Subscriber numbers generate contributions that support scholarships for workshops.
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 are applicable to most emotional malfunctions including depression, substance abuse, ADHD, PTSD, 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.
“Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI ‒ deliberate, repetitive, neural information.” – WeVoice (Madrid, Málaga)
Recovery: the action or process of regaining possession or control of something stolen or lost.
Empowerment: the process of becoming stronger and more confident in controlling one’s life and claiming one’s rights.
Neuroplasticity: our brain’s ability to form and reorganize synaptic connections in response to learning or experience.
Proactive: controlling a situation by causing something to happen rather than responding to it after it has happened.
Proactive Neuroplasticity: accelerated learning through DRNI – the deliberate, repetitive, neural input of information.
Dr. Robert F. Mullen’s years of researching and implementing programs to (1) moderate symptoms of emotional dysfunction and (2) pursue personal goals and objectives demonstrate the learning effectiveness of proactive neuroplasticity. DRNI – the deliberate, repetitive, neutral input of information dramatically accelerates and consolidates our pursuit of personal goals and objectives—eliminating a bad habit, self-transformation—harnessing our intrinsic aptitude for extraordinary living.
Neuroplasticity is evidence of our brain’s constant adaptation to learning. Scientists refer to the process as structural remodeling of the brain. It is what makes learning and registering new experiences possible. All information notifies our neural network to realign, generating a correlated change in behavior and perspective.
“I have never encountered such an efficient professional … His work transpires dedication, care, and love for what he does.” – Jose Garcia Silva, PhD, Composer Cosmos
What is significant is our ability to dramatically accelerate learning by consciously compelling our brain to repattern its neural circuitry. Deliberate, repetitive, neural information (DRNI) empowers us to proactively transform our thoughts and behaviors, creating healthy new mindsets, skills, and abilities.
Reactive neuroplasticity is our brain’s natural adaption to information. Information includes all thought, behavior, experience, and sensation. Active neuroplasticity is cognitive pursuits such as engaging in social interaction, teaching, aerobics, and creating. Proactive neuroplasticity is the most effective means of learning and unlearning because the regimen of deliberate, repetitive neural input of information accelerates and consolidates restructuring.
Our Online Self-Empowerment Workshops
The ultimate objectives of our Self-Empowerment Workshops are to:
Provide the tools and techniques of proactive neuroplasticity to accelerate and consolidate goals and objectives.
Recognize and utilize our character strengths, virtues, and achievements.
Design a targeted process to regenerate our self-esteem and motivation.
Replace adverse habits with healthy new ones that underscore our potential.
Logistics. Individually target workshops are most effective with a maximum of ten on-site participants, and eight participants for the current online workshops.
Hebbian Learning
Today, we recognize that our neural pathways are not fixed but dynamic and malleable. The human brain retains the capacity to continually reorganize pathways and create new connections and neurons to expedite learning.
Neurons do not act by themselves but through neural circuits that strengthen or weaken their connections based on electrical activity. The deliberate, repetitious, input of information impels neurons to fire repeatedly, causing them to wire together. The more repetitions, the more robust the new connection. This is Hebbian Learning. DRNI is the most effective way to promote and retain learning and unlearning.
We not only prompt our neural network to restructure by deliberately inputting information, but through repetition, we cause circuits to strengthen and realign, speeding up the process of learning and unlearning.
“I am simply in awe at the writing, your insights, your deep knowing of transcendence, your intuitive understanding of psychic-physical pain, your connection of the pain to healing … and above all, your innate compassion.” – Jan Parker, PhD
Accelerates and Consolidates Learning
What happens when multiple neurons wire together? Every input of information, intentional or otherwise, causes a receptor neuron to fire. Each time a neuron fires, it reshapes and strengthens the axon connection and the neural bond. Repeated neural input creates multiple connections between receptor, sensory, and relay neurons, attracting other neurons. An increase in learning efficacy arises from the sensory neuron’s repeated and persistent stimulation of the postsynaptic cell.
Postsynaptic neurons multiply, amplifying the positive or negative energy of the information. Energy is the size, amount, or degree of that which passes from one atom to another. The activity of the axon pathway heightens, urging the synapses to increase and accelerate the release of chemicals and hormones that generate the commitment, persistence, and perseverance useful to recovery or the pursuit of personal goals and objectives.
