Social Phobia and Social Anxiety
The focus of social anxiety is a fear of negative evaluation by others. This fear of what others might be thinking is so intense and pervasive, that individuals with social phobia avoid certain social interactions or situations in order to avoid feeling the associated anxiety. Specific thoughts of what others are thinking vary widely, but are all negative. For example, you might have the thought that others will think that you are "weird", "a loser", "ugly", or "stupid". Ironically, one of the most common concerns of people with social phobia is that they will appear anxious to others. Fear that others will notice their hands trembling, their face flushing, or their voice quavering, leads to increased anxiety, which increases the likelihood of the very thing that is most feared. This is a perfect example of the control paradox that is central to acceptance and commitment therapy.
According to the DSM-IV, the central criteria for social phobia are:
- Experiencing a marked fear of one or more social situations in which you are exposed to possible scrutiny by others.
- Experiencing this fear as excessive.
- Avoiding certain social situations or else enduring them with intense distress.
Since human beings are essentially pack animals, we are "hard wired" for a certain amount of social anxiety. Since there is survival value in being accepted by the pack, we are programmed to look for signs of rejection by others. The person with social phobia is not only hypervigilant in watching for rejection cues, he develops hypotheses about what others are thinking. The problem with these hypotheses is that there is no way to test whether or not they are true. Even if other people say positive things about you, it is impossible to know whether they really mean those things. Instead of asking whether these thoughts are true (an unanswerable question), the more relevant question in social phobia would be: Is it useful to "buy" these thoughts?
Acceptance and commitment therapy makes the distinction between "having" a thought and "buying" it. While a person with social phobia has no control over which thoughts they have in social situations (most of these troubling thoughts are automatic and beyond their control), they can learn to choose whether or not to buy a given thought. In ACT parlance, cognitive defusion is the ability to have a thought without buying it. Experiencing thoughts and anxiety in a defused way makes it unnecessary to avoid valued social situations. "Pure O" OCD explains how socially anxious narratives drive avoidance, and how to change your response to those narratives. While the book's focus is on obsessive thoughts in general, the skills presented can readily be applied to obsessive thoughts about social performance.