Recovery from Social Anxiety and Related Conditions

Robert F Mullen, PhD
Director/ReChanneing

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The distinction between social anxiety disorder and social anxiety is a matter of severity; reference to one includes the other. The recovery tools and techniques provided apply to comorbid emotional malfunctions including depression, substance abuse, generalized anxiety, and issues of self-esteem and motivation. These malfunctions originate homogeneously, their trajectories differentiated by environment, experience, and the diversity of human thought and behavior.          

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Enlisting Positive Psychologies to Challenge Love Within SAD’s Culture of Maladaptive Self-Beliefs

in C.-E. Mayer and E. Vanderheiden (eds.) International Handbook of Love. Transcultural and Transdisciplinary Perspectives, Springer Publications, 2021.

Revised and updated April 2024.

Social anxiety disorder (SAD) is one of the most common disorders, affecting the emotional and mental well-being of over 15 million U.S. adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. These observations provide insight into the relationship deficits experienced by people with SAD. Their innate need for intimacy is no less dynamic than any individuals, but their impairment disrupts the ability (means of acquisition) to establish affectional bonds in almost any capacity. The spirit is willing, but competence is insubstantial. The means of acquisition and how SAD symptomatically challenges them is the context of this research.

Notwithstanding overwhelming evidence of social incompatibility, there is hope for the startlingly few SAD persons who commit to recovery. A psychobiographical approach integrating positive psychology’s optimum human functioning with CBT’s behavior modification, neuroscience’s network restructuring, and other supported and non-traditional approaches can establish a working platform for discovery, opening the bridge to procuring forms of intimacy previously inaccessible. 

Keywords: Love. Social anxiety disorder. Intimacy. Philautia. Means-of-acquisition.

59.0 Social Anxiety Disorder

Social anxiety disorder (SAD) is the second most commonly diagnosed form of anxiety in the United States (MHA, 2019). The Anxiety and Depression Association of America (ADAA, 2019a) estimates that nearly 15 million (7%) American adults experience its symptoms, and Ritchie and Roser (2018) report 284 million SAD persons worldwide. Global statistics are subject to “differences in the classification criteria, culture, and gender” (Tsitsas & Paschali, 2014) and “in the instruments used to ascertain diagnosis” (NCCMH, 2013).

Studies in other Western nations (e.g., Australia, Canada, Sweden) note similar prevalence rates as in the USA, as do those in culturally Westernized nations such as Israel. Even countries with strikingly different cultures (e.g., Iran) note evidence of social anxiety disorder (albeit at lower rates) among their populace (Stein & Stein, 2008).

SAD is the most common psychiatric disorder in the U.S. after major depression and alcohol abuse (Heshmat, 2014). It is also arguably the most underrated and misunderstood. A “debilitating and chronic” affliction (Castella et al., 2014), SAD “wreaks havoc on the lives of those who suffer from it” (ADAA, 2019a). 

The disorder attacks all fronts, negatively impacting the entire body complex, delivering mental confusion (Mayoclinic, 2017b), emotional instability (Castella et al., 2014; Yeilding, 2017), physical dysfunction (NIMH, 2017; Richards, 2019), and spiritual malaise (Mullen, 2018). 

Emotionally, persons experiencing SAD feel depressed and lonely (Jazaieri et al., 2015). Physically, they are subject to unwarranted sweating and trembling, hyperventilation, nausea, cramps, dizziness, and muscle spasms (ADAA, 2019a; NIMH, 2017). Mentally, thoughts are discordant and irrational (Felman, 2018; Richards, 2014). Spiritually, they define themselves as inadequate and insignificant (Mullen, 2018).

SAD is randomly misdiagnosed (Richards, 2019), and the low commitment to recovery (Shelton, 2018) suggests a reticence by those infected to recognize and or challenge their malfunction. Roughly 5% of SAD persons commit to early recovery, reflective of symptoms that manifest maladaptive self-beliefs of insignificance and futility.

Grant et al. (2005) state, “about half of adults with the disorder seek treatment,” but that is after 15–20 years of suffering from the malfunction (Ades & Dias, 2013). Resistance to new ideas and concepts transcends those of other mental complications and is justified by, among other attributions:

• General public cynicism
• Self-contempt of the afflicted, generated by maladaptive self-beliefs.
• Ignorance or ineptitude of mental health professionals.
• Real or perceived social and mental health stigma.
• The natural physiological aversion to change.

