Treating Anxiety in Both Individual and Social Contexts

Given the narrowness of affordable professional psychological support available, it is vital that those who experience fear and anxiety difficulties find ways of strengthening their own capacities. In the UK, most readily available for social anxiety disorder are Cognitive Behavioural Therapy (CBT) and antidepressant medication.

Even if available, given the socio-economic and other norms underlying treatments, their suitability may not be universal. In a recent blog post titled, Understanding Social Anxiety and Social Power, Nyteshade references the difference between people’s psychological capacities in social situations: “We are not all ‘neurotypical’ (I highly doubt I am); some of us are suffering a constant inner-battle. And we are not all the ‘neutral’ agents of this society, namely white and middle class. Being placed in the wrong social category is a high cause of anxiety…”

An inherent socio-economic and/or psychological capacity presumption of some CBT treatments for social anxiety disorder is that patients have safe social spaces in which to regularly expose and thus reduce their fears, to fulfil the behavioural aspect of the treatment. Another presumption in some CBT treatments is that most social fear that give rise to anxiety or phobia are by definition ‘cognitive distortions’ and unrealistic. The individual’s sense of vulnerability is, seemingly, judged from a ‘typical’ standard.

Klodo writes, in a blog post, titled, Flaws in CBT: “if you act shy people dont notice or are to busy to care? BULLSHIT. they all notice, many comment especially on your blushing , think you act weird. why is he so quiet, strange and never speaks first? Then they ignore you and want nothing to do with you.”

For those who feel as if they fall through the gaps in treatment, other approaches must be sought, including individual training. In a recently published piece titled The Plasticity of Well-Being, researchers from the University of Wisconsin-Madison propose a framework for understanding and training in well-being with four parts: awareness, connection, insight and purpose: “These dimensions are central to the subjective experience of well-being and can be strengthened through training. In this respect, they can be likened to skills, and the cultivation of well-being to building a repertoire of skills.”

In their proposal, which they present as a starting point for further research and discussion, the researchers argue that lack of a state of awareness, which is estimated as 47% of time we spend in a state of distraction, is linked to a variety of ill-health outcomes and markers, including stress, anxiety, depression and attention deficit hyperactivity disorder. They suggest that training in attention-based meditation and psychotherapy can boost meta-awareness – “awareness of the processes of conscious experience, such as the recognition that one is experiencing an emotion, a thought, or a sensory perception as it occurs in real time.”

Awareness of one’s thoughts activates, the researchers write, the prefrontal cortex (PFC) that form part of the brain’s central-executive network and, when resulting in self-regulation of emotions, specifically, the dorsolateral prefrontal cortex (dlPFC). Training, they argue, can develop these neurological processes with different effects, they suggest, depending on the type: “Focused attention meditation, for instance, is linked to reduced activations in regions of the default-mode network (DMN), a network associated with mind wandering and self-referential thought, while open monitoring meditation is not, suggesting that meta-awareness may lead to reduced mind wandering in some cases and to meta-aware mind wandering in others.”

The researchers also present their two more social dimensions of well-being, connection and purpose, in a subjective manner, suitable for personal training through, for example. compassion-based meditation or as part of therapy, such as Acceptance and Commitment Therapy (ACT). It is likely that, to be most effective, these social states would require some form of social or community integration, which the researchers leave open for: “It is also likely that individual differences in baseline characteristics play an important role in moderating the impact of strategies to cultivate well-being. We envision a future “precision-medicine” approach that tailors training protocols for different types of individuals based on baseline individual differences.”

This framework by researchers from the University of Wisconsin-Madison offers a wider approach to treating anxiety disorders and other mental health illnesses, looking beyond cognitive approaches with rigid underlying norms and standards of psychological capacity, which can exclude some. It points towards a social-individual understanding of well-being and treatment but, in the absence of this ideal, for now, those who suffer from fears and anxieties can pursue training to improve their own capacities, alongside other support they may get. This may be affirmations or mantras, meditation, prayer, therapy or any other method that works upon vulnerabilities.

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Poems from Winter Solstice – 26th December 2020

Soft the air
the swan’s glide

the stones underneath

across the river
the departed ship

see the cormorant dive.

21/12/20

~

Looking for the river
by the banks

Hours we walked
over and under

There were geese and swans
and crowds

but the river showed
no face nor sound.

21/12/20

~~

An older man
at the open door,

From such difficulties
they rose, she says.

