Category Archives: Social Anxiety

The Impact of Unresolved Blame and Guilt in Recovery

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Blame and guilt are normal emotions that become toxic when unresolved. They collaborate when blame is utilized to avoid personal accountability, and when guilt is a consequence of accepting blame for harming another. They both generate shame until or unless addressed.

Blame

Blame is the act of censuring, holding responsible, or making negative statements about the self, an individual, or group that their action(s) were wrong, and they are socially or morally irresponsible. Blame is threefold: (1) blaming others who have harmed us; (2) blaming ourselves for harming another; (3) blaming ourselves for self-harm. 

Blaming is a natural and healthy response to situations, although the initial act is often distorted. For example, children often blame themselves for household disharmony. A student may blame a failing test grade on their stupidity rather than their lack of preparedness. We blame ourselves for our dysfunction and society for making our life so difficult. We blame ourselves, our parents, our neighbors, god, and anyone caught lurking for inconsequential things or situations beyond anyone’s control.

Most of our blaming is in response to forgettable, harmless situations. Some blaming carries significant emotional weight, especially if the harm is serious or prolonged. We often carry that emotional baggage throughout our life. It is unhealthy and non-conducive to recovery. When we hold onto these feelings, we construct our neural network with anger, hurt, and resentment. To paraphrase Buddha, holding onto anger is holding onto a hot coal with the intent of throwing it at someone else; you’re the one who gets burned. Our transgressors are likely (1) unaware they injured us, (2) have forgotten the injury, (3) take no responsibility for it, (4) or don’t care. The only person negatively impacted is the blaming party.

Those who have harmed us should be held accountable, and we must take responsibility for our own transgressions. To release the negative energy, we must forgive those transgressions and move on. Why is that difficult to do? Because our anger and righteous indignation satisfy us. We also become physiologically addicted to the pleasurable chemicals that reward our hatred and resentment.

Our transgressions against another manifest in guilt and shame—negative baggage that can only be released by accepting responsibility, making amends, and forgiving ourselves.

Self-blame is one of the most toxic forms of self-abuse. Since it is irrational to self-harm, it is caused by our dysfunction. We falsely self-blame for our behaviors and our perceived character deficits caused by our dysfunction. We are not our dysfunction, therefore, any blame must be ascribed to the dysfunction; self-blame is irrational and delusory. When addressed rationally, it can lead to positive change.

Dysfunctions thrive on our self-denigration, self-contempt, and other hyphenated forms of self-abuse. Mindfulness of this supports recovery.

Guilt

Guilt is a psychological term for a natural self-conscious emotion that condemns the self while conscious of being evaluated by another person(s). It is the physiologically harmful feeling of having done something wrong, with an implicit need to correct or amend.

There are multiple levels and factors of guilt. We feel guilt for harming another, and for being the type of person who would affect harm. We feel guilt for harming ourselves. We guilt ourselves for things over which we have no control (cognitively distorted guilt).

The sensation of guilt is a reminder that we have done something wrong that we need to correct or amend. Such actions can remove the overriding vehemence of guilt from our conscience. Guilt is self-focused but highly socially relevant: It supports important interpersonal functions by, for example, encouraging adjusting or repairing valuable relationships and discouraging acts that could damage them. 

Rather than taking responsibility for guilt-provoking actions, we often play the blame game, ascribing the guilt to another entity. Since we subconsciously recognize our attribution, we add the burden of blame to the burden of guilt.

Until or unless we are mindful of our actions that elicited the guilt, and address those actions, we carry that emotional baggage throughout our life. It is unhealthy and non-conducive to self-esteem and recovery. When we hold onto guilt, we pattern our neural network with self-doubt, self-contempt, and self-unworthiness.

The harmful impact of guilt can be resolved by:

  1. Mindfulness (recognition and acceptance) of the act that incurred the guilt.
  2. Recognizing and disputing any cognitively distorting guilt for things we are not responsible for or things over which we have no control.
  3. Making direct amends for acts we are responsible for. Making substitutional amends if direct amends are not possible. 
  4. Then forgiving our self for the act that incurred the guilt. 

When we allow the negativity of guilt to take up valuable space in our brain, it impedes the flow of positive thought and action necessary for recovery. To excise this harmful negativity, we must forgive ourselves (which requires amending or remedying). Years of hanging onto guilt take their toll, and the negative self-image builds and solidifies, and overwhelms anything that hints at self-worth or value. Guilt is considered a ‘sad’ emotion, along with agony, grief, and loneliness, each a debilitating symptom of social anxiety disorder.

By withholding forgiveness, we deny ourselves the ability to function optimally; it is divisive to our wellbeing and disharmonious to our true nature. Forgiving is the only way to expel the hostility. We cannot hope to recover without courageously absolving our self and others whose behavior contributed to our negativity.

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

The Hostility of Mental Health Stigma

Mental Health Stigma (MHS) is the hostile expression of the abject undesirability of a human being who has a mental illness. It is the instrument that brands the mentally dysfunctional (victim) defective due to stereotypes. MHS is purposed to protect the general population from unpredictable and dangerous behaviors by any means necessary. MHS is fomented by prejudice, ignorance, and discrimination. The stigmatized are devalued in the eyes of others and subsequently in their self-image as well.

Between 50 and 65 million U.S. adults and adolescents have a mental illness; 90% of those will be impacted by mental health stigma, a presence that elicits unsupportable levels of shame and jeopardizes the emotional and societal wellbeing of the victim.

Origins and Evolution

The Signaling Event. MHS is triggered by a set of signals or signaling event, i.e., an occasion, experience, news story, encounter where the visibility of behaviors and mannerisms associated with mental illness elicit a reaction.

The Label. Labeling defines the signaling event and distinguishes it from other labels. ‘Woman’ is a label; it is specific, restrictive to gender, and says certain things that distinguish it from other labels. A successful label elicits a strong public reaction. The defining characteristics of the label become the stereotype. Labeling is subject to the labeler’s belief system and, like stereotype and stigma, is reliably inaccurate because of implied expectations of behavior. 

The Stereotype. Labeling gives the signal a moniker for identification; the stereotype defines it and gives it meaning. Stereotyping is a cognitive differentiation of something that piques one’s interest; everyone stereotypes. Mental health stereotyping is distinguishable by pathographic overtone that identifies the victim as unpredictable, potentially violent, and undesirable. 

