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Anxiety: Friend or Foe?
Shyness. We've heard this word a lot. At one time or another, all of us have probably thought of ourselves as shy. Indeed, research shows that 93 percent of all people have experienced shyness. What does it mean to be "shy"? For some, it may mean being quiet, reserved, or timid. For others, shyness is a catch-all word to describe what may at first seem like a personality trait, but is in fact a fear response that pervades their lives and prevents them from doing things that they would like to do, such as finding personal fulfillment and achieving career goals.
Over the years, in working with thousands of people who call themselves "shy," I have come to realize that this word is too general to be of much help in identifying a problem and solving it. The actual response to the stress of interaction is called social anxiety. Of course, just as one person might say he is "a little shy around women" and another might say she is "extremely shy about speaking in front of a group," it is also true that there is a wide spectrum of social anxiety, from mild nervousness all the way to social phobia, in which interaction-related anxiety is so extreme that a person actually avoids the specific situations that cause it. Avoidance, too, has its degrees, and can mean anything from being characteristically reserved at work, even though you have an idea or solution to propose, to refusing to attend social gatherings. Social phobia -- commonly defined as performance anxiety in which the individual fears humiliation, embarrassment, or being evaluated -- is quite common, and, according to a November 1991 article in the Journal ofClinical Psychiatry, is an emerging problem that is just beginning to receive attention: "If the 1980s were considered to be the 'decade of anxiety,' most would agree that panic disorder and obsessive-compulsive disorder received the most attention. The 1990s are sure to be another decade of anxiety, but we can expect other anxiety disorders to take the limelight, particularly social phobia." Until now, the article states, social phobia has been "overlooked" as a disorder, and I believe that mental health professionals have often looked at it as part of a general anxiety problem, lumping it together with other conditions. But social anxiety is a very specific problem. As a psychotherapist with more than thirteen years of experience in developing a program for individuals with social anxiety, I have observed that by nature, people with social anxiety are extremely resistant to getting help, so there is much about this population that has not been fully understood or studied. As for the increased awareness of social anxiety, I see it as an indication that technological advances and an increasingly competitive workplace are taking their toll on society. Further, I think families today are less able to "hide" or protect their socially anxious members. People with social anxiety can only benefit from this increased awareness. For some, a little information about how they respond to stress may be enough to minimize the anxiety response; for others, a more detailed application of overall strategies is in order. Whatever your social functioning level, this book can help you to work through your anxiety to be a more productive and fulfilled human being.
As you begin your exploration of social anxiety, it is important to grasp some basic concepts. First, understand that "shyness" and social anxiety are two closely related dynamics: Both terms describe a learned response to social interaction. In unfamiliar situations, or even familiar situations whose outcome may be unknown -- meeting new people, giving a speech, asking someone for a date, negotiating a raise -- a "shy" or socially anxious person may hesitate to pursue the things he or she is interested in, or even begin to avoid situations that cause nervousness or anxiety. For example, if you fear that asking your supervisor to explain a basic point at work will make you appear stupid and you therefore avoid asking questions, you are allowing your social anxiety -- your fear of humiliation or embarrassment -- to control your actions and inhibit your career success. In your personal life, feeling out of place at parties because of anxiety might lead you to decline many social invitations. When you fear rejection, the interactions you do have can become unsatisfying. Your anxiety can prevent you from giving all you can to a conversation and can prevent others from responding fully to all you have to offer.
I call this fear response interactive inhibition. How does interactive inhibition affect you? At work, you may stay in a "safe" job, in which all duties are clear and manageable although no longer challenging, rather than ask for more responsibility or look outside your company for a change. In your personal life, you might hesitate to get close to people, although you have friends to socialize with. Your inhibited emotion may inhibit the quality of intimacy.