On the quiet street
with its vestibules.

24/12/20

~~~

Today, the seagulls sailed

and the graveyard paths

crossed by sunlight and memory.

25/12/20

Resilience and capacity as part of overcoming anxiety and depression

If fear is made up of a mismatch between perception of threat and capacity to deal with it, it makes sense to treat fear or anxiety disorders with a two-pronged approach. The first is the typical cognitive behavioural therapy approach of rationalising and testing perceptions. The other would be to strengthen actual threat resistance – through improving self-esteem, hopefulness and psychological resistance. The former is a highly cognitive and more individualistic approach but, the latter, may not always be, relying, at times, on engaging more directly the subconscious and being part of a social community.

In a recent blog post, What a shame she’s fucked in the head, Emily Lawrence, who experiences social anxiety and depression symptoms, writes of discussing the ‘five second rule’ with her therapist, to fight a sort of cognitive paralysis: “if you keep thinking about wanting to do something for more than a few seconds, your brain will start to “kill” the thought or instinct you have, and you’ll start thinking of all the reasons why you shouldn’t do that particular thing.”

Another psychological technique she discusses is visualisation, to counter feelings of hopelessness: “So before I go to sleep at night, I need to visualize what I want my morning to be like, and visualize myself doing the things I want to accomplish that next day, instead of simply worrying that I’m not going to get anything done because of the embedded thought in my head that is constantly telling me that I’m “too depressed” and “incapable.”

Vincent, in his recent blog post, Affirmations to protect my sensitivity against hostile work and social interactions, discusses handling workplace hostility. He rationalises his personal affirmations of being ‘normal’, ‘smart’ and ‘strong’: “I remember that if people attempt to insult me, or dismiss me, it’s because of their own insecurities and fears. It is a way for them to feel “big”, because somehow I have made them feel “small”.”

He also discusses putting on “emotional, mental and spiritual armour” before social situations where he thinks he might face hostility of some sort: “By mentally preparing myself for the possibility of hostile behaviour, I am then ready for it and can manage and respond to it in a calm honest manner.”

Such approaches do not just look at threat perception (or, in the case of despairing feelings, hopelessness perception) but, also, psychological resilience or capacity. I think that it is the combined approach – perhaps, describable as cognitive and emotional, that may sometimes be most helpful in reducing our fears.

In a recent blog post, Owning my awkwardness, Adrianna Carlesimo, finds that rather than completely denying her perception of her moments of social awkwardness, she investigates the shame she associates with it: “I can be lovable BECAUSE OF, rather than in spite of, my awkwardness. This is a new belief I’m working on internalizing, and honestly, it’s a relief to stop trying to convince myself that maybe I wasn’t actually awkward.”

She describes an incident when she began to blush and “say a few awkward things” during a work zoom call with a client team after their CEO praised her work. A person on the zoom call commented on her blushing. Adrianna wrote: “While this is the type of situation that years ago would have me ruminating for hours, days, weeks on end, wanting to curl up into a ball every time I remembered it; today, I just felt slightly embarrassed immediately after the moment passed, and then just laughed to myself. I was able to find my inner peace before the end of the 60 minute call.”

Similarly, Emily Lawrence, describes gradually coming to terms with her difficulties with social interaction and being quiet: “Like, yes, I am an introvert; I am quiet; what fucking difference does it make?? Yes, talking is hard for me. Words are hard. It’s always been hard. But at the end of the day, I know that I’m trying to improve, so I’ve really just started to stop caring about what others think about me, and am realizing that the right people will understand and be patient with me.”

Rather than simply a cognitive change to more realistic threat perception, reducing the shame and vulnerability of social difficulties may sometimes take emotional resilience and this too may need to be actively worked on, often, with support of others. JN Manson writes, in their recent post, High Anxiety: “But the greatest benefit of the CBT process was the opportunity to talk to someone smart, who has empathy and deep understanding, that was the most priceless gift…”

Poems from underneath – 19th December 2020

The crow rises
and falls away
with the stars.

14/12/20

~

The gates closed
around the sun.

With the stars
and fir trees.

The evening
of pink light and leaves.

17/12/20

~~

The crows and seagulls
across the fields.

Their island of light.

14/12/20

~~~

You are good,
the newcomer said.

Which, of course,
means drowning.

But, still,
you chew on his words.

19/12/20