The consequence of DRNI over an extended period is obvious. Multiple firings substantially accelerate and consolidate learning. In addition, DRNI activates long-term potentiation, which increases the strength of the nerve impulses along the connecting pathways, generating more energy. Deliberate, repetitive, neural information generates higher levels of BDNF(brain-derived neurotrophic factors) proteins associated with improved cognitive functioning, mental health, and memory.
We know how challenging it is to change, remove ourselves from hostile environments, and break habits that interfere with our optimum functioning. We are physiologically hard-wired to resist anything that jeopardizes our status quo. Our brain’s inertia senses and repels changes, and our basal ganglia resist any modification in behavior patterns. DRNI empowers us to assume accountability for our emotional well-being and quality of life by proactively controlling the input of information.
Neural Reciprocity
Our brain reciprocates our efforts in abundance because every viable input of information engages millions of neurons with their own energy transmission. DRNI plays a crucial role in reciprocity. The chain reaction generated by a single neural receptor involves millions of neurons that amplify energy on a massive scale. The reciprocating energy from DRNI is vastly more abundant because of the repeated firing by the neuron receptor. Positive energy in, positive energy multiplied millions of times, positive energy reciprocated in abundance.
Conversely, negative energy in, negative energy multiplied millions of times, negative energy reciprocated in abundance.
Our brain does not think; it is an organic reciprocator that provides the means for us to think. Its function is the maintenance of our heartbeat, nervous system, and blood flow. It tells us when to breathe, stimulates thirst, and controls our weight and digestion.
Hormonal Neurotransmissions
Because our brain does not distinguish healthy from toxic information, the natural neurotransmission of pleasurable and motivational hormones happens whether we feed it self-destructive or constructive information. That is one of the reasons breaking a habit, keeping to a resolution, or recovering is challenging. We receive neurotransmissions of GABA for relaxation, dopamine for pleasure and motivation, endorphins for euphoria, and serotonin for a sense of well-being. Acetylcholine supports our positivity, glutamate enhances our memory, and noradrenalin improves concentration. In addition, information impacts the fear and anxiety-provoking hormones, cortisol and adrenaline. When we input positive information, our brain naturally releases neurotransmitters that support that negativity.
Conversely, every time we provide positive information, our brain releases chemicals and hormones that make us feel viable and productive, subverting the negative energy channeled by the things that impede our potential.
The power of DRNI is that a regimen of positive, repetitive input can compensate for decades of irrational, self-destructive thoughts and behaviors, and provide the mental and emotional wherewithal to effectively pursue our personal goals and objectives.
Personal goals and objectives are those things we want to change about ourselves: eliminating a bad habit or behavior, improving life satisfaction, and revitalizing self-esteem and motivation. The deliberate, repetitive, neural input of information significantly improves the probability of recovery. Likewise, it empowers us to pursue those personal goals and objectives that make our lives more viable and productive.
ReChanneling targets the personality through empathy, collaboration, and program integration, utilizing an integration of science and east-west psychologies. Science gives us proactive neuroplasticity, CBT and positive psychologies are western-oriented, and eastern practices provide the therapeutic aspects of Abhidharma psychology and the overarching truths of ethical behavior.
The current workshops consist of ten online weekly sessions, meeting in the evening and lasting roughly 1-1/2 hours. There is minimal homework (approximately 1 hour weekly).
For low-income students, weekly tuition is less than the cost of a movie and popcorn.
The cost of the workshop is on a sliding scale:
$40 per session if income is $100,000+
$35 per session if income is $75,000 – $99,999
$30 per session if income is $50,000 – $74,999
$25 per session if income is less than $25,000 – $49,999
$20 per session if income is under $25,000.
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TO REGISTER OR REQUEST ADDITIONAL INFORMATION, PLEASE COMPLETE THE FOLLOWING
Applicants will be contacted to schedule an interview.
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WHY IS YOUR SUPPORT SO IMPORTANT? ReChanneling develops and implements programs to (1) moderate symptoms of emotional dysfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to regenerate self-esteem. All donations support scholarships for groups, workshops, and practicums.
Subscriber numbers generate contributions that support scholarships for workshops.
“Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI—deliberate, repetitive, neural information.” — WeVoice (Madrid)
Social Anxiety Disorder
Social anxiety disorder (SAD) is one of the most common mental disorders, negatively impacting the emotional and mental well-being of roughly 40 million U.S. adults and adolescents who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. As the third-largest mental health care problem in the world, SAD is culturally identifiable by the persistent fear of social and performance situations.
Social anxiety makes us feel helpless and hopeless, trapped in a vicious cycle of fear and anxiety, and restricted from living a ‘normal’ life. We feel alienated and disconnected – loners filled with uncertainty, hesitation, and trepidation. Our fear of criticism, ridicule, and rejection is so severe, that we avoid the life experiences that interconnect us with others and the world. The irony is, that we have far more to fear from our distorted perceptions than the opinions of others. Our imagination takes us to dark and lonely places.
We fear the unknown and unexplored. We obsess about upcoming events and how we will reveal our shortcomings. We experience anticipatory anxiety for weeks before a situation and anticipate the worst. We feel like we are under a microscope, and everyone is judging us negatively. We worry about what we say, how we look, and how we express ourselves. We worry about what we will say, how we will look, and how others perceive us. We feel undesirable and worthless.
Roughly 40 million U.S. adults will experience SAD this year. The National Institute of Mental Health estimates that roughly 10% of adolescents currently experience symptoms. Statistics are imperfect for LGBTQ+ persons; the Anxiety and Depression Association of America estimates the community is twice as likely to contract it than their straight or gender-conforming counterparts. Statistics are fluid, however; a high percentage of persons who experience SAD refuse treatment, fail to disclose it, or choose to remain ignorant of its symptoms.
SAD is ostensibly the most underrated, misunderstood, and misdiagnosed disorder. It is nicknamed the ‘neglected anxiety disorder’ because few therapists want or have the expertise to tackle it, and the massive number of revisions, substitutions, and changes in defining SAD result in the probability of misdiagnosis. Debilitating and chronic, SAD attacks on all fronts, negatively affecting our entire lived-body. It manifests in mental confusion, emotional instability, physical dysfunction, and spiritual malaise. Emotionally, we are depressed and lonely. In social situations, we are subject to unwarranted sweating, trembling, hyperventilation, nausea, and muscle spasms. Mentally, our thoughts are discordant and irrational. Spiritually, we define ourselves as inadequate and insignificant.
The commitment-to-remedy rate for those experiencing SAD is unexemplary ― reflective of symptoms that manifest perceptions of worthlessness and futility. SAD’s poor recovery rates mirror a general inability to afford treatment due to employment instability. Over 70% of us are in the lowest economic group.
SAD is a pathological form of everyday anxiety. Feeling anxious or apprehensive in certain situations is normal; most of us are nervous speaking in front of a group and anxious when visiting our dentist. The typical individual recognizes the normality of a situation and accords it with appropriate attention. We anticipate it, personalize it, dramatize it, and obsess about its negative implications. We make mountains out of molehills.
We are inordinately apprehensive others will think us incompetent, stupid, or undesirable. There is persistent anxiety and fear of social situations such as dating, interviewing for a position, answering a question in class, and 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 can seem so fierce that many believe it is beyond our control, which manifests in perceptions of helplessness and hopelessness. Negative self-evaluation interferes with our desire to pursue a goal, attend school, or do anything that might precipitate our anxiety. We often anguish over things for weeks before they happen and negatively predict the outcomes. We avoid situations where there is the potential for embarrassment or ridicule. After a situation, our imagination creates false scenarios, and we obsess about our prior behavior.
The overriding fear of being found wanting manifests in our self-perspectives of inferiority and unattractiveness. We are unduly concerned we will say something that will reveal our ineptitude. We walk on eggshells, supremely conscious of our awkwardness, surrendering to the GAZE―the anxious state of mind that comes with the fear we are the center of attention. Our social interactions are often clumsy, small talk inelegant, and attempts at humor embarrassing. Our anticipation of repudiation motivates us to dismiss relationship overtures to offset any possibility of rejection. SAD is repressive and intractable, imposing self-destructive thoughts and behaviors. SAD establishes its authority through defeatist measures produced by distorted and unsound interpretations of reality that govern our perspectives of attractiveness, intelligence, and desirability.
Maladaptive Self-Beliefs
Maladaptive is a term created by Aaron Beck, the pioneer of cognitive-behavioral therapy. A unique characteristic of SAD, a maladaptive self-belief is a reaction or perspective unsupported by reality. We can find ourselves in a supportive and approving environment, but SAD tells us we are unwelcome and the subject of ridicule and disparagement. SAD distorts our perception, and we adapt negatively (maladapt) to a positive situation. To analogize, if the room is sunny and welcoming, SAD tells us it is dark and unapproving.
We circle the block endlessly before entering a situation, then end up avoiding it entirely. We try to hide in the classroom, our hearts pounding, hands sweaty, hoping we will not be asked to contribute. We lie awake at night, consumed by all the stupid things we said and did during the day. We are inordinately concerned about the visibility of our anxiety and are often preoccupied with sexual performance or arousal.
We crave companionship but shun social situations for fear others will find us unattractive or stupid. We avoid speaking in public, expressing opinions, or even fraternizing with peers. We are prone to low self-esteem and high self-criticism due to childhood disturbance which precipitates a disruption in our natural physiological and psychological development, allowing the onset of SAD.
Then to top it off, we consistently beat ourselves up. We blame ourselves for our lack of social skills. We feel shame for our inadequacies. We guilt ourselves when we avoid getting close to someone, terrified of rejection. We know these feelings are irrational; we know we are not responsible for our emotional dysfunction. But our social anxiety compels us to self-loath and self-destruct. How did this happen to me, we ask ourselves? It originated with our Core Beliefs.
Core and Intermediate Beliefs
Core beliefs are determined by our childhood physiology, heredity, environment, information input, experience, learning, and relationships.
Negative core beliefs are generated by any childhood disturbance that interferes with our optimal physical, cognitive, emotional, and social development. Cumulative evidence that a toxic childhood is a primary causal factor in lifetime emotional instability has been well-established. Any number of things can generate a negative core belief. Our parents are controlling or do not provide emotional validation. Perhaps we were subject to gender bullying or a broken home. The disturbance can be real or imagined, intentional or accidental. A toddler who finds their parental quality time interrupted by a phone call can feel a sense of abandonment, which can generate core beliefs of unworthiness and insignificance. This is important when it comes to attributing blame or accountability for our SAD because of the possibility no one is responsible; certainly not the child.
SAD senses our vulnerability and onsets in adolescence. A combination of genetic and environmental factors drives SAD. Researchers recently discovered a specific serotonin transporter gene called ‘SLC6A4’ that is strongly correlated with susceptibility to the disorder. SAD can linger in our system for years or even decades before asserting itself.
Core beliefs remain as our belief system throughout life. They mold the unquestioned underlying themes that govern our perceptions. Even if a core belief is irrational or inaccurate, it still defines how we see the world. When we decline to question our core beliefs, we act upon them as though they are real and true.
Core beliefs are more rigid and exclusive in individuals with social anxiety because we tend to store information consistent with negative beliefs and ignore evidence that contradicts them. SAD generates a cognitive bias—a subconscious error in thinking that leads us to misinterpret information, impacting the rationality and accuracy of our perspectives and decisions.
Negative core beliefs fall within two categories: self-oriented (I am unlovable, I am stupid) and other-oriented (You are unlovable, you are stupid). Individuals with self-oriented negative core beliefs view themselves in one of four ways:
Helpless (I am weak, I am incompetent)
Hopeless (nothing can be done about it)
Undesirable (no one will like me)
Worthless (I don’t deserve to be happy).
These beliefs can lead to fears of intimacy and commitment, an inability to trust, debilitating anxiety, codependence, aggression, feelings of insecurity, isolation, a lack of control over life, and resistance to new experiences.
We are not defined by our social anxiety, but by ourcharacter strengths, virtues, and attributes.
Individuals expressing other-oriented negative core beliefs view people as demeaning, dismissive, malicious, and manipulative. We tend to blame others for our condition, avoiding personal accountability (I can’t trust anyone). This generates serious anxiety towards situations we perceive as potentially dangerous, causing us to avoid them in anticipation of harm. (A ‘situation’ is defined as the set of circumstances ̶ thefacts, conditions, and incidents affecting us at a particular time in a particular place. For social anxiety disorder, situations are the places that generate discomforting anxiety or stress such that it impacts our emotional well-being and quality of life.)
So, we accumulate negative core beliefs due to childhood disturbance and other early-