When your interactions are inhibited by social anxiety, you are unable to get as much out of life as possible, and so a "harmless personality trait" can become a major obstacle that stands in the way of fulfillment and productivity. But this doesn't have to be the case. Social anxiety is a learned response -- habit that can be broken. This book will show you, step by step, how to break the social anxiety cycle that may have caused loneliness in your personal life, decreased productivity in the workplace, and an overall lack of fulfillment. As you begin to understand that social anxiety is a combination of attitudinal, emotional, behavioral, and physical responses, you will see that there is actually no such thing as shyness. Rather, what you may refer to as "shyness" is actually social anxiety, a psychophysiological response that you can learn to control. To recognize social anxiety is to give yourself permission to resolve the issues that cause your symptoms. In working through this self-help program, learn to substitute the phrase "social anxiety" for the vague term "shyness" and you will start to see your response pattern in a different light: as a way of reacting that you have chosen, not some unchangeable instinct that has chosen you.
In more than a decade of psychotherapy practice, I have met thousands of people who refer to themselves as "shy." Often, these people believe shyness is a fait accompli, a matter of genetic predisposition that they must deal with as a fact of life. They say they were "born shy" -- their parents, grandparents, or other relatives are shy too, and it's just in their blood to be timid. Of course, behavior also can be handed down through conditioning -- perhaps your mom always got nervous before a party so you learned to react the same way. Believing that "shyness" is an indelible component of the personality can be a real stumbling block to overcoming social fears. "That's just the way I am" becomes an excuse for not taking responsibility for individual well-being. In order to change this mind-set, it is important to understand that because shyness is learned, it can be unlearned. Anxiety can be controlled.
But there is no pill to cure the problem. As with all aspects of life, if you really want to get the most out of your social interactions on the job and after hours, you have to put a good deal into them. It takes hard work and a genuine commitment to change. If you sit there waiting passively for the day when your "shyness" will disappear, you will miss out on all the things that, deep down, you really want. And I am not just talking about having fun. In our ever-changing economic climate, your job security and career growth depend on your ability to interact productively, to initiate dialogue, stand up for your ideas, and negotiate compromise. Your ability to evaluate the social chemistry of the workplace and to establish and maintain your position on the team may well determine your career success. Not everyone rises to the top, outshining colleagues, but not everyone wants to and that is not always what is required. But most people must work with others, and cooperation demands social skills and confidence.
This reminds me of David, a brilliant young computer programmer whose difficulty in interacting almost cost him an important promotion. Right out of college, he landed an excellent entry-level job with a growing firm. Within nine months, he was promoted to a managerial position -- a real success story. But it was after his promotion that his troubles began.
Although he was fine in front of a computer terminal, David had great difficulty coordinating his work with other members of his department, whether they were his superiors or people who reported to him. Poor communication skills and a tendency to be a perfectionist combined to create a management nightmare: Though it was clear David knew exactly what needed to be done to keep things running smoothly, it seemed he had trouble delegating his duties to subordinates. When a problem arose, he preferred to solve it himself -- even when it took twice as much time -- rather than ask his superiors to jump in and help. At his quarterly review, his boss addressed the department's concerns and offered to extend David's probationary period if he would try harder to interact with others. In working with me, David became aware that he was uncomfortable turning over any aspect of his responsibilities for fear of seeming unable to accomplish his job on his own. After exploring these doubts, he was able to fully utilize his superiors' knowledge, and to rely on his co-workers to get the job done in the most productive and efficient manner. As David learned, if you accept the challenge and take responsibility for your reactions, you will begin to see that you can learn to manage your anxiety and have a healthy, rewarding social life, as well as a more fulfilling career.
The first step in overcoming your problem is to acknowledge that what you call shyness is anxiety, a very specific kind of anxiety. As you begin to understand this concept, you will be able to make use of the strategies and techniques I have developed to solve the problem. Remember, to use the word "shy" to describe yourself is to give up control of your life and your ability to improve it. Call yourself "shy," and that's the end of the story. Admit you have social anxiety, however, and you are on your way to a more relaxed, fulfilling life in which you are in control. Shyness, after all, means many things to many people. But anxiety is more concrete -- I usually describe it as an attitudinal, emotional, behavioral, and physical response to stress, although not necessarily a negative response.