Ironically, 14th century asylums in Spain and Egypt were built to protect the mentally afflicted from the dangerous and violent members of society.

Mental health labeling and stereotypes support and collaborate with preconceived notions of mental illness, generated by the natural aversion to weakness and difference. This is supported by an ignorant and prejudicial belief system and, on occasion, personal experience. Labels and stereotypes are unbound by truth or evidence; believability is the ultimate criterion.  

Stigma. A stigma is a brand or mark that negatively impacts a person or group by distinguishing and separating that person or group from others. The branding concept originated with the ancient Greek custom of identifying criminals, slaves, or traitors by carving or burning a mark into their skin. Stigma is identified by three types: (1) abominations of the body, (2) moral character stigmas, and (3) tribal stigmas. The first refers to physical deformity or disease; tribal stigmas describe membership in devalued races, ethnicities, or religions; and moral character stigma refers to persons perceived as weak, immoral, duplicitous, dishonest, e.g., criminals, substance addicts, cigarette smokers, and the mentally ill. 

Mental Health Stigma. The objective of a MHSisto protect the general population from the unpredictable and dangerous behaviors associated with mental illness by any means necessary, including deception, misinformation, and fear-baiting. Its ultimate goal is to negatively impact the social reintegration of the victim. 

  • Anticipatory stigma is the expectation of a stigma due to behavior or diagnosis, and subsequent adverse social reaction. This causes a resistance by the potential victim to disclose any physiological aberration.  
  • Stigma-avoidance identifies those who avoid or postpone treatment fearing the associated stigma will discredit them and negatively impact their quality of life. Studies indicate almost one third of the potential victims resist disclosure, impacting the potential for recovery.
  • Family-stigmatization occurs when family members reject a child or sibling because of their mental illness. Throughout history, it was commonly accepted that mental illness was hereditary or the consequence of poor parenting. A 2008 study found 25% to 50% of family members believe disclosure will bring shame to the family. (Courtesy-stigma denotes a supportive family member.)

An active stigma is a parasitic one. If it finds enough suitable hosts, the parasitosis can spread rapidly by traditional means. Studies show the aversion to mental illness is prosocially hard-wired which provides an abundance of hosts.  

Contributing Factors to MHS. The stigma triad of ignorance, prejudice, and discrimination is generated and supported by preconceived notions, general obliviousness, a lack of education, and society’s deep-rooted fear of its susceptibility. The primary attributions to MHS are public opinion, media misrepresentation, visibility, diagnosis, and the disease or pathographic model of mental healthcare. 

How MHS Affects the Victim 

MHS impacts the victim through a series of stigma experiences:

  • Felt stigma. The anticipated or implied threat of a stigma.  
  • Enacted stigma. The activated stigma. 
  • External stigma. Victim holds the perpetrator responsible for the stigma. 
  • Internalized stigma. Victim assumes behavioral responsibility for the stigma.
  • Experienced stigma. Victim’s reaction to the stigma.

The victim anticipates their mannerisms, behaviors or diagnosis will generate a stigma (felt stigma). When the stigma is realized it becomes an enacted stigma. The victim blames the person who originated the stigma (external stigma) or assumes responsibility due to behavior (internalized stigma). When the stigma impacts the victim’s wellbeing, it becomes an experienced stigma

MHS Impact. Mental health stigma can negatively affect the victim’s emotional wellbeing and quality of life by jeopardizing their:

(mind, body, spirit, and emotions)

  • Livelihood
  • Housing
  • Social status
  • Relationships

Solution

Mental health stigma will not be mitigated or eliminated until the mental healthcare community embraces the wellness model over the disease of mental health. The disease model of mental health focuses on the problem; creating a harmful symbiosis of individual and diagnosis. The wellness model https://robertfmullen.com/2020/07/21/the-disease-model-versus-the-wellness-model-of-recovery/

emphasizes the solution. A battle is not won by focusing on incompetence and weakness but by knowing and utilizing our strengths, and attributes. That is how we positively function―with pride and self-reliance and determination―with the awareness of what we are capable. 

Establishing new parameters of wellness calls for a reformation of thought and concept. In 2004, the World Health Organization began promoting the advantages of the wellness over disease perspective, defining health as a state of physical, mental and social well-being and not merely the absence of disease or infirmity. The World Psychiatric Association has aligned with the wellness model and it has become a central focus of international policy. Evolving psychological approaches have become bellwethers for the research and study of the positive character strengths that facilitate the motivation, persistence, and perseverance helpful to recovery. Wellness must become the central focus of mental health for the simple reason that the disease model has provided grossly insufficient results.

A WORKING PLATFORM showing encouraging results for most physiological dysfunctions and discomforts is an integration of positive psychology’s optimum human functioning with CBT’s behavior modification, neuroscience’s network restructuring, and other positivity targeted approaches. including affirmations, autobiography, and methods to regenerate self-esteem and motivation.

This new wellness paradigm, however, should not be a dissolution of medical model approaches but an intense review of their efficacy, and repudiation of the one-size-fits-all stance within the mental health community. 

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Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

The Value of Mindfulness in Recovery

The value of mindfulness in recovery is immeasurable

We share an intimate and unhealthy relationship with our dysfunction or discomfort that manifests in many ways. 

  • The tolerant relationship. We recognize our condition is detrimental to a healthy and productive lifestyle, but we are too lazy or apathetic to address it. 
  • The resigned relationship. We devalue our character strengths and virtues, convincing ourselves any attempt at recovery is futile. We have given up.
  • The self-pitying relationship. We wallow in our misery because it comforts us and confirms our victimization.
  • The assimilate relationship. We acclimate to our condition, adapting and incorporating it into our system. This is the odd relationship where we become our dysfunction.
  • The denial relationship. We refuse to acknowledge the problem, denying its existence, our dismissal so pervasive it subconsciously metastasizes, like unchecked cancer. 

Every physiological dysfunction and discomfort generate a correlated deficiency of self-esteem due to the condition itself, and the corresponding disruption in natural human development. The overwhelming majority of dysfunctional onset happens during adolescence due to a toxic childhood environment caused by physical, emotional, or sexual disturbance. This disturbance manifests in perceptions of abandonment, exploitation, and detachment, engendering a disruption in natural human development which negatively impacts our self-esteem 

Self-esteem is mindfulness (recognition and acceptance) of our value to our self, society, and the world. Self-esteem can be further understood as a complex interrelationship between how we think about ourselves, how we think others perceive us, and how we process or present that information. 