Many motivated towards recovery are unable to afford treatment due to SAD-induced “impairments in financial and employment stability” (Gregory et al., 2018). The high percentage of jobless people experiencing social anxiety disorder in the U.S. is related to “job inefficiency and instability” (Felman, 2018), greater absenteeism, job dissatisfaction, and frequent job changes. “More than 70% of social anxiety disorder patients are in the lowest economic group” (Nardi, 2003).

According to leading experts, the high percentage of SAD misdiagnoses is due to “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” (Nagata et al., 2015). The Social Anxiety Institute (Richards, 2019) reports that, among patients with generalized anxiety, an estimated 8.2% had the condition, but just 0.5% received a correct diagnosis. A recent Canadian study by Chapdelaine et al., 2018 reported that out of 289 individuals meeting the criteria for social anxiety disorder, 76.4% were improperly diagnosed.

Social anxiety disorder is a pathological form of everyday anxiety. The clinical term “disorder” identifies extreme or excessive impairment negatively affecting functionality. Feeling anxious or apprehensive in certain situations is normal; most individuals are nervous speaking in front of a group and anxious when pulled over on the freeway. The typical individual recognizes the ordinariness of a situation and accords it appropriate attention. The SAD person anticipates it, takes it personally, dramatizes it, and obsesses over its negative implications (Richards, 2014).

SAD’s culture of maladaptive self-beliefs (Ritter et al., 2013) and negative self-evaluations (Castella et al., 2014) aggravate anxiety and impede social performance (Hulme et al., 2012). “Patients with SAD often believe they lack the necessary social skills to interact normally with others” (Gaudiano & Herbert, 2003). Maladaptive self-beliefs are distorted reflections of a situation, often accepted as accurate. 

Core beliefs are enduring fundamental understandings, often formed in childhood and solidified over time. Because SAD persons “tend to store information consistent with negative beliefs but ignore evidence that contradicts them, [their] core beliefs tend to be rigid and pervasive” (Beck, 2011). These rudimentary beliefs influence the development of intermediate beliefs―attitudes, rules, and assumptions that influence one’s overall perspective, which, in turn, generates our thoughts and behavior. 

As the third-largest mental health care problem in the world (Richards, 2019), social anxiety disorder is culturally identifiable by the victims’ “marked and persistent fear of social and performance situations in which embarrassment may occur” and the anticipation that “others will judge [them] to be anxious, weak, crazy, or stupid” (APA, 2017). SAD “is a pervasive disorder that causes anxiety and fear in almost all areas of a person’s life” (Richards, 2019). SAD affects the “perceptual, cognitive, personality, and social processes” of the afflicted, who find themselves caught up in “a densely interconnected network of fear and avoidance of social situations” (Heeren & McNally, 2018).

The superficial overview of SAD is intense apprehension—the fear of being judged, negatively evaluated, and ridiculed (Bosche, 2019). There is persistent anxiety or fear of social situations such as dating, interviewing for a position, answering a question in class, or dealing with authority (ADAA, 2019a; Castella et al., 2014). Often, mere functionality in perfunctory situations―eating in front of others, riding a bus, using a public restroom—can be unduly stressful (ADAA, 2019a; Mayoclinic, 2017b). 

SAD persons are unduly concerned that they will say something that will reveal their ignorance (Ades & Dias, 2013). They walk on eggshells, supremely conscious of their awkwardness, surrendering to the GAZE―the anxious state of mind that comes with the maladaptive self-belief that they are the center of attention (Felman, 2018; Lacan, 1978). Their movements can appear hesitant and awkward, small talk clumsy, attempts at humor embarrassing, and every situation reactive to negative self-evaluation (ADAA, 2019a; Bosche, 2019). They are apprehensive of potential “negative evaluation by others” (Hulme et al., 2012) and concerned about “the visibility of anxiety and preoccupation with performance or arousal” (Tsitsas & Paschali, 2014). 

