THURSDAY, January 10th, 2013.

Overcoming your social phobia

          Courtesy: John Winston Bush, PhD

New York Institute for Cognitive and Behavioral Therapies

        SOCIAL PHOBIA (also called social anxiety disorder) is an excessive fear of

what other people might think of us. Our opinions of each other should

matter — if they didn’t, we’d be living in a corner of hell, not a civilized

society. But when someone is suffering from social phobia, he or she is

feeling an exaggerated concern for public opinion — one that goes far beyond

what we need in order to relate to other people for our mutual benefit.

In social phobia, we are aware of fear or gnawing anxiety — in the actual

presence of other people, in anticipation of being in their presence, or when

we imagine them being somewhere else but thinking of us. But though it

might seem otherwise, it is not actually their physical presence or being in

their thoughts that we dread, nor is it even being the direct focus of their

attention. It is how they might judge us if we give them the chance — by

being in their presence, by calling attention to ourselves, or doing something

to remind them of us.

We imagine — or most often, unconsciously assume — that they will see us

as ugly, stupid, weak, awkward, unwelcome, worthless, or cursed with some

other undesirable quality. In time, we may even come to believe (at least in

our less rational moments) that we really are as bad as all that.

Strictly speaking, it isn’t even people’s judgments that we fear, but our own

emotional reactions to their judgments, whether the judgments are real or

imaginary. At bottom, what we are afraid of is the private (often quite

secret) experience of feeling embarrassed, ashamed, guilty, disgraced, rejected

or humiliated.

These can be very painful, even crippling, emotions, and it might make sense

to try to head them off when there is a real likelihood of their happening.

But in social phobia, we have these reactions even when no one is judging us

negatively, and we expect to have them in future situations where they are

objectively unlikely. In addition — and in a sense this is the worst of it —

we believe or assume that such feelings have to be unbearable, rather than

being experiences we can cope with, take in stride and put behind us in a

reasonable amount of time.

How is such craziness possible?

Good question. You’d think that the minds of humans, whose brains have

made us the dominant species on our planet, would be immune to such

absurdities. But as it turns out, even otherwise competent brains are capable

of something as senseless as making us afraid of routine contacts with other

people. Current neuroimaging and related research points to two factors that

in combination can result in social phobia:

• Hypersensitive amygdalas. We have two bits of brain tissue, each about

the size of the smallest segment of our little finger, that have been “wired”

for sentry duty. They are shaped roughly like almonds1, and there is one

on each side of the brain, in the temporal lobes — so called because they

are located behind our temples. (In

this cutaway picture2, the bulge at

the lower tip of the gold loop where

the yellow arrow is pointing.) Their

job is to pick up on signs of possible

danger.

If our amygdalas detect danger where

it isn’t, or react as if we were in great

danger when the peril is actually

slight, they are going to send false

alarms to the parts of our brains that mobilize us for self-protection —

responses that include running away, freezing, hiding, and fighting. In

social phobia, false alarms somehow come to be triggered by the sight or

sound of other people, or even by remembering or imagining ourselves in

the presence or thoughts of other people.

• Unbalanced communication between brain regions. No doubt due to the

strong evolutionary bias in favor of staying physically alive, human brains

are so arranged that danger signals take priority over our capacity to carry

on other activities, including high-level conscious thinking. In the world of

our prehistoric ancestors, the smart but unwary were likely to end up

impaled on an enemy’s spear — survival of the skittish, you might say.

The result is that there are more brain-cell fibers sending information

from the amygdalas and nearby structures to the frontal cortex — the

region behind our foreheads where we do our rational thinking — than

there are running in the other direction. This enables the amygdalas’

danger signals to hijack our thought processes rather effectively. They {1 Amygdala is the Greek word for almond. 2 Courtesy of www.vesalius.com.} have about a half-second jump on cortical activation, which is all they need

to take over the ship and set off a vicious cycle in which fear alternates

with struggling to escape or tame the fear, with unpredictable and

sometimes very painful consequences.

For most of us in today’s world, however, there aren’t too many hostile

tribes in the vicinity. Thus if our amygdalas very often over-react to

situations involving other people, social isolation and lost opportunities

rather than an extended lifespan are likely to be the result.

        So now what do I do?

Oh, you mean that lovely explanation hasn’t cured your social phobia

already? Well, all right, if you insist; here are the things that (with one

possible exception) you will need to do to become more comfortable with your

fellow humans. They’re grouped under five headings:

• Cognitive — correcting some of your thoughts, beliefs and assumptions

about how others see you, and about the stake you have in their opinions

of you.

• Behavioral — entering and remaining in the presence of other people long

enough for your fears to subside. (Which they will do all by themselves if

you go about it in the right way.)

• Defusion and mindfulness — activities, to be described below, that will

make it easier to carry out your cognitive and behavioral tasks.

• Medication — another way for some people to help carry out their cognitive

and behavioral tasks, but assumed unnecessary until shown otherwise.

• Personal values — clarifying what it is you care about, and what you

would want to work toward if given a chance.