Self-esteem deficits are the consequence of disapproval, criticism, and apathy of influential others—family, colleagues, ministers, teachers. Any number of factors impact self-esteem including our environment, sexual orientation, race and ethnicity, and education. 

  • Our negative self-image is generated by our deficit of self-esteem.
  • Self-esteem administers and is determined by our self-properties. Positive self-properties include self -reliant, -compassionate, -confidant, -worth, etc.  Negative self-properties are self -destructive, -loathing, -denigrating, etc. 
  • Our positive self-properties tell us we are of value, consequential, and desirable.  
  • Our intrinsic self-esteem is never fully depleted or lost; underutilized self-properties can be dormant like the unexercised muscle in our arm or leg. 
  • Self-esteem impacts our mind, body, spirit, and emotions separately and in concert. Mindfulness of this complementarity is important to emotional and behavioral control as we learn to utilize each component. 
  • We rediscover and reinvigorate our self-esteem through exercises designed to help us become mindful of our inherent strengths, virtues, and attributes.  

Neural restructuring. The primary objective or consequence of recovery is the restructuring of our neural network. When neural pathways reshape, there is a correlated change in behavior and perspective. Our brain is not a moral adjudicator, but an organic reciprocator, adapting and correlating to stimuli. 

Every stimulus we input causes a receptive neuron to fire, transmitting a message from neuron to neuron until it generates a reaction. Neural restructuring is the deliberate input of positive stimuli to compensate for years of dysfunctional negative input. Deliberate repetitious stimuli compel neurons to fire repeatedly causing them to wire together. The more repetitions the quicker and stronger the new connection.

Neural restructuring is deliberate plasticity—functionally modifying our neural network through repetitive activation. Plasticity is our brain’s capacity to change with learning—to relearn. Studies in brain plasticity evidence the brain’s ability to change at any age. Behavioral Plasticity is the capacity and degree to which human behavior can be altered by environmental factors such as learning and social experience.  In theory, a higher degree of plasticity makes an organism more flexible to change, whereas a lower degree of plasticity result in an inflexible behavior pattern. Behavioral plasticity enables an organism to change its behavior through learning.

Mindfulness is the state of active, open recognition and acceptance of present realities. It is the act of embracing our flaws as well as our inherent character strengths, virtues, and attributes. Mindfulness is the key to re-engaging our positive self-properties that constitute healthy self-esteem 

True mindfulness of our dysfunction is more than recognition and acceptance; it is embracement. By embracing our flaws as well as our character strengths, virtues, and attributes, we embrace ourselves. Love is linked to positive mental and physical health outcomes. Love motivates recovery. Embracing our dysfunction or discomfort is an act of love.

Our condition is a natural component of human development. It is evidence of our humanness. Think of it as an emotional virus. We are not our dysfunction any more than we are an accidental broken limb. We are individuals with a dysfunction. Embracing it does not mean we don’t want to transform into a healthy and more productive individual; it encourages transformation. 

Embracing is not acquiescence, resignation, or condoning. Acquiescence is accepting our condition and doing nothing to change it. Condoning is accepting it and allowing it to fester. Resignation is defeatism. Embracing is logically accepting ourselves for who we are—human dysfunctional beings abounding in ability and potential. It is embracing our character strengths, virtues, and attributes that facilitate the motivation, persistence, and perseverance to recover. It is embracing our totality. Healthy self-love is a fundamental component of self-esteem; we can never strive towards our potential until we truly learn to embrace ourselves. The value of mindfulness in recovery is immeasurable. 

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

Love, Friendship, and Social Anxiety

Publications

Enlisting Positive Psychologies to Challenge Love within SAD’s Culture of Maladaptive Self-Beliefs in C.-E. Mayer, E. Vanderheiden (eds.) International Handbook of Love: Transcultural and Transdisciplinary Perspectives. Insight into the relationship deficits experienced by people with SAD. Their innate need-for-intimacy is no less dynamic than that of any individual, but their impairment disrupts the ability (means-of-acquisition) to establish affectional bonds in almost any capacity. Now available from Amazon and other fine booksellers. Prepublication draft can be accessed here.

Also

How an Honorable Psychobiography Embraces the Fluidity of Truth in New Trends in Psychobiography, Chap. 5 (pp: 79-95). Springer. doi:10.1007/978-3-030-16953-4-https://link.springer.com/book/10.1007/978-3-030-16953-4

Finding your inherent character strengths, virtues, and attributes that generate the motivation and perseverance to succeed.

The Art of Authenticity: Constantin Stanislavski and Merleau-PontyJournal of Literature and Art Studies, 6 (7):790-803 (2016). doi:10.17265/2159-5836/2016.07.010.  https://www.academia.edu/26811760/The_Art_of_Authenticity

Utilizing Stanislavski’s method for authentic stage acting to address our volatile emotions to deconstruct and better understand and control them. 

Broadening the Parameters of the Psychobiography. The Extraordinariness of the ‘Ordinary’ Extraordinary. Psychobiographical Illustrations on Meaning and Identity in Sociocultural Contexts in Palgrave series, Sociological Psychology of the Lifecourse.

Discovering the inherent character strengths, virtues, and attributes of the unheralded persons who have achieved significant and noteworthy personal milestones.

Holy Stigmata, Anorexia, and Self-Mutilation: Parallels in Pain and Imagining. Journal for the Study of Religions and Ideologies, 9:25, 2010.   (PDF) Holy Stigmata, Anorexia and Self-Mutilation: Parallels in Pain and Imagining (researchgate.net)

Addresses the types of personalities that engage in self-mutilation and how some manipulate their self-inflicted pain for healing and empowerment.

Establishing a Wellness Model for LGBTQ+ Persons with Anxiety and Depression. Academia.edu, Researchgate.com. doi:10.13140/RG.2.2.17550.38728 (PDF) Establishing a Wellness Model for LGBTQ+ Persons with a Mental Dysfunction (researchgate.net)

The wellness model’s emphasis on character strengths, virtues, and attributes not only positively impacts the self-beliefs and image of a mentally ill person but resonates in sexual and gender-based identities and portends well, the recovery-remission of an LGBTQ+ person

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

Utilizing Complementarity for Social Anxiety (and other physiological dysfunctions)

Complementarity is the inherent cooperation of our human system components in maintaining physiological equilibrium. Sustainability-of-life and sustainability of our dysfunction require simultaneous mutual interaction.