Picture the athlete at the starting line of a race -- adrenaline pumping, energy flowing, muscles tightening, skin aglow with anticipatory perspiration, heart beating faster and faster, the mind focused on only one thing: the starter's gun and the race. Now, picture the person about to enter a social gathering. He or she approaches the door, behind which a number of people are talking, laughing, having fun -- adrenaline pumping, energy flowing, pulse beginning to quicken, the mind focused on anticipation: "What will happen when I enter the room?" "Will I see anyone I know?" "What will they think of me?"
What do these situations have in common? The answer is anxiety. For the athlete, anxiety is channeled into energy that just may win the race. By allowing the anxiety to play a role in gearing him or her up for the race, the athlete is making good use of the natural fight-or-flight response. For the partygoer, it is not so clear. If that person is willing to let being "keyed up" or "excited" be a positive kind of energy flow, then any initial nervousness or uncertainty will remain manageable and nonthreatening. But if the physical sensations of anxiety become distracting and the thoughts obsessive, the party guest is in for a difficult time. Similarly, a person who prepares for an important meeting may feel a kind of nervous energy in gearing up for negotiations. But if that same person, although well prepared, allows interactive inhibition to keep him from suggesting a solution, questioning a point, or voicing an opinion, he will feel a real letdown. When holding back becomes a habit, the pervasive feeling of "Oh no, I did it again" may lead to a lack of enthusiasm that interferes with productivity and job satisfaction. The truth is, we all want to be heard without -- if we can reasonably avoid it -- being rejected or embarrassed. How to resolve this dilemma? First, by understanding anxiety in its simplest terms. The more you understand about anxiety, the more you will be able to control it. Remember, social anxiety is not some abstract phenomenon or indelible personality trait. It is an explainable dynamic that you can choose to control.
Let's look more closely at the athlete. For that person, in that situation, anxiety is normal and appropriate. In fact, it is crucial to effective performance. Without it, the physiological workings of the body would fall short of what is required. In the second example, anxiety is also appropriate. But it can become negative if the person begins to worry about what is going on inside the room: "What are they laughing about?" "Will anyone talk to me?" "Am I dressed right?" "Will I seem nervous?" At that point it's the degree of incapacity -- the extent to which the anxious feelings and thoughts prevent interacting -- that becomes the most important issue. (In the workplace, these thoughts may run to "Have I done enough research?" "What if I can't answer my boss's questions?" "Can they tell I'm anxious?")
Anxiety is a fact of life! Everyone experiences it. It began in our cave-dweller days as a fight-or-flight response. Think of it this way: If you were walking through the woods and you ran into a bear, it would be normal for your body to activate the fight-or-flight response. Your heart would race, your muscles would tense up, your pupils would dilate, you would breathe more rapidly. The same thing would happen today if you were walking down the street and ran into a mugger. There is a simple, scientific explanation of this response: Your mind and body are preparing to protect you -whether you can feel it happening or not.
Let us briefly examine this process. Your nervous system is divided into two basic parts: The voluntary nervous system controls actions that require thought, such as using the different parts of your body to drive a car; the autonomic nervous system, among its many functions, suspends all nonessential activity of the body and increases the physiological activity needed to confront the situation -- either by fighting or by fleeing the external threat. Here is what it is responsible for:
* increased muscle tension
* accelerated heartbeat
* rapid breathing
* constriction of peripheral blood vessels (this is what causes cold hands)
* dilation of the pupils
* suspension of the digestive process
* dry mouth
* a voiding of bladder and bowels In addition, the fight-or-flight response causes a marked increase in the flow of adrenaline through the bloodstream and therefore added strength.
What does running from a bear have to do with social anxiety? Everything. An anxiety reaction is your fight-or-flight response. If you see a bear, it's okay to run, and in fact your physical symptoms of anxiety will probably be the least of your problems. But if you have those same symptoms when you go to a party or speak in front of a group, you are almost certainly overreacting to a stressful but relatively safe situation. It is a question of degree, and there are many degrees of anxiety. Some nervousness is all right, but not so much that you begin to run from interacting with other people.