SAD persons frequently generate images of themselves performing poorly in feared social situations (Hirsch & Clark, 2004; Hulme et al., 2012), and their anticipation of repudiation motivates them to dismiss overtures to offset any possibility of rejection (Tsitsas & Paschali, 2014). SAD is repressive and intractable, imposing irrational thought and behavior (Richards, 2014; Zimmerman et al., 2010). It establishes its authority through its subjects’ defeatist measures produced by distorted and unsound interpretations of actuality that govern perspectives of personal attractiveness, intelligence, competence, and other errant beliefs (Ades & Dias, 2013).

We are all familiar with the free association test. The person in the white coat tosses out seemingly random words, and the recipient responds with the first word that comes to mind. Consider the following reactions: boring, stupid, worthless, incompetent, disliked, ridiculous, inferior (Hulme et al., 2012). Most people use personal pejoratives daily, but few personalize and take them to heart like a SAD person. 

Maladaptive self-appraisals, over time, become automatic negative thoughts called ANTs (Amen, 1998) implanted in the neural network (Richards, 2014). They determine initial reactions to situations or circumstances. They inform how to think, feel, and act. The ANT voice exaggerates, catastrophizes, and distorts. SAD persons crave the company of others but shun social situations for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking publicly, expressing opinions, or fraternizing with peers. People with social anxiety disorder generally possess low self-esteem and high self-criticism. (Stein & Stein, 2008)

The Anxiety and Depression Association of America (ADAA, 2019a) includes many emotional and mental disorders related to, components of, or a consequence of social anxiety disorder, including avoidant personality disorder, panic disorder, generalized anxiety disorder, depression, substance abuse, eating disorders, OCD, and personality disorders including avoidant and dependent.

Personality disorders involve long-term patterns of thoughts and behaviors that are unhealthy and inflexible. The behaviors cause serious problems with relationships and work. People with personality disorders have trouble dealing with everyday stresses and problems. (UNLM, 2018)

Personality reflects deep-seated patterns of behavior affecting how individuals “perceive, relate to, and think about themselves and their world” (HPD, 2019). A personality disorder denotes a “rigid and unhealthy pattern[s] of thinking, functioning and behaving,” which potentially leads to “significant problems and limitations in relationships, social activities, work, and school” (Castella et al., 2014). 

A recent article in Scientific American speculates that “mental illnesses are so common that almost everyone will develop at least one diagnosable mental disorder at some point in their life” (Reuben & Schaefer, 2017).

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59.1.1. SAD and Interpersonal Love

In unambiguous terms, the desire for love is at the heart of social anxiety disorder (Alden et al., 2018). SAD persons struggle to establish close, productive relationships (Castella et al., 2014; Fatima et al., 2018). The diagnostic criteria for SAD, outlined in the DSM-V (APA, 2017), include: “Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.” SAD persons frequently demonstrate significant impairments in friendships and intimate relationships (Castella et al., 2014). Their avoidance of social activities severely limits the potential for comradeship (Desnoyers et al., 2017; Tsitsas & Paschali, 2014). Their inability to interact rationally and productively (Richards, 2014; Zimmerman et al., 2010) limits the potential for long-term, healthy relationships. According to Whitbourne (2018), the SAD person’s avoidance of others puts them at risk of feeling lonely, having fewer friendships, and being unable to take advantage of the enjoyment of being with people who share their hobbies and interests.

There is a pressing need for more comprehensive research to delve into the relationship between SAD and interpersonal love (Montesi et al., 2013; Read et al., 2018). A study by Rodebaugh et al. (2015) highlights the need for more high-quality studies; Alden et al. (2018) underscore the lack of attention given to the SAD individual’s inability or refusal to function in close relationships. The limited existing studies indicate that SAD individuals exhibit inhibited social behavior, shyness, lack of assertion in group conversations, and feelings of inadequacy in social situations (Darcy et al., 2005). The prevailing culture of maladaptive self-appraisal hampers the development of trusting and supportive interpersonal relationships (Topaz, 2018).

Although closely intertwined, the desire for love and the process of ‘acquisition’ are distinct. Most forms of interpersonal love necessitate the successful interplay of desire and acquisition. The desire for love represents the non-consummatory aspect of Freud’s eros life instinct (Abel-Hirsch, 2010). ‘Acquisition’ refers to the methods and skills required to complete the transaction―techniques that vary depending on the specific parameters of love. 

