Where Social Anxiety Comes From
Everybody has some social anxiety. In fact, if you had no social anxiety at all, you would struggle to function in everyday life. Social anxiety, or the fear of negative evaluation by others, is what motivates us to behave in prosocial ways. Simple pleasantries like saying “please” or “thank you” or choosing to dress professionally at an interview are driven by a fear of social rejection. So when does social anxiety become a disorder and where does this disorder stem from?
Social Anxiety Disorder has deep evolutionary roots. Early humans learned to elicit important social resources via practicing social comparison to others and closely self-monitoring (Gilbert, 2001). They learned to be seen as attractive to ensure social acceptance and find reproductive partners to pass on their genes (Gilbert, 2001).
Today, finding a partner is made easier with the aid of big cities, dating apps, meet-up groups, and more. Social comparison to others or careful self-monitoring may be less necessary. In fact, excessive social comparison to others can negatively impact self-esteem, and constant self-monitoring can make it difficult to stay present in one’s life (Vogel, et. al. 2014). While the risks and challenges of being human have changed over millennia, our physiological wiring has been slower to adapt. People with Social Anxiety Disorder are left with active, effective threat response systems that keep them comparing themselves to others and monitoring their own appearance and behaviors, even when there is low likelihood of social rejection or few consequences of negative evaluation by others.
The Nature of Social Anxiety Disorder
Social Anxiety Disorder is characterized by “safety behaviors”—behaviors to avoid the occurrence of feared outcomes. For people with Social Anxiety Disorder, these behaviors are aimed at avoiding social rejection. But what happens when one is so afraid of social rejection that they, for example, stay quiet and avoid all social encounters? Or only ask questions of others without ever sharing details about themselves? By avoiding socializing to keep others from evaluating them negatively, people with Social Anxiety Disorder may forgo opportunities to make meaningful connections. Without ever talking about themselves, they may struggle to develop closeness and intimacy in their relationships. Thus, safety and avoidance behaviors backfire, and can turn fears into self-fulfilling prophecies.
Cognitively, Social Anxiety Disorder is characterized by negative automatic thoughts. These are words, phrases, or images that pop into one’s head repeatedly and tend to be distorted, harsh, or unhelpful. One common thought pattern for people with Social Anxiety Disorder is Mind Reading—the tendency to think about what other people are thinking. People with Social Anxiety Disorder may think that others think they are “weird,” “boring,” or “unlikeable,” etc., even in the absence of evidence to support these thoughts.
These negative thoughts are often amplified through selective attention and confirmation bias. Selective attention is the tendency to focus on details that confirm our negative thoughts. For example, someone with Social Anxiety Disorder might notice every time a stranger looks at them, but not notice all of the times that a stranger walks past without glancing at them. Confirmation bias might lead socially anxious individuals to interpret ambiguous evidence in such a way that confirms their unhelpful beliefs. For instance, someone with social anxiety might draw the conclusion that even strangers with neutral facial expressions seem displeased or judgmental.
Individuals with Social Anxiety Disorder may also become hyper-focused on their own presentation and may feel exceedingly self-conscious about their appearance or behaviors. With practice, one can learn to intentionally shift their focus of attention away from their own perceived flaws and towards the world around them.
Cognitive Behavioral Treatment for Social Anxiety Disorder
In Cognitive Behavioral Therapy (CBT) for Social Anxiety Disorder, clients learn to identify their maladaptive “safety” and avoidance behaviors, and set small goals to begin to eliminate these habits. These behavioral changes often entail exposing themselves to social situations. Treatment may center around developing skills to manage fears without relying on avoidance or “safety” behaviors. Setting up behavioral experiments, often called exposures, in which clients try anxiety-provoking behaviors in a controlled or planned way can allow clients to learn that their feared outcomes are unlikely and they can tolerate their own discomfort in order to live by their values.
In traditional Exposure Therapy, clients rate and rank feared activities based on how uncomfortable they predict they will feel while completing certain behaviors. Clients then work their way through the list of activities with the support of a therapist, emphasizing the ways that the activities may feel scary, but remain safe and worth the evoked anxiety. Over time, clients habituate to their fears—their anxiety response diminishes. Clients also learn that they can complete, and may even enjoy, activities that are important to them while tolerating anxious or uncomfortable feelings.
Cognitively, it can be helpful to challenge negative automatic thoughts about oneself, others, and the future. This practice entails learning to differentiate between thoughts versus facts. Then, with help from a therapist, clients practice gathering facts of a situation that they use to support or refute their Negative Automatic Thoughts. This process is similar to gathering data to study a hypothesis, or gathering evidence to support and refute a thesis statement in an essay. Clients then can weigh the evidence to generate more balanced, alternative thoughts. This process helps clients think more flexibly, can decrease the degree to which clients believe unhelpful thoughts, and can diminish the intensity of painful feelings that accompany those unhelpful thoughts.
CBT for Social Anxiety Disorder at the outpatient level can be administered in 1:1 individual psychotherapy or via Cognitive Behavioral Group Therapy. Both treatment options are empirically shown to be effective in treatment of Social Anxiety Disorder. At Cambridge Psychology Group, we have immediate availability for individual treatment via psychotherapy, or through our 2-week Intensive CBT Program where adults and adolescents (age 16+) can receive CBT and Exposure Therapy in the state of Massachusetts. If you or a loved one are one of the 12.1% of Americans who will struggle with Social Anxiety Disorder at some point in their lifetime (Kessler et. al., 2005), our intake team would be honored to help you begin your treatment journey!
Gilbert, P. (2001). Evolution and social anxiety: The role of attraction, social competition, and social hierarchies. Psychiatric Clinics, 24(4), 723-751.
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry.2005;62(6):593–602. doi:10.1001/archpsyc.62.6.593
Vogel, E. A., Rose, J. P., Roberts, L. R., & Eckles, K. (2014). Social comparison, social media, and self-esteem. Psychology of Popular Media Culture, 3(4), 206–222. https://doi.org/10.1037/ppm0000047
Joy Gage, LCSW is a certified social worker at Cambridge Psychology Group who works with older adolescents and adults both in person and via telehealth. She specializes in treating anxiety, mood disorders, and OCD. She utilizes exposure therapy, exposure and response prevention (ERP), Cognitive Behavioral therapy (CBT), and Acceptance and Commitment Therapy (ACT) among other evidence-based modalities. She enjoys working with young people to overcome their fears, and to find, express, and celebrate their authentic selves amidst life transitions and social pressures.