I am well versed in relaxation techniques and have served as a stress management consultant to numerous corporations. Yet even I experience anxiety symptoms on occasion. During the past several years, I have had the opportunity to appear on many television and radio shows and have given countless lectures. Never have I made an appearance without my hands being cold! What does this mean? When your hands are dry and warm, you are relaxed. When your hands become cool and sweaty, it's a safe bet that stress and anxiety are present. And yet I enjoy public speaking! I have gotten to the point where these appearances are fun, and I look forward to doing these shows. When I do them, I am concentrating intensely and working very hard to channel my energy. The cold hands are merely a physiological manifestation of this hard work. My mind and body are gearing up to perform, and the result is positive anxiety.
Anxiety becomes negative when you start to avoid the situation that causes it. For example, if I were to stop making public appearances because I didn't like the physical manifestations of my stress response, or even to make the appearances but allow myself to be distracted by my cold hands or other symptoms -- perhaps thinking, "Can they tell my hands are clammy" "Am I making sense ?" -- that would be counterproductive. It's important to me to make these appearances, so I channel my gearing-up anxiety into positive energy.
Anxiety does not exist to control you. You exist to control it. It is, as I said, a simple fact of life that can be managed. In fact, used properly, it can actually give you an extra boost by heightening your energy and awareness. If you have social anxiety about such things as giving a presentation, speaking up at a meeting, attending a social gathering, initiating plans, developing intimacy in friendships and dating, then learning to manage your anxiety will help. This book will teach you how to channel your anxiety -- not how to eliminate it. The twelve chapters delineate a five-step program that essentially works like this:
Step 1: Identify your anxiety symptoms and recognize the ways in which they interfere with your life. Your social fears prevent you from doing things you would like to do (pursue friendships, date, achieve career success). Pinpointing your stress responses and noting what causes them give you the information you need to move on to Step 2.
Step 2: Set short- and long-term social goals. Having identified the situations you have trouble confronting, you can identify immediate goals to work toward, and start to form a vision of your ideal social self. Goal-setting is a valuable way of letting your imagination offer a reward for your hard work. Next, you will begin to learn skills that can make your dream a reality.
Step 3: Learn stress management and self-awareness. The techniques outlined in this book will allow you to control your anxiety response and tune in to your own desires and strong points, giving you more to share as you become more comfortable interacting. With your anxiety in check and your self-awareness guiding you toward fulfillment, anxiety becomes positive energy and will be the base of your self-empowerment. Now you are ready to polish your social skills.
Step 4: Learn or refine social skills. Your fear has diminished, making it possible to refine social skills and enhance your interactive productivity, which will make the difference between social success and failure. Good conversation, active listening, an awareness of what behavior is appropriate -- all of these skills will add to your overall social ability and self-empowerment.
Step 5: Expand and refine your social network. At this point, you are ready to roll. You understand your anxiety, your stress is manageable, and you have learned the finer points of interacting in a positive, productive manner. The final step is to use your community's resources to create, expand, or refine your social network to best meet your interactive goals. No matter who you are, you can improve your social network to better suit your needs. From here, anything is possible!
As you follow this program, you will learn to accept that it is okay to have anxiety. What is not okay is to let your anxiety control you.
Alan, a young man of twenty-two, is typical of the people who have come to me for treatment. Outwardly, he seemed well adjusted and likable. His sense of humor added fun to our sessions, and he was an active conversationalist who was well liked by his peers. If you met him in an informal setting, you would have no idea that an attractive, articulate person like Alan could get nervous or anxious about any social situation. But Alan suffered from the most common social anxiety today: fear of public speaking. He was afraid to stand up in front of a group and talk. For almost four years, he put off taking the public-speaking class that was required for college graduation. By his last semester, however, he knew there was no more avoiding it. He had to take the class or miss out on receiving his degree. Although he was scared, he was also highly motivated to confront his fear and finish his course load.
At first, Alan experienced a typical anxiety reaction or panic response: His hands got clammy, his heart raced, and he experienced every stutter, every verbal misstep as a huge blunder that no one would ever forget. He would blush, or imagine he was blushing, and then worry about what his classmates thought of him. Sometimes, he would feel a little short of breath and then worry that he would hyperventilate and need to rush from the room. He was intensely aware of all these symptoms of nervousness, though his audience of classmates thought little of it -- they too were nervous about their speaking assignments, and were sympathetic. Alan's symptoms diminished as he gave more speeches, and watched others make the same mistakes without losing face.
The sensations that troubled Alan are typical of anxiety sufferers. Also typical is the tendency to avoid what you fear. The possibility of blushing or hyperventilating had become as scary to Alan as giving a speech, and in putting off the class, he was avoiding all these things.
Alan was not alone. Far from it: Millions of people feel some panic or anxiety symptoms regularly. Sometimes they are mild reactions that are easily connected to a particular situation or event. But in other instances they are more pervasive and more debilitating. The physical sensations may even be severe enough to warrant a visit to the emergency room, where a frustrated anxiety sufferer may be told that there is nothing wrong but stress. But panic symptoms are indeed real. Their cause? An internal mishandling of stress or emotions. What occurs with a panic or anxiety attack is a psychophysiological reaction: a mind-body response. While the body is preparing itself to confront the stressor, the mind is filled with fear and apprehension, with thoughts like "I'm losing control" or "I know I'm going to fail." Together, the body and mind are overreacting to their own fight-or-flight instincts.
Let's consider situations you may be avoiding because they cause a fight-or-flight anxiety reaction. Below are some possibilities:
Interaction with an authority figure Giving a presentation at work Eating in public Speaking in front of a group Taking interactive responsibility at work Signing a check or other document in front of someone Talking on the telephone Talking to someone you don't know Talking to someone you do know (outside the family)
Making social plans with someone (outside the family)
Going on a date Using a public bathroom Going to a party Going to a singles-oriented event or program Interacting with people at work Waiting in line Sitting in a doctor's or dentist's waiting room Being examined by a doctor or dentist Going to the theater Going to a restaurant Maintaining eye contact when talking to someone Going to any public place Taking public transportation Other
Are some of these situations stressful for you? Go back over the list, checking off the ones that apply to you. As you check them off, think about the degree to which your fear hampers your social life. And if you recognize a situation that you actively avoid because you find it too stressful -- say, you never use a public bathroom at all because you're "too shy" or it makes you anxious -- make note of that, too.
Now that you've given some thought to the situations that cause anxiety, let's examine the particular symptoms of your anxiety. We will look at physical symptoms -- what your body does when you feel anxious -- and thought patterns -- what thoughts bother you when you feel anxious. Use Charts 1 and 2 (pp. 23 and 24) to rank these symptoms in terms of frequency (whether they occur twice a month or as often as once a day), severity (whether they cause you minor discomfort or absolute panic), and the degree to which they interfere with your social life (not at all or significantly). The last category is very important, since it will help you to determine to just what extent your social anxiety disables you. The rankings in that category should be interpreted as follows:
1. Not at all. If you choose this answer, you usually experience no discomfort whatsoever when the thought or feeling in question arises. You may experience the symptom, but you are fully able to continue what you are doing (talking to an acquaintance, addressing a group, working with your supervisor, and so on) without becoming distracted or trying to leave the situation.
2. A little. If a symptom interferes a little, it may occasionally cause you to lose your train of thought, or to falter or hesitate during conversation. Still, you find ways to compensate, and your interaction is not inhibited to a noticeable extent. You continue to interact with others on a regular basis, and none of your symptoms causes you to avoid interacting completely.
3. Moderately. A symptom that moderately interferes with interaction would be one that occasionally keeps you from doing something you would like to do (such as approach and speak to a stranger at a party) or are required to do (make a cold sales call on a prospective client). You are uncomfortable enough with the symptom at least to consider whether encountering it is worth the anxiety involved.
4. Significantly. For social anxiety symptoms to affect significantly the degree to which you interact, they must have caused you to develop the habit of avoiding the situations that cause them, whether by procrastination or merely by passive participation (such as attending a meeting without contributing anything). While you don't avoid all interaction, you probably try to stay out of it when you can, and spend a great deal of time negatively evaluating those interactions you do have. This may cause others to view you as aloof or distracted in conversation.
5. Severe to the point of incapacity. This is where social phobia comes in. We'll talk more about that in Chapter 4, but for now, understand that for social anxiety to become a phobia, must be so severe that you avoid the situation that causes the anxiety whenever possible, even when it means forgoing a promotion or spending all your free time in total solitude. At this stage, you fear your symptoms just as much as you fear the interaction.
Now take several minutes to go through each list of symptoms, using the rankings to determine how much each plays a role in your current daily life.
Remember, there is a wide range of what is considered normal, and even feeling slightly nervous or keyed up is within that normal range. The goal is not avoiding anxiety but managing it, getting it under control. Whatever your anxiety level, by following the steps in this self-help plan and adapting them to your needs, you can empower yourself to interact more effectively. Later, you will do these indexes again. It is important to realize that your progress will be based on relativity. As you compare previous indexes to the most current one, look not only at totals but also at the individual categories and their frequency, severity, and degree of interactive interference.
To help you make general sense of your ratings, let me use as examples two people who have come to me for treatment. Each experienced different extremes of anxiety -- Shelly was highly functioning but unfulfilled professionally, while Adam was incapacitated by fear on all fronts. Whereas Alan, our earlier example, a relatively high-functioning person with severe anxiety about a specific situation (public speaking), was somewhere in the middle, the two people introduced here were at opposite poles when compared to the norm: Shelly was high-functioning, and Adam was low-functioning. Understanding their perspectives may help you to gauge your own level of anxiety.
Shelly: At thirty-five, Shelly was an associate with a small law firm. She and her husband enjoyed socializing with friends and neighbors in the suburb where they lived, and often entertained at home. Shelly was not anxious or inhibited in purely social situations, and often hosted gatherings herself. At work, however, she did experience a slight degree of anxiety when it came to initiating projects or accepting responsibility. Her interactive inhibition -- resistance to asking for help or doing things on her own -- was preventing her from being made partner. How did social anxiety interfere with productivity at work? For Shelly, the safety of her position, with its predictable duties and conservative style of dress, was reassuring when she joined the firm right out of law school. But in order to get ahead at the firm, Shelly needed to do more than conform to the social system that existed at work. She had to go beyond meeting assignments and seek out new solutions and challenges.
Instead, though, Shelly waited for her supervisor to give his opinion on the cases assigned to her. Usually, her hesitancy to make decisions or take action on her own caused her to procrastinate -- a bad habit that was hard to conceal as deadlines came and went. She didn't realize that action relieves anxiety. Instead, she feared the outcome of the risks she had to take in speaking her mind. She was unwilling to endure the pain of anxiety these risks would entail. Even when she had ideas of her own, she was extremely hesitant to express them, assuming that they were off-base or, as she said, "Somebody else would have made the same points already." Shelly's thinking was skewed: The firm hired her because they recognized capability and potential. Her training and experience were valuable to them, so some more initiative on her part would only have increased her value and could have netted her the partnership she hardly dared dream about. Perhaps more important, even if her ideas were rejected, the outcome would not have been devastating. No one is right 100 percent of the time or always says or does exactly the right thing. Shelly would not have been fired for thinking aloud as part of a problem-solving team.
Shelly's interactive inhibition had another cost as well. In performing the same duties the same way, without the experience of taking a risk that might pay off, of following a case start to finish, of meeting new challenges, she had dug herself into a rut. Her limited self-esteem was self-perpetuating, and the result was a lack of fulfillment. It's true she w