How is this physiologically supported? 

Every thought and behavior generates a realignment of our neural network which produces a correlated change in our thought and behavior. Our neural network transmits the chemical and electrical maintenance that maintains our vital functions: heartbeat, nervous system, and blood–flow. It tells us when to breathe. It generates our mood, controls our weight and digestion. It provides acetylcholine for learningnoradrenaline for concentration, glutamate for memory (Mind), adrenaline for muscles, endorphins to relax (Body), dopamine for motivation, GABA for anxiety (Spirit), and serotonin for mood stabilization (Emotions).

Examples of Complementarity (Simultaneous Mutual Interaction).

  • The freeway fender bender: I could have died (mind), I’m sweating, my heart is pounding (body), I’m angry, and frustrated (emotions), and suddenly conscious of my mortality (spirit).
  • The social gathering: are they looking at me (mind), I’m shaking and sweating (body), I’m afraid I’ll say or do something stupid (emotions), and they probably won’t like me, anyway (spirit).

Mindfulness of Complementarity.

Recognizing that the “Self’ is not a single entity but a complex collective of four major components: mind, body, spirit, and emotions (“MBSE”); accepting that these components react simultaneously and work in concert. One component will seem to dominate, depending on the situation. 

How is this relevant to social anxiety?

The symptoms of social anxiety attack our self-image. Because this causes us to build up defense mechanisms, our reactions are often irrational (self-destructive). This is especially pertinent in situations where our anxiety and depression generate self-denigrating or unhealthy responses: the social event, job performance review, the interview, the classroom.

The clinical term ‘disorder’ identifies extreme or excessive impairment that negatively affects 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 socially anxious person anticipates it, takes it personally, dramatizes it, and obsesses on its negative implications. 

Let’s look at an example applicable to social anxiety disorder: We find ourselves in a social situation where our apprehensions and fears overwhelm us. We feel incompetent and unattractive. Our dysfunction persuades us we are being judged, criticized, or held in contempt. We either feel we are the center of attention or invisible. Our deflated spirit and fraught emotions fight for dominance. 

How do we alleviate our fears and associated symptoms? We engage a well thought out and prepared diversion from our emotional/spiritual malaise by utilizing our supporting components, e.g., our mind and body. To divert is “to change course or turn from one direction to another.”  When ‘A’ is overwhelming, we engage ‘B’ or ‘C’ to mitigate “A.” (We instinctively divert readily. We go for a walk to calm our emotions, pray when anguished, vent frustration by bellowing or breaking something.) There are numerous ways to divert as we will discover; here are a few examples

Engage your body. Place a small item in your shoe, snap the rubber band around your wrist, or carry a distracting item in your pocket like a pushpin. Your slight physical discomfort diverts from your emotional and spiritual woes.

Engage your mind. Find three items in the room: the blue couch, red vase, cuckoo clock, and focus on them in moments of stress. Prepare event-focused PAs, repeating them the week before and mentally at the event. Learn the lyrics to an empowering song and mentally sing it.

Engaging Mind and Body. Subtly mimic a fearless or confident character from a film or book. Paul Newman created the walk to establish the character. 

With Positive Autobiography and positive psychologies, we retrieve those extraordinary moments of our lives resisted or repressed by the negative self-image generated by our dysfunction. Reflecting on these just before and during the event challenges our irrational perceptions of incompetence and worthlessness. 

Through mindfulness, practice, and the simultaneous restructuring of our neural network, these distractions or diversions will eventually become less important. 

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort (neuroses/disorders). Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for groups, workshops, and practicums.

Social Anxiety Disorder: General Overview

Social anxiety disorder onsets at adolescence. The afflicted are not responsible for their dysfunction.

Social anxiety disorder (SAD) is one of the most common mental disorders, affecting the emotional and mental wellbeing of millions of U.S. adults and adolescents who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. SAD is the second most diagnosed form of anxiety in the United States. Statistics estimate 40 million U.S. adults will experience SAD. The National Institute of Mental Health estimates 9.1% of adolescents (ages 10 to 19) currently experience symptoms, and 1.3% have severe impairment. Statistics are imperfect for LGBTQ+ persons; the Anxiety and Depression Association of America estimates their susceptibility is 1.5-2.5 times higher than that of their straight or gender-conforming counterparts. All statistics are fluid, however; a high percentage of persons who experience SAD refuse treatment, fail to disclose it, or remain ignorant of its symptoms. 

SAD is arguably the most underrated and misunderstood psychological dysfunction. Debilitating and chronic, SAD attacks on all fronts, negatively affecting the entire body complex. It manifests in mental confusion, emotional instability, physical dysfunction, and spiritual malaise. Emotionally, persons experiencing SAD are depressed and lonely. In social situations, they are physically subject to unwarranted sweating and trembling, hyperventilation, nausea, cramps, dizziness, and muscle spasms. Mentally, thoughts are discordant and irrational. Spiritually, they define themselves as inadequate and insignificant. 

The commitment-to-remedy rate for those experiencing SAD in the first year is less than 6%. This statistic is reflective of symptoms that manifest perceptions of worthlessness and futility. SAD also has lower recovery-remission rates because many of the afflicted are unable to afford treatment due to symptom-induced employment instability. Over 70% of SAD persons are in the lowest economic group.

Social anxiety disorder is a pathological form of everyday anxiety. Feeling anxious or apprehensive in certain situations is normal; most individuals are nervous speaking in front of a group and anxious when visiting their dentist. The typical individual recognizes the normalcy of a situation and accords it appropriate attention. The SAD person anticipates it, personalizes it, dramatizes it, and obsesses on its negative implications. The clinical term “disorder” identifies extreme or excessive impairment that negatively affects functionality.

The generic symptom of SAD is intense apprehension—the fear of being judged, negatively evaluated and ridiculed. There is persistent anxiety and fear of social situations such as dating, interviewing for a position, answering a question in class, or dealing with authority. Often, mere functionality in perfunctory situations―eating in front of others, riding a bus, using a public restroom—can be unduly stressful. 

