part0011

E veryone experiences social anxiety from time to time. It can often be situation specific — if we’re facing an interview, attending a social event alone, or performing a difficult task in front of others — or sometimes there are just periods in our lives when we feel a little more anxious than at other times. However, sometimes social anxiety can appear more permanent and affect every part of our lives. How do we go from temporary or situation-specific anxiety to developing an anxiety disorder?

Most anxiety disorders develop through what psychologists call Escape Avoidance Learning, which follows this general pattern:

Let’s say something happened at a cinema when I was a child. Maybe I tripped over when waiting in line to buy a ticket, spilled popcorn I was holding onto the floor, and the other people in the line laughed at me. I had suppressed it, as when I was younger it was embarrassing and painful. Now, much later on in life, I visit the cinema and I’m in a line waiting to buy tickets and smell popcorn.

The smell of popcorn may be enough to bring up some sense of anxiety, as this is how associational memory works. It only takes a small trigger to connect us back to something that was difficult or unpleasant.

I find the anxiety unpleasant, especially if I’m having some kind of physiological response (heart beating rapidly, shallow breathing). I may feel like I’m going to have a panic attack.

I want to get rid of the unpleasant sensation, so I decide I’m going to get away from the situation by leaving the lobby, or I may even leave the cinema altogether.

As I found relief from my anxiety by leaving the situation, I’m more likely to repeat this behaviour in the future. This is called negative reinforcement — the reinforcement that comes from removing an unpleasant experience. So the next time I go to the cinema and smell popcorn, I’ll be more likely to do the same thing because it feels good to have the negative experience stop. This can also extend to other situations; I may avoid the post office and shopping in the high street. In extreme cases this can lead to fully blown Social Anxiety Disorder.

Even though the behaviour may not develop into something as serious as Social Anxiety Disorder, most of us develop these little patterns around things we’re afraid of, and start to avoid situations that make us feel anxious. This is then negatively reinforced, and causes limiting and problematic behaviour. We don't face our fears; we avoid them or distract ourselves from them. So how is anxiety like this normally treated?

In the 1980s a number of universities, particularly in the United States, started exploring interventions for anxiety and phobias created by specific situations.8 Many of the universities experimented treating people with snake phobias to investigate and illustrate how anxiety caused by Escape Avoidance Learning can be treated. Although the experiments didn’t investigate social anxiety specifically, the same principles apply to any type of anxiety. The interventions were generally designed using the following pattern:

1. The participants would arrive at the university and be told by a researcher that a snake is locked in a cage in a room some distance away.

2. Then, in the early days of this research, a relaxation method called ‘reciprocal inhibition ’ was performed. This involved the participant being trained to reduce their anxiety using a muscle relaxation technique. However, later on in the research it was discovered this step wasn’t necessary, and participants were encouraged to stay with the experience and allow the anxiety to be there until it went by itself.

3. With the snake still in a distant room, the researcher talked to the participant, described the snake, answered any questions, and then just waited until nothing happened and the anxiety declined.

4. The snake was then moved to a closer room and the participant would be given time to calm down. Step-by-step, the snake was moved closer, until it was brought into the same room and put in front of the participant.

It was discovered if you repeat this exercise a number of times, the person would eventually lose their snake phobia. The anxiety response became extinguished because the participant experienced nothing terrible happened. This approach has since been found to work for nearly all phobias. This is an example of the amygdala learning from experience. It works by activating the memory circuits that cause the anxiety and then allowing learning to rewire the neural pathways and eliminate or reduce the anxiety response.

Often, when people seek treatment for social anxiety, they aren’t initially interested in ‘handling the snake’. They don’t want the treatment to feel uncomfortable, or to face their fears. People want to get rid of the anxious feelings without feeling discomfort, but there is no magic bullet for treating social anxiety. Like the people who handled the snake, this book focuses on teaching us to increase our capacity to bear the anxiety and to change our relationship with the experience.

Later in the book- chapters 14 and 15 - we’ll look at learning through experience in more detail. The chapters will explain how we can use exposure treatment to design a Social Anxiety Action Plan and practically apply it in social situations that cause us anxiety.

When we use specific interventions and mindfulness-based exercises to treat our social anxiety, research indicates they can go further than just improving our experience of anxiety. With consistent practice we can change the structure and functioning of our brain in ways that benefit us beyond our mental health. In the next part we’ll introduce exercises that will create a solid foundation by calming the mind, increasing energy, and preparing you for the mindfulness skills introduced in the next section. We’ll start by looking at the power of mindset.