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.