Social anxiety news and stories round-up

Blogs

An artist studying art therapy gives an account of her life and experiences of bullying, judgement of her physical appearance and of subsequent social anxiety: “The pain and loneliness I felt from my social isolation was beyond imagining, so I drew to feel less alone. I am no stranger to heartbreak, betrayal and disappointment, and rather then let the pain defeat me I used it to create something beautiful. Heartbreak actually inspired most of my artworks. I use my emotional pain as a major source of inspiration in most of my works. I like to focus on the themes of life and death, nature because it brings life to my heart, and death which represents the suffering.”

A series of clearly written suggestions for using our senses to de-stress, highlighting sound, smell, feel and touch: “Figure out what sounds bring you a sense of peace or help relax you and begin using them to your advantage. The most commonly suggested method for this would be through listening to music, as this can have a positive psychological impact and has been shown to help ease low moods. Whether you are a fan of upbeat pop or more melancholy ballads, music can help us explore our emotions and ease our stress very effectively.”

A succinct post, describing emotions, particularly, feelings of helplessness: “Went for a walk with Sherri yesterday…and came back just full of social anxiety…I just have such a proliferation of thoughts after social encounters, even with people I trust. Why is it so hard to be straight forward? I’m so fed up with myself…”

The writer presents succinct descriptions of childhood friendships, which provide an insightful perspective into character and bonds: “From my infant friend Lincoln, I learnt in humans that I like those who complement my personality, but that’s not to say I atall dislike people similar to me. In fact a certain threshold of shared ethics is necessary. If you ask me when I juxtapose all of these friendships, I see very little in common. Maybe that’s the point. I build myself strong allies of a diverse settings.”

Research

This is a 1990 publication which suggests that social anxiety or phobia has a high incidence amongst the Saudi population and compares it to “the West” where “agoraphobia is the most common phobic disorder and constitutes about 60% of all clinically diagnosed phobic conditions, while social phobia is relatively rare.” The article goes on to suggest some possible reasons for this, including sociocultural.

I have included this article in this list particularly for the following quote: “Social anxiety seems to arise in people who are unduly sensitive to disapproval and criticism and who have inflexible ideas about social conventions which cause them to expect criticism unnecessarily.” This is attributed to a 1974 journal article which I could not find online: Nichols KA. Severe social anxiety. Br J Med Psychol. 1974; 47:301-6.

This quotation suggests an objective judgement of social fear based on an unspecified general standard, without reference to individual history, vulnerabilities or capacities. This objective standard may be helpful for identification of the need for treatment or support, but as a definition of social anxiety, it denies the subjective experience and condition of the person with symptoms and thus denies a holistic treatment approach. The definition also denies the reality of social power differences and social harms, beyond disapproval and criticism. I believe that this narrowly focused understanding of social anxiety disorder is found in modern medical understanding and treatments.

“Social anxiety is a highly prevalent and impairing condition. Understanding prodromal features of social anxiety in infancy can facilitate early intervention and mitigate negative long-term impacts. The present study is the first to examine social anxiety risk markers across multiple indices in infants with fragile X syndrome (FXS), who are at elevated risk for comorbid social anxiety disorder. Evidence suggests that infants with FXS display both behavioral and physiological markers of social anxiety that are detectable as early as 12 months of age. However, these findings were nuanced and not consistent across all measures, highlighting the importance of a multi-method biobehavioral approach.”

Articles

Australian freelance writer, Marnie Vinall, describes the positive experience of joining and integrating into a supportive Aussie rules football team: “I managed to make it a whole three weeks in before needing to sit out a training session because my anxiety got the better of me. It was in a regular drill called “chaos”, which involves a series of balls going in any and every direction. The purpose to practise kicking, marking, calling for the ball and making yourself open and available. “The aim,” the coach said, “is to get your hands on the ball as many times as possible.”

“For some, it will be hard to quiet the ‘threat brain’ and as a result, we may actually see a rise in OCD type symptoms. It’s important to understand that with OCD it is actually anxiety and fear at the root of the problem, it’s just the OCD are the symptoms we see.”

Another article looking at the fears that reopening of countries may bring, with particular attention on those most vulnerable, such as people with anxiety disorders: “Experts say it’s important to acknowledge your stress during this transition. It’s normal to feel nervous. People shouldn’t judge themselves too harshly for their anxieties.”

A deeper look at foods beneficial to emotional and physical health: “Serotonin has a calming effect and also promotes sleep and relaxation, McKittrick explained. In fact, low levels of brain serotonin, research has suggested, can lead to increased vulnerability to psychosocial stress.

Tryptophan is an amino acid that is necessary for the production of serotonin in the brain. Complex carbs including whole grains and vegetables can help boost levels of serotonin because they make tryptophan more available in the brain.”

Very frank and insighful account of a woman fearing social interactions after the lifting of pandemic restrictions in the UK: “Fortunately, I found a career where I could escape those feelings for a couple of hours. As a nanny, social anxiety dissipated as the focus was on the children and I was able to forget about me. I worked long hours and did something so fulfilling, that I realised when it came to caring for others – such as the children I worked with, or taking my husband to hospital – the feeling of being needed, the purpose of doing something for others, overtook the dread and fear.”

Prior to the lockdown in the UK, she had started a new job role: “I don’t currently know if I will be able to go back to it – the most I can achieve is going to a chemist to collect my husband’s medication once a month and that is a mammoth task that takes a lot of psychological build-up.”

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.