Let us visualize love as a bridge, with desire (thought) at one end and acquisition at the other; the span is the means of acquisition (behavior). The SAD person cannot get from one side to the other because the means of acquisition are structurally deficient (Desnoyers et al., 2017; Tsitsas & Paschali, 2014). They grasp the fundamental concepts of interpersonal love and are presented with opportunities but lack the skills to close the deal. Painfully aware of the tools of acquisition, they cannot seem to operate them.

59.2. Cognitive-Behavioral Therapy

CBT, a short-term, skills-oriented approach, aims to explore relationships among a person’s thoughts, feelings, and behaviors while changing the culture of maladaptive self-beliefs into productive, rational thought and behavior (Richards, 2019). It focuses on “developing more helpful and balanced perspectives of oneself and social interactions while learning and practicing approaching one’s feared and avoided social situations over time” (Yeilding, 2017). Roughly 90% of approaches endorsed by the “American Psychological Association’s Division 12 Task Force on Psychological Interventions” are cognitive-behavioral treatments (Lyford, 2017). 

Recent meta-analytic evidence suggests that cognitive-behavioral therapy as an effective treatment for SAD compares favorably with other psychological and pharmacological treatment programs (Cuijpers et al., 2016). Individuals who undergo CBT show changes in brain activity, suggesting that this therapy also improves brain functioning (NAMI, 2019).

However, there is no guarantee of success, and stand-alone CBT is imperfect (David et al., 2018; Mullen, 2018). The best outcome one can hope for is the mitigation of SAD symptoms through thought and behavior modification and the simultaneous restructuring of the neural network, along with other supported and non-traditional treatments.

Behavioral and cognitive treatments are globally accepted methodologies. Multiple associations worldwide are “devoted to research, education, and training in cognitive and behavioral therapies” (McGinn, 2019). Conferences “where knowledge transfer takes place through debates, round table discussions, poster presentations, workshops, symposia, and exhibitions” are offered globally. David et al. (2018) credit CBT as the best behavioral modification standard currently available in the field for the following reasons:

1. CBT is the most researched form of psychotherapy. 
2. No other form of psychotherapy is systematically superior to CBT in the treatment of anxiety, depression, and other disorders; if there are systematic differences between psychotherapies, they typically favor CBT. 
3. CBT theoretical models/mechanisms of change have been the most researched and are in line with the current mainstream paradigms of the human mind and behavior (e.g., information processing).

Cognitive-behavioral therapy is arguably the gold standard of the psychotherapy field. David et al. (2018) maintain that “there are no other psychological treatments with more research support to validate.” Studies of CBT have shown it to be an effective treatment for a wide variety of mental illnesses, including depression, SAD, generalized anxiety disorders, bipolar disorder, eating disorders, PTSD, OCD, panic disorder, and schizophrenia (Kaczkurkin & Foa, 2015; NAMI, 2019). However, David et al. (2018) suggest that if the gold standard of psychotherapy defines itself as the best in the field, then CBT is not the gold standard. There is room for further improvement, “both in terms of CBT’s efficacy/effectiveness and its underlying theories/mechanisms of change.”

Lyford (2017) provides two examples of criticism. A 2013 meta-analysis published in Clinical Psychology Review comparing CBT to other therapies failed to “provide corroborative evidence for the conjecture that CBT is superior to bona fide non-CBT treatments.” An 8-week clinical study by Sweden’s Lund University in 2013 concluded that “CBT was no more effective than mindfulness-based therapy for those suffering from depression and anxiety.”

Another meta-analysis conducted by psychologists Johnsen and Friborg (2015) tracked 70 CBT outcome studies conducted between 1977 and 2014. It concluded that “the effects of CBT have declined linearly and steadily since its introduction, as measured by patient self-reports, clinician ratings, and rates of remission.” According to the authors, “Just seeing a decrease in symptoms,” he says, “doesn’t translate into greater well-being.” 

While this study is mindful of the common belief that CBT is the best approach to alleviate SAD’s pattern of irrational thoughts and behaviors, stand-alone CBT is not the most productive course of treatment. New and innovative methodologies supported by a collaboration of theoretical construct and integrated scientific psychotherapy are needed to address mental illness as represented in this era of advanced complexity. 