The fear that manifests in social situations is so fierce that many SAD persons believe it is beyond their control, which manifests in perceptions of incompetence and hopelessness. Negative self-evaluation interferes with the desire to pursue a goal, attend school, or do anything that might trigger anxiety. Often, the subject worries about things for weeks before they happen. Subsequentially, they will avoid places, events, or situations where there is the potential for embarrassment or ridicule.

The overriding fear of being found wanting manifests in self-perspectives of inferiority and unattractiveness. SAD persons are unduly concerned they will say something that will reveal their ignorance, real or otherwise. 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 they are the uncomfortable center of attention. Their social interactions can appear hesitant and awkward, small talk clumsy, attempts at humor embarrassing–every situation reactive to negative self-evaluation. 

‘Maladaptive’ is a term created by Aaron Beck, the ‘father’ of cognitive-behavioral therapy. Although maladaptive self-beliefs can occur with many psychological dysfunctions, they are most common to SAD. A maladaptive self-belief is a negative self-perspective unsupported by reality. SAD persons can find themselves in a supportive and approving environment, but they tell themselves they are unwelcome and the subject of ridicule and contempt. They ‘adapt’ negatively to a positive situation.

SAD persons are often concerned about the visibility of their anxiety and are preoccupied with performance or arousal. SAD persons frequently generate images of themselves performing poorly in feared social situations, and their anticipation of repudiation motivates them to dismiss overtures to offset any possibility of rejection. The SAD subject meticulously avoids situations that might trigger discomfort. The maladaptive perceptions of inferiority and incompetence can generate profound and debilitating guilt and shame.  

SAD is repressive and intractable, imposing irrational thoughts and behavior. 

The key to SAD’s hold on its victims is its uncanny ability to sense vulnerability in the child/adolescent. SAD is like the person who comes to dinner and stays indefinitely. It feeds off its host’s irrationality. It crashes on the couch, surrounded by beer cans drained of hope and potential. It monopolizes the bathroom, creating missed opportunities. It becomes the predominant fixture in the house. After a while, its host not only grows accustomed to having it around but forms a subordinate dependency.

SAD persons crave the companionship but shun social situations for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers. People with SAD are prone to low self-esteem and high self-criticism due to the dysfunction itself, and its causal disruption in natural human development.

SAD onset occurs during adolescence and can linger in the system for years or even decades before asserting itself. Any number of situations or events trigger the infection. The SAD person could have been subject to bullying or a broken home. Perhaps parents were overprotective, controlling, or unable to provide emotional validation. In some cases, its cause is perceptual. A child whose parental quality time is interrupted by a phone call can sense abandonment. The SAD person is not accountable for their dysfunction; there is the likelihood no one is intentionally responsible. 

SAD is routinely comorbid with depression and substance abuse. Symptom are similar to those of avoidant personality disorder, panic disorder, generalized anxiety disorder, depression, substance abuse, eating disorders, OCD, and schizophrenia. Coupled with the discrepancies and disparity in its definition, epidemiology, assessment, and treatment, SAD is usually misdiagnosed.

For over 50 years, cognitive-behavioral therapy has been the go-to treatment for SAD. Only recently have experts determined that CBT can be ineffectual unless combined with a broader approach to account for SAD’s complexity and the individual personality. A SAD subject subsisting on paranoia sustained by negative self-evaluation is better served by multiple approaches, including those defined as new (third) wave (generation) therapies, developed through client trust, cultural assimilation, and therapeutic innovation. CBT, positive psychology, and neural restructuring might serve as the foundational platform for integration. SEE One-Size-Fits-All 

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for workshops and practicums.

Video: Social Anxiety Disorder and Relationships

YouTube

This YouTube Video is a brief PowerPoint presentation of social anxiety disorder and its impact on the individual’s emotional wellbeing and quality of life. One of the characteristics of social anxiety disorder, or its appropriate acronym, SAD, is the difficulty in establishing interpersonal relationships. SAD persons find it hard to establish close, personal connections. The avoidance of social activities and fear of rejection limits the potential for comradeship, and the inability to interact rationally and productively makes long-term, healthy relationships difficult.

Social anxiety disorder is arguably the most underrated and misunderstood psychological dysfunction. A debilitating and chronic affliction, SAD affects the perceptual, cognitive, personality, and social activities of the afflicted. It wreaks havoc on the person ‘s emotional wellbeing and quality of life. Almost one out of every three persons in the U. S. experiences some anxiety disorder at some point in their lives; 30 million are impacted by social anxiety disorder.

MORE YOUTUBE VIDEOS

The disease or medical model of ‘mental’ health focuses on a deficit, disease model of human behavior. The wellness model focuses “on positive aspects of human functioning.” This disease model ‘defective’ emphasis has been the overriding psychiatric perspective for well over a century.

When our neural pathways realign, there is a correlated change in behavior and perspective. Every thought, word, and action impel a receptive neuron to fire, transmitting a message, neuron to neuron to its destination. Positive messages contain the healthy thoughts and behaviors that supplant and overwhelm the years of toxic input generated by our dysfunction.

ReChanneling is dedicated to researching methods to alleviate symptoms of psychological dysfunctions (neuroses) and discomfort that impact our emotional wellbeing and quality of life. It does this by targeting the personality through empathy, collaboration, and program integration.

Dispelling some of the folklore and misinformation about physiological dysfunction. We are all casualties of the ignorance, prejudice and discrimination attached to mental illness. Myth Number 1: Mental illness is an abnormal condition.

Self-esteem is the self-recognition of our value as applicable to our self, others, and the world; value is the accumulation of our positive self-qualities that generate our character strengths and virtues. Every physiological dysfunction generates a correlated deficiency of self-esteem due to the condition itself, and the corresponding disruption in natural human development.

Why is your support essential? ReChanneling is dedicated to research and development of methods to mitigate symptoms of physiological dysfunction and discomfort (neuroses). Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for workshops and practicums.

Social Anxiety Disorder and Relationships.

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. (Pre-order, Amazon).

Robert F. Mullen

Social anxiety disorder (SAD) is one of the most common psychophysiological malfunctions, 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 that of any individual, but their impairment disrupts the ability (means-of-acquisition) to establish affectional bonds in almost any capacity. The spirit is willing, but competence insubstantial. It is the means-of-acquisition and how they are symptomatically challenged by SAD that 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 the procurement of forms of intimacy previously inaccessible. It is an arduous and measured crossing that only 5% of the afflicted will even attempt in the first year of onset.

