompany them, the emotions that arise, and the entire system that comes into play when this occurs. Mindfulness gives not only a clearer understanding of cognitive patterns and content, but also a greater tolerance for what is arising somatically in the moment.
- Mindfulness brings awareness and nonjudgment to present-moment experience.
- Individuals with Social Anxiety Disorder often have a great deal of judgment and negative self-talk around their symptoms.
- Mindfulness can help alleviate judgment and negative evaluations.
Although individuals with social anxiety might never be "social butterflies" like the people in the photo above, midfulness can help to alleviate some of the discomfort related to social anxiety and perhaps make socializing easier and less painful. It's important to pick mindfulness activities that you enjoy, though. Sitting meditation, walking meditation, yoga, and breathing exercises are among the most popular, but choose an activity that works for you. In addition, remember that mindfulness, at its basis, is about learning how to pay attention to your experience and observe the workings of your mind, emotions, and body non-judgmentally. Please check out the John Kabat-Zinn video below for more information about mindfulness.
Mindfulness with Jon Kabat-Zinn
John Kabat-Zinn on Mindfulness
In this video, John Kabbat-Zinn discusses mindfulness and its uses.
Anderson, P., Burton, M., Masuda, A., Price, M., and Schmertz, S. (March, 2013). The Relation Between Mindfulness and Fear of Negative Evaluation Over the Course of Cognitive Behavioral Therapy for Social Anxiety Disorder. Journal of Clinical Psychology. 69(3). 222–228.
Brady, V., and Whitman, S. (April, 2012). An Acceptance and Mindfulness-Based Approach tSocial Phobia: A Case Study.Journal of College Counseling. 15. 81-96.
Goldin, P. And Gross, J. (2010). Effects of Mindfulness-Based Stress Reduction (MBSR) on Emotion Regulation in Social Anxiety Disorder. Emotion. 10(1). 83-91.
Kashdan, T., and Steger, M. (Feb, 2006). Expanding the Topography of Social Anxiety: An Experience-Sampling Assessment of PositiveEmotions, Positive Events, and Emotion Suppression. Psychological Science. 17(2). 120-128.
Rasmussen, M., and Pigeon, A. (March, 2011). The Direct and Indirect Benefits of Dispositional Mindfulness on Self-Esteem and Social Anxiety. Anxiety, Stress, & Coping. 24(2). 227-233.
Richards, T. (n/a). Comprehensive Cognitive-Behavioral Therapy For Social Anxiety Disorder. Social Anxiety Institute.Retrieved on 11/20/2013 from https://socialanxietyinstitute.org/comprehensive-cognitive-behavioral-therapy-social-anxiety-disorder