Social Phobia - An Inside Look

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Social phobia - an inside look

Outside first.

What do we see as bystanders? A young man enters the company of friends / acquaintances, greets (… and sometimes not) and sits on the edge, a little further away from everyone, as if adhering to the most acceptable distance from the center of views, communication, some kind of interactions. He seems to be here, and at the same time he is not here. As if he seeks to leave here, staying here … He is silent, and speaks only when he is addressed, while, if it attracts everyone's attention, he is embarrassed. His phrases are short, laconic and monotonous. He practically does not show emotions and in every possible way avoids attracting attention. We see him in a different situation - he is walking along a crowded street, a certain stiffness can be traced in his gait, sometimes he limps due to the increased tone of the leg muscles. There is tension on his face. Everything changes when he is in a place where there is no other person's gaze. In this place, calm and relaxation comes.

What happens inside is internal events.

What is the internal environment of this person filled with in the episode of manifestation of social phobia? As soon as he realizes that he is visible to others, a certain model of thinking (which, in essence, is toxic and maladaptive) is triggered, accompanied by the activation of the sympathoadrenal system. I propose to consider the thinking model of this person.

A person enters a room in which several people are present. The presence of people (external trigger) and the realization that he is currently becoming an object of attention and evaluation (internal trigger) triggers an anxious expectation mode. From the point of view of the metacognitive approach, the basis of social phobia is the cognitive-attentive syndrome (CAS), which consists of anxiety and rumination, inflexible attention control and fixation on threats, unproductive coping strategies such as avoidance.

In our example, it looks like this. After a young person with social phobia is in a situation of potential social assessment, the CAS is activated. He greets those present (thereby getting into a situation of self-presentation), already with this action, excessive conceptual processing in the form of anxiety is possible, which is accompanied by a chain of verbal thoughts “What if they don’t want to say hello to me”, “What if they don’t like me”,“What if I smell unpleasant”,“What if I look awkward”. Attention is focused on these intrusive thoughts and feelings, in addition, the young person constantly focuses on the image of how he looks in the eyes of others, and on the threats in the form of assessment that can be given to him. His threat monitoring also includes tracking the intonation in the speech of others, if it is directed towards him. In general, monitoring threats is a problem, as it increases the sense of subjective danger, thereby increasing or maintaining emotional arousal.

Despite the awareness of the exaggeration of the danger, anxiety can increase due to these processes. During the conversation, his voice begins to tremble and his mouth dries up, he has thoughts that others notice all this and begin to laugh at him, that they condemn him. Reacting to these thoughts with anxiety or fear, his physiological reactions intensify, such as tremors, a feeling of heat, profuse sweating, etc. All this increases the experience of anxiety like an avalanche. Unable to control fear, he finds an excuse to leave this place, after which the anxiety subsides.

CAS arises from knowledge and beliefs that are metacognitive in nature. Positive metacognitive beliefs about anxiety, threat monitoring and other strategies (which imply the usefulness of worrying, or monitoring threats as a response to internal stimuli) are important, as well as negative metacognitive beliefs about the uncontrollability, importance and danger of thoughts and feelings.

In a young person, positive metacognitions of anxiety are statements “I have to worry to avoid bigger problems”, “I have to worry in order to be ready for attack / rejection”. Negative beliefs sound like "Anxiety is out of control", "Feeling anxious means I'm in danger."

As a consequence, positive metacognitions support the CAS model, while negative ones force one to abandon attempts to control, as well as give negative and threatening interpretations of internal events. Because the young man used avoidance to cope with uncomfortable sensations, it interfered with the normal self-regulation process and the adaptive learning process. A vicious circle has formed in typical situations: anxiety - avoidance - relief - worry.

Repetitive worry reinforces the habitual way of responding, so that the young person has little awareness of this activity. And the force of habit and lack of awareness contribute to the feeling of uncontrollability of these mental processes.