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) estimate nearly 15 million (7%) American adults currently experience its symptoms. Ritchie and Roser (2018) report 284 million SAD persons, worldwide, and the National Institute of Mental Health (NIMH, 2017) report 31.1% of U.S. adults experience some anxiety disorder at some time in their lives, 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” psychophysiological affliction (Castella et al., 2014), SAD “wreaks havoc on the lives of those who suffer from it” (ADAA, 2019a). SAD attacks all fronts, negatively affecting 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, Morrison, & Gross, 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).

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We invite you to join our online group, “Strategizing Your Mental Dysfunction.” If you are committed to alleviating those symptoms that impact your emotional wellbeing and quality of life, contact us. This is a no-fee discussion and support group. You are not alone, it is not your fault, and you deserve to be treated with dignity and respect. ___________________________________

The National Institute of Mental Health estimates that 9.1% of adolescents experience social anxiety disorder, and 1.3% have severe impairment (NIMH, 2017). The onset of SAD is generally considered “to take place between the middle and late teens” (Tsitsas & Paschali, 2014). Like other pathogens, SAD can remain dormant for years before symptoms materialize. Any number of situations or events trigger the initial contact; it could be hereditary, environmental, or the result of some traumatic experience. The LGBTQ community is 1.5–2.5 times as susceptible to SAD “than that of their straight or gender-conforming counterparts” (Brenner, 2019). 39.5% of general anxiety sufferers pursue recovery compared to “5% of SAD persons in the first year of experiencing the malfunction” (Shelton, 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. Approximately 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,

1. general public cynicism,

2. self-contempt by the afflicted, generated by maladaptive self-beliefs,

3. ignorance or ineptitude of mental health professionals,

4. real or perceived social stigma, and

5. 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, Wong, Craig, Marker, & Peters, 2018). The high percentage of jobless people experiencing social anxiety disorder in the U.S. is related to “to job inefficiency and instability” (Felman, 2018), greater absenteeism, job dissatisfaction, and or 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 are due to “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” (Nagata, Suzuki, & Teo, 2015). The Social Anxiety Institute (Richards, 2019) reports, among patients with generalized anxiety, an estimated 8.2% had the condition, but just 0.5% were correctly diagnosed. A recent Canadian study by Chapdelaine, Carrier, Fournier, Duhoux, and Roberge (2018) reported, of 289 participants in 67 clinics meeting criteria for social anxiety disorder outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), 76.4% were improperly diagnosed.

Social anxiety disorder is a pathological form of everyday anxiety. The clinical term “disorder” identifies extreme or excessive impairment that negatively affects 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 on its negative implications (Richards, 2014).

SAD’s culture of maladaptive self-beliefs (Ritter, Ertel, Beil, Steffens, & Stangier, 2013) and negative self-evaluations (Castella et al., 2014) aggravate anxiety and impede social performance (Hulme, Hirsch, & Stopa, 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. The cofounder of CBT, Aaron Beck provides three types of maladaptive self-beliefs responsible for persistent social anxiety. 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). Core beliefs influence the development of intermediate beliefs―attitudes, rules, and assumptions that influence one’s overall perspective, which, in turn, influences thought and behavior. Automatic thoughts and behaviors (ANTs) are real-time manifestations of maladaptive self-beliefs, dysfunctional in their irrationality (Richards, 2014; Wong, Moulds, & Rapee, 2013).

Negative self-images reported by patients with social anxiety disorder reflect a working self that is retrieved in response to social threat and which is characterised by low self-esteem, uncertainty about the self, and fear of negative evaluation by others. (Hulme et al., 2012)

Halloran and Kashima (2006) define culture as “an interrelated set of values, tools, and practices that is shared among a group of people who possess a common social identity.” 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 “others will judge [them] to be anxious, weak, crazy, or stupid” (APA, 2017). Although studies evidence “culture-specific expression of social anxiety” (Hoffman, Asnaani, & Hinton, 2010), SAD “is a pervasive disorder and 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). This overriding fear of being found wanting manifests in perspectives of incompetence and worthlessness (Richards, 2019). SAD persons are unduly concerned they will say something that will reveal their ignorance, real or otherwise (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 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), 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, Dalrymple, Chelminski, Young, & Galione, 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. These maladaptive self-beliefs, over time, become automatic negative thoughts (Amen, 1998) implanted on the neural network (Richards, 2014). They determine initial reactions to situations or circumstances. They inform how to think and 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 in public, expressing opinions, or even fraternizing with peers … People with social anxiety disorder are typified by low self-esteem and high self-criticism. (Stein & Stein, 2008)

Anxiety and other personality disorders are branches of the same tree. “There is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression (19%), substance-abuse disorder (17%), GAD [generalized anxiety disorder] (5%), panic disorder (6%), and PTSD (3%)” (Tsitsas & Paschali, 2014). 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 schizophrenia.

Personality disorders are a group of mental illnesses. They 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 “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).

59.1.1. SAD and Interpersonal Love

In unambiguous terms, the desire-for-love is at the heart of social anxiety disorder (Alden, Buhr, Robichaud, Trew, & Plasencia, 2018). Interpersonal love relates to communications or relationships of love between or among people. The diagnostic criteria for SAD, outlined in the DSM-V (APA, 2017), includes: “Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.” SAD persons find it inordinately difficult to establish close, productive relationships (Castella et al., 2014; Fatima, Naizi, & Gayas, 2018). Their avoidance of social activities limits the potential for comradeship (Desnoyers, Kocovski, Fleming, & Antony, 2017; Tsitsas & Paschali, 2014), and their inability to interact rationally and productively (Richards, 2014; Zimmerman et al., 2010) makes long-term, healthy relationships unlikely. SAD persons frequently demonstrate significant impairments in friendships and intimate relationships (Castella et al., 2014). According to Whitbourne (2018), SAD persons’ avoidance of other people puts them at risk for 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 death of research directly investigating the relationship between SAD and interpersonal love (Montesi, Conner, Gordon, & Fauber, 2013; Read, Clark, Rock, & Coventry, 2018). A study on friendship quality and social anxiety by Rodebaugh, Lim, Shumaker, Levinson, and Thompson (2015) notes the lack of relative quality studies, and Alden et al. (2018) report on the lack of attention paid to the SAD person’s inability or refusal to function in close relationships. The few studies that do exist report that the SAD person exhibits inhibited social behavior, shyness, lack of assertion in group conversations, and feelings of inadequacy while in social situations (Darcy, Davila, & Beck, 2005). This dominant culture of maladaptive self-beliefs results in the tendency to avoid new people and experiences, making the development of “adequate and close relationships (e.g., family, friends, and romantic relationships)” extremely challenging (Cuming & Rapee, 2010). Experiencing social anxiety disorder translates to less trust and perceived support from close interpersonal relationships (Topaz, 2018).

Although intimately related, the desire-for-love and the means-of-acquisition are binary operations. Most forms of interpersonal love require the successful collaboration of wanting and obtaining. The desire-for-love is the non-consummatory component of Freud’s eros life instinct (Abel-Hirsch, 2010). The means-of-acquisition are the methods and skills required to complete the transaction―techniques that vary depending upon the type of love in the offing. 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 purposed for SAD is typically conceptualized as a short-term, skills-oriented approach aimed at exploring 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). CBT 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). Almost 90% of the approaches empirically supported by the “American Psychological Association’s Division 12 Task Force on Psychological Interventions” involve cognitive-behavioral treatments, according to Lyford (2017). “Individuals who undergo CBT show changes in brain activity, suggesting that this therapy improves your brain functioning as well” (NAMI, 2019).

Recent meta-analytic evidence suggests that CBT as an effective treatment for SAD compares favorably with other psychological and pharmacological treatment programs (Cuijpers, Cristea, Karyotaki, Reijnders, & Huibers, 2016). There is no guarantee of success, however, and standard CBT is imperfect (David, Cristea, & Hoffman, 2018; Mullen, 2018). The best outcome a SAD sufferer can hope for is mitigation of symptoms through thought and behavior modification and the simultaneous restructuring of the neural network, along with other supported and non-traditional treatments..

“[M]any patients, although being under drug therapy, remain symptomatic and have recurrence of symptoms,” according to the Brazilian Journal of Psychiatry. “40–50% are better, but still symptomatic, and 20–30% remain the same or worse.” (Manfro, Heldt, Cordiol, & Otto, 2008)

Behavioral and cognitive treatments are globally proven methodologies. There are multiple associations worldwide, “devoted to research, education, and training in cognitive and behavioral therapies” (McGinn, 2019). CBT Conferences (2019) are offered across the globe, “where knowledge transfer takes place through debates, round table discussions, poster presentations, workshops, symposia, and exhibitions.” David et al. (2018) credit CBT

as the best standard we have in the field currently available—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) Moreover, the 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).

The Association for Behavioral and Cognitive Therapies (ABCT) is “a worldwide humanitarian organization,” fostering the “dissemination of evidence-based prevention and treatments through collaborations with the World Health Organization (WHO) and the United Nations Educational, Scientific and Cultural Organization (UNESCO)” (McGinn, 2019). The World Confederation of Cognitive and Behavioural Therapies (WCCBT) is a global multidisciplinary organization promoting health and well-being through the scientific development and implementation of “evidence-based cognitive-behavioral strategies designed to evaluate, prevent, and treat mental conditions and illnesses” (ACBT, 2019).

Cognitive-behavioral therapy is arguably the gold standard of the psychotherapy field. David et al. (2018) maintain, “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 if the gold standard of psychotherapy defines itself as the best in the field, then CBT is not the gold standard. There is clearly 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 and concluded that “the effects of CBT have declined linearly and steadily since its introduction, as measured by patients’ self-reports, clinicians’ ratings, and rates of remission.” According to the authors, “Just seeing a decrease in symptoms,” he says, “doesn’t translate into greater well-being.” This is reflective of most one-size-fits-all approaches.

While this study recognizes CBT as the best foundation for addressing the SAD culture of maladaptive self-beliefs, it makes the point standard CBT, alone is not necessarily 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. A SAD person subsisting on paranoia sustained by negative self-evaluation is better served by multiple non-traditional and supported approaches, including those defined as new (third) wave (generation) therapies, developed through client trust, cultural assimilation, and therapeutic innovation with CBT and positive psychology 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 subject’s means-of-acquisition in seven of eight categories (with the notable exception of healthy philautia). The three primary categories: (1) philia (comradeship), (2) eros (sexual), and (3) agape (selfless and unconditional), are followed by (4) storge (family), (5) ludus (provocative), (6) pragma (practical), and the two extremes of philautia: (7) narcissistic and, (8) positive self-qualities. Forms of inanimate love are excluded from this study, “including love for experiences (meraki), objects (érōs), and places (chōros)” (Lomas, 2017).

1. 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 or judged by others (Mayoclinic, 2017b).

2. Eros is reciprocal feelings of shared arousal between people physically attracted to each other, the fulfillment declared 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) has significant consequences in terms of acquiring a sexual partner, and satisfaction of the sexual act (Montesi et al., 2013). SAD’s culture of maladaptive self-beliefs poses severe challenges to their ability to establish, develop, and maintain romantic relationships (Cuncic, 2018; Topaz, 2018). A study by Montesi et al. (2013), examining the SAD’s person’s symptomatic fear of intimacy and sexual communication concluded, “socially anxious individuals experience less sexual satisfaction in their intimate partnerships than nonanxious individuals, a relationship that has been well documented in previous research.” The study reported a lacuna of literature, however, examining the sexual communication of SAD persons.

3. 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 infects adolescents who have experienced detachment, exploitation, and or neglect (Steele, 1995). This form of love characterizes itself through unselfish giving; the SAD person’s maladaptive self-belief she or he is the constant focus-of-attention is a form of self-centeredness bordering on narcissism (Mayoclinic, 2017a).

4. Again, the primary cause of SAD stems from childhood hereditary, environmental (Felman, 2018; NAMI, 2019), or traumatic events (Mayoclinic, 2017b). In each case, the SAD person is exploited (unconsciously or otherwise) in the formative stages of human motivational development: those of physiological safety and belongingness and love (Maslow, 1943). As a result, storge or familial love and protection, vital to the healthy development of the family unit, is severely affected. The exploited adolescent (Steele, 1995) faces serious challenges recognizing or embracing familial love as an adolescent   or adult.

5. SAD persons’ conflict with the provocative playfulness of ludus is evident by the fear of being judged and negatively evaluated by others (Mayoclinic, 2017b) as well as themselves (Hulme et al., 2012; Ritter et al., 2013). Persons experiencing SAD do not find social interaction pleasurable (Richards, 2019) and have limited expectation things will work out advantageously (Mayoclinic, 2017b). Finally, SAD persons’ maladaptive self-beliefs generally result in inappropriate behavior in social situations (Kampmann, Emmelkamp, & Morina, 2019).

6. The obvious synonym for pragma is practicality―a balanced and constructive quality counterintuitive to someone whose modus operandi is discordant 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 SAD personality sustains itself though irrationality (Felman, 2018) and maladaptive self-beliefs (Hulme et al., 2012; Ritter et al., 2013). 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).

The onset of SAD is a consequence of early psychophysiological disturbance (Felman, 2018; Mayclinic, 2019a). The receptive juvenile might be the product of bullying (Felman, 2018), abuse (NAMI, 2019), or a broken home. Perhaps parental behaviors are overprotective or controlling or do not provide emotional validation (Cuncic, 2018). Subsequently, the SAD person finds it difficult to let his or her guard down and express vulnerability, even with someone they love and trust (Cuncic, 2018). 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.”

There is a large body of research linking love with positive mental and physical health outcomes (Rodebaugh et al., 2015). Relationships, love, and associations with others lead one to recognition of their value to society “and motivates them towards building communities, culture and work for the welfare of others” (Capon & Blakely, 2007). Love is developed 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 mediator in the relationship between SAD and interpersonal love (Lee, Dean, & Jung, 2008) and is strongly associated with the 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).

The good man should be a lover of self (for he will both himself profit by doing noble acts, and will benefit his fellows), but the wicked man should not; for he will hurt both himself and his neighbours, following as he does evil passions. (Grewal, 2016)

59.4.1. Unhealthy Philautia

Unhealthy philautia is akin to clinical narcissism―a mental condition in which people function with an “inflated sense of their own importance [and a] deep need for excessive attention and admiration.” Behind this mask of extreme confidence, the Mayoclinic report (2017a) states, “lies a fragile self-esteem that’s vulnerable to the slightest criticism.” SAD persons live on the periphery of morbid self-absorption through their self-centeredness. Their obsession with excessive 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 has come to mean “an inflated sense of one’s status, abilities, or accomplishments, especially when accompanied by haughtiness or arrogance” (Burton, 2016). The self-centeredness and self-absorption of a SAD person often present themselves as arrogance; in fact, the words are synonymous. The critical difference is that SAD persons do not possess an inflated sense of their own 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 of healthy philautia, which is commonly interpreted as the self-esteeming virtue―an unfortunate and wholly incomplete definition. Rather than self-esteem only, philautia incorporates the broader spectrum of all positive self-qualities.

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

Positive self-qualities determine one’s relation to self, to others, and the world. They provide the recognition that one is of value, 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-love (philautia), as the best exemplar of love … is the standard by which to judge the friendliness of the man’s relations with others.

Positive self-qualities are obscured by SAD’s culture of maladaptive self-beliefs and the interruption of the normal course of natural motivational development. Positive psychology embraces “a variety of beliefs about yourself, such as the appraisal of your own appearance, beliefs, emotions, and behaviors” Cherry, 2019). It points to measures “of how much a person values, approves of, appreciates, prizes, or likes him or herself” (Blascovich & Tomaka, 1991). Ritter et al. (2013) conducted a study on the relationship of 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 the continuous infusion of healthy philautia into a SAD person supports self-positivity and interconnectedness with all aspects of interpersonal love. “One sees in self-love the defining marks of friendship, which one then extends to a man’s friendships with others” (Deigh, 2001). Self-worthiness and self-respect improve self-confidence, which allows the individual to overcome fears of criticism and rejection. Risk becomes less potentially consequential, and the playful aspects of ludus less threatening. Self-assuredness opens the door to traits commonly associated with successful interpersonal connectivity―persistence and persuasiveness, optimism of engagement, 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). A good person is, spiritually, one that is loved by God; reciprocation is instinctive and effortless. “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 in accordance with 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 their 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. Their perspectives generate from the shadows projected by the unapproachable light outside the cave. They name these maladaptive self-beliefs: useless, incompetent, timid, ineffectual, ugly, insignificant, stupid. The prisoners have formed a subordinate dependency with their surroundings and resist any other reality until, one day, they find themselves loosed from their bondage and emerge into the light. Like the 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 or 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.

Social exclusion is inherently aversive and reduces explicit self-esteem in healthy individuals … the effect of exclusion has been measured in terms of its impact on positive affect and on four fundamental need scores (self-esteem, control, belonging, and meaningful existence) which contribute to psychological well-being. (Hulme et al., 2012)

The study’s results were consistent with evidence based on implicit self-esteem in other disorders; it found that negative self-imagery reduces positive implicit self-esteem in both high and low socially anxious participants. It provided supporting evidence of the effectiveness of promoting positive self-beliefs over negative ones, “because these techniques help patients to 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 would conceivably remain the foundation for future programs, however it is not the therapeutic gestalt it claims to be. Productive cognitive-behavioral approaches emphasize the replacement of SAD’s automatic negative thoughts and behaviors (ANT’s) 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, targeted in treatment, and changed, the resulting maladaptive thoughts, symptoms, and behaviors will also change.

Clinicians and researchers have reported the lack of clear 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 disparity 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 lacks methodological clarity. Johnsen and Friborg (2018) cite the varying forms of CBT used in study 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). This study maintains neither faction should be ignored if we are to effectively challenge address the evolving complexities of positive self-qualities and their importance to the individual’s psychological well-being.

The deficit of positive self-qualities in individuals impaired by SAD’s symptomatic culture of maladaptive self-beliefs combined with 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 a new concept; it was being discussed in symposia almost two-and-a-half centuries ago. The psychological ramifications and methods to address it, however, 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 the procurement of 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 the integration of 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 might be useful supplements to typical interventions. Behavioral exercises can be used to 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 the presence of 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 network restructuring, and other non-traditional and supported approaches would establish a working platform for discovery.

Why is your support essential? ReChanneling is dedicated to research and development of methods to alleviate symptoms of physiological dysfunction and discomfort. Our vision is to reshape the current pathographic emphasis on diagnoses over individual, which fosters a deficit, disease model of human behavior. Treatment programs must disavow ineffective, one-size-fits-all approaches and target the individual personality through communication, empathy, collaboration, and an integration of historically and clinically practical methods. All donations support scholarships for workshops and practicums.

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