Multiple nontraditional and supported approaches, including those defined as new (third) wave (generation) therapies, better serve the dual complexity of social anxiety and personality. These therapies are developed through client trust, cultural assimilation, and therapeutic innovation, with CBT, positive psychology, and neuroscience serving as the foundational platform for integration.

59.3. Categories of Interpersonal Love

In Nicomachean Ethics, Aristotle (1999) encapsulates love as “a sort of excess of feeling.” Utilizing the classic Greek categories of interpersonal love is vital to this study; each classification illustrates how SAD symptoms thwart the means of acquisition. 

1. Philia. Aristotle called philia “one of the most indispensable requirements of life” (Grewal, 2016). Philia is a bonding of individuals with mutual experiences―a “warm affection in intimate friendship” (Helm, 2017). This platonic love subsists on shared experience and personal disclosure. A core symptom of a SAD person is the fear of revealing something that will make them appear “boring, stupid or incompetent” (Ades & Dias, 2013). Even the anticipation of interaction causes “significant anxiety, fear, self-consciousness, and embarrassment” (Richards, 2014) because of the fear of being scrutinized and judged (Mayoclinic, 2017b).

2. Eros translates to reciprocal feelings of shared arousal between people physically attracted to each other, the fulfillment determined by the sexual act. The SAD person’s self-image of unlikability (Stein & Stein, 2008), coupled with the fear of intimacy (Montesi et al., 2013) and rejection (Tsitsas & Paschali, 2014) challenges the successful acquisition of a sexual partner and satisfaction with the sexual act (Montesi et al., 2013). SAD’s culture of maladaptive self-appraisal severely challenges their ability to establish, develop, and maintain intimate relationships (Cuncic, 2018; Topaz, 2018). A study by Montesi et al. (2013) examining the SAD person’s symptomatic fear of intimacy and sexual communication concludes, “socially anxious individuals experience less sexual satisfaction in their intimate partnerships than nonanxious individuals, a relationship that well documented in previous research.” 

3. Agape. Through the universal mandate to love thy neighbor, the concept of agape embraces unconditional love that transcends and persists regardless of circumstance (Helm, 2017). SAD generally onsets adolescents who have experienced detachment, exploitation, and or neglect (Steele, 1995). Agape is characterized by unselfish giving. The SAD person’s conviction that they are the constant focus of attention is a form of self-centeredness bordering on narcissism (Mayoclinic, 2017a).

4. Storge. Social anxiety disorder stems from childhood hereditary, environmental (Felman, 2018; NAMI, 2019), or traumatic events (Mayoclinic, 2017b). The afflicted are exploited (unconsciously or otherwise) in the formative stages of human motivational development, which include physiological safety, belongingness, and love (Maslow, 1943). As a result, storge or familial love and protection, vital to the healthy development of the family unit, is impacted. The exploited adolescent (Steele, 1995) faces serious challenges recognizing or embracing familial love as an adolescent or adult.

5. Ludus. A SAD person’s conflict with the provocative playfulness of ludus is evident by their fear of being judged and negatively evaluated (Mayoclinic, 2017b).SAD persons do not find social interaction pleasurable (Richards, 2019) and have limited expectations that things will work out advantageously (Mayoclinic, 2017b). Finally, the SAD person’s maladaptive self-appraisal generally results in inappropriate behavior in social situations (Kampmann et al., 2019).

6. Pragma. The obvious synonym for pragma is practicality―a balanced and constructive quality counterintuitive to someone whose modus operandi is irrational thought and behavior (Richards, 2014; Zimmerman et al., 2010). Pragma is mutual interests and goals securing a working and endurable partnership facilitated by rational behavior and expectation—the pragmatic individual deals with relationships sensibly and realistically, conforming to standards considered typical. The overriding objective of a SAD person is to “avoid situations that most people consider “‘normal'” (WebMD, 2019).

Social anxiety disorder is a consequence of early psychophysiological disturbance (Felman, 2018; Mayoclinic, 2019a). The receptive juvenile might be the product of bullying (Felman, 2018), sibling abuse (NAMI, 2019), or a broken home. Perhaps parental behaviors are overprotective, controlling, or lack emotional validation (Cuncic, 2018). Subsequently, the SAD person finds it difficult to express vulnerability, even with someone they love and trust. Alden et al. (2018) note that SAD persons “find it difficult, in their intimate relationships, to be able to self-disclose, to reciprocate the affection others show toward them.”

Research links love with positive mental and physical health outcomes (Rodebaugh et al., 2015). Healthy relationships make one recognize their value to society “and motivate them towards building communities, culture and work for the welfare of others” (Capon & Blakely, 2007). Love develops through social connectedness. Social connectedness, essential to personal development, is one of the central psychological needs “required for better psychological development and well-being” (Deci & Ryan, 2000). Social connectedness plays a significant role as a mediator in the relationship between SAD and interpersonal love (Lee et al., 2008) and is strongly associated with one’s level of self-esteem (Fatima et al., 2018).

59.4. Philautia

The seventh and eighth categories of interpersonal love are the two extremes of philautia: narcissism and positive self-qualities. To Aristotle, healthy philautia is vigorous “in both its orientation to self and to others” due to its inherent virtue (Grewal, 2016). “By contrast, its darker variant encompasses notions such as narcissism, arrogance, and egotism” (Lomas, 2017). In its positive aspect, any interactivity “has beneficial consequences, whereas in the latter case, philautia will have disastrous consequences” (Fialho, 2007).

59.4.1. Unhealthy Philautia

Unhealthy philautia is akin to clinical narcissism―a mental condition, as stated earlier, in which people possess an inflated sense of their importance and an appetite for excessive attention and admiration. Behind this mask of extreme confidence, the Mayoclinic (2017a) states, “lies a fragile self-esteem that’s vulnerable to the slightest criticism.” SAD persons live on the periphery of morbid self-absorption. Their obsession with attention (ADAA, 2019b) mirrors that of unhealthy philautia. In Classical Greece, persons could be accused of unhealthy philautia if they placed themselves above the greater good. Today, hubris means “an inflated sense of one’s status, abilities, or accomplishments, especially when accompanied by haughtiness or arrogance” (Burton, 2016). The self-centeredness of a SAD person often presents itself as arrogance; in fact, the words are synonymous. The critical difference is that SAD persons do not possess an inflated sense of their importance but one of insignificance.

59.4.2. Healthy Philautia

Aquinas’ (1981) response to demons and disorder states, “Evil cannot exist without good.” The Greeks believed that the narcissism of unhealthy philautia would not exist without its complementary opposition, commonly interpreted as self-esteeming virtue―an unfortunate and incomplete definition. Rather than only focusing on self-esteem, philautia incorporates the broader spectrum of all positive self-qualities.

Instead, we are concerned with various positive qualities prefixed by the term self, including -esteem, -efficacy, -reliance, -compassion, and -resilience. Aristotle argued in Nicomachean Ethics that self-love is a precondition for all other forms of love. (Lomas, 2017)

Positive self-qualities determine one’s relation to self, others, and the world. They recognize that one is valuable, consequential, and worthy of love. “Philautia is important in every sphere of life and can be considered a basic human need” (Sharma, 2014). To the Greeks, philautia “is the root of the heart of all the other loves” (Jericho, 2015). Gadamer (2009) writes of philautia: “Thus it is; in self-love one becomes aware of the true ground and the condition for all possible bonds with others and commitment to oneself.” Healthy philautia is the love that is within oneself. It is not, explains Jericho (2015), “the desire for self and the root of selfishness.” Ethicist John Deigh (2001) writes:

Accordingly, when Aristotle remarks that a man’s friendly relations with others come from his relations with himself … he is making the point that self-virtuous love (philautia), as the best exemplar of love … is the standard by which to judge the friendliness of the man’s relations with others.

SAD’s culture of maladaptive self-appraisal and the interruption of natural motivational development obscure our positive self-qualities. Positive psychology embraces “a variety of beliefs about yourself, such as the appraisal of your own appearance, beliefs, emotions, and behaviors” (Cherry, 2019). It measures “how much a person values, approves of, appreciates, prizes, or likes him or herself” (Blascovich & Tomaka, 1991). Ritter et al. (2013) studied the relationship between SAD and self-esteem. The research concluded that SAD persons have significantly lower implicit and explicit self-esteem relative to healthy controls, which manifest in maladaptive self-beliefs of incompetence, unattractiveness, unworthiness, and other irrational self-evaluations.

Healthy philautia is essential for any relationship; it is easy to recognize how it supports self-positivity and interconnectedness. “One sees in self-love the defining marks of friendship, which one then extends to a man’s friendships with others” (Deigh, 2001). Self-worth improves self-confidence, which allows the individual to overcome fears of criticism and rejection. Risk becomes less consequential, and the playful aspects of ludus are less threatening.

Self-assuredness opens the door to traits commonly associated with successful interpersonal connectivity―persistence and persuasiveness, optimism of engagement, and a willingness to vulnerability. A SAD person’s recognition of her or his inherent value generates the realization that they “are a good person who deserves to be treated with respect” (Ackerman, 2019). “To feel joy and fulfillment at being you is the experience of philautia” (Jericho, 2015). The philautia described by Aristotle “is a necessary condition to achieve happiness” (Arreguín, 2009), which, as we continue down the classical Greek path, is eudemonic. In the words of positive psychologist Stephen (2019), eudaimonia describes the notion that living by one’s daimon, which we take to mean ‘character and virtue,’ leads to the renewed awareness of one’s ‘meaning and purpose in life.’

Aristotle touted the striving for excellence as humanity’s inherent aspiration (Kraut, 2018). He described eudaimonia as “activity in accordance with virtue” (Shields, 2015). Eudaimonia reflects the best activities of which man is capable. The word eudaimonia reflects personal and societal well-being as the chief good for man. “The eudaimonic approach … focuses on meaning and self-realization and defines well-being in terms of the degree to which a person is fully functioning” (Ryan & Deci, 2001). It is through recognition of one’s positive self-qualities and potential productive contribution to the general welfare that one rediscovers the intrinsic capacity for love. Let us view this through the symbolism of Socrates’ tale of the Cave (Plato, 1992). In it, we discover SAD persons chained to the wall. The shadows projected by the unapproachable light outside the cave generate their perspectives. They name these maladaptive self-beliefs: useless, incompetent, timid, ineffectual, ugly, insignificant, and stupid. The prisoners form a subordinate dependency on their surroundings and resist any other reality until they are loosed from their bondage and emerge into the light. Like cave dwellers, the SAD person breaks away from maladaptive self-beliefs into healthy philautia’s positive self-qualities, which encourage and support connectivity to all forms of interpersonal love.

A study published in Cognitive Behaviour Therapy (Hulme et al., 2012) looked at the effect of positive self-images on self-esteem in the SAD person. Eighty-eight students were screened with the Social Interaction Anxiety Scale (SIAS) and divided between the low self-esteem group and the high self-esteem group. The study had two visions. The first was to study the effect of positive and negative self-beliefs on implicit and explicit self-esteem. The second was to investigate how positive self-beliefs would affect the negative impact of social exclusion on explicit self-esteem and whether high socially anxious participants would benefit as much as low socially anxious participants.

The researchers used a variety of measures and instruments. The Social Interaction Anxiety Scale is standard in SAD therapy and CBT workshops; the Implicit Association Test (IAT) reveals the strength of the association between two different concepts. The Rosenberg Self-Esteem Scale (RSES) is a 10-item self-report measure of explicit self-esteem; the State-Trait Anxiety Inventory-Trait (STAI-T) is a 20-item scale that measures trait anxiety; and the Depression Anxiety Stress Scale-21 (DASS-21) is a self-report scale measuring depression, anxiety, and general distress.

The study found that negative self-imagery reduces positive implicit self-esteem in both high and low socially anxious participants. It provided evidence of the effectiveness of promoting positive self-beliefs over negative ones “because these techniques help patients access a more positive working self” (Hulme et al., 2012). It also demonstrated that positive self-imagery maintained explicit self-esteem even in the face of social exclusion.

59.5. Conclusion

For 25 years, since the appearance of SAD in DSM-IV, the cognitive-behavioral approach has reportedly been effective in addressing social anxiety disorder. It is structurally sound and conceivably remains the foundation for future programs. However, it is not the therapeutic gestalt it claims to be. Productive cognitive-behavioral approaches emphasize replacing SAD’s automatic negative thoughts and behaviors (ANTs) with automatic rational ones (ARTs).

As defined by UCLA psychologists Hazlett-Stevens and Craske (2002), CBT approaches treatment with the assumption that a specific central or core feature is responsible for the observed symptoms and behavior patterns experienced (i.e., lawful relationships exist between this core feature and the maladaptive symptoms that result). Therefore, once the central feature is identified and targeted, maladaptive thoughts and behaviors will be mitigated.

Clinicians and researchers have reported the lack of a precise diagnostic definition for social anxiety disorder; features overlap and are comorbid with other mental health problems (ADAA, 2019a; Tsitsas & Paschali, 2014). Experts cite substantial discrepancies and disparities in the definition, epidemiology, assessment, and treatment of SAD (Nagata et al., 2015). More specifically, according to a study published in the Journal of Consulting and Clinical Psychology (Alden et al., 2018), “there is not enough attention paid in the literature to the ability to function in the close relationships” required for interpersonal love.

Standard CBT also needs more methodological clarity. Johnsen and Friborg (2018) cite the various forms of CBT used in studies and therapy over the years. Experts point to two predominant types of CBT: “the unadulterated CBT created by Beck and Ellis, which reflects the protocol-driven, highly goal-oriented, more standardized approach they first popularized,” and the more integrative and collaborative approaches of “modern” CBT (Wong et al., 2013). 

The deficit of positive self-qualities in individuals impaired by SAD’s symptomatic culture of maladaptive self-beliefs and the interruption of the natural course of human motivational development is a new psychological concept in our evolving conscious complexity. Cognitive-behavioral therapies focus on resolving negative self-imaging and irrationality through programs of thought and behavioral modification. Positive self-qualities in healthy philautia is not new; it was discussed in symposia almost two-and-a-half centuries ago. However, the psychological ramifications and methods to address it are in their formative stages. There is a need for innovative psychological and philosophical research to address the broader implications of healthy philautia’s positive self-qualities, which could deliver the potential for self-love and societal concern to the SAD person, opening the bridge to procuring all forms of interpersonal love.

Kashdan, Weeks, and Savostyanova (2011) cite the “evidence that social anxiety is associated with diminished positive experiences, infrequent positive events, an absence of positive inferential biases in social situations, fear responses to overtly positive events, and poor quality of life.” Models of CBT that attempt only to reduce the individual’s avoidance behaviors would benefit from addressing, more specifically, the relational deficits that such people experience, as well as positive psychological measures to counter SAD’s culture of maladaptive self-beliefs. Non-traditional and supported approaches, including those defined as new (third) wave (generation) therapies, with CBT serving as the foundational platform for integration, would widen the scope and perspective in comprehending SAD’s evolving intricacies.

One such step is integrating positive psychology within the cognitive behavioral therapy model, which, “despite recent scientific attention to the positive spectrum of psychological functioning and social anxiety/SAD … has yet to be integrated into mainstream accounts of assessment, theory, phenomenology, course, and treatment” (Kashdan et al., 2011). CBT would continue to modify automatic maladaptive self-beliefs, thoughts, and behaviors, and positive psychology would replace them with positive self-qualities.

Training in prosocial behavior and emotional literacy can supplement typical interventions. Behavioral exercises practice the execution of considerate and generous social skills. Positive affirmations have enormous subjective value as well. Data provide evidence for mindfulness and acceptance-based interventions, where the goal is not only to respond to the negativity of maladaptive self-beliefs but to pursue positive self-qualities despite unwanted negative thoughts, feelings, images, or memories. Castella et al. (2014) suggest motivational enhancement strategies to help clients overcome their resistance to new ideas and concepts. Ritter et al. (2013) tout the benefits of positive autobiography to counter SAD’s association with negative experiences, and self-monitoring helps SAD persons to recognize and anticipate their maladaptive self-beliefs (Tsitsas & Paschali, 2014). Finally, the importance of considering the “nuanced and unique dynamics inherent in the relationships among emotional expression, intimacy, and overall relationship satisfaction for socially anxious individuals” should be thoroughly considered (Montesi et al., 2013). As positive psychology turns its attention to the broader spectrum of philautia’s positive self-qualities, integration with CBT’s behavior modification, neuroscience’s brain restructuring, and other non-traditional and supported approaches would establish a working platform for discovery.

Proactive Neuroplasticity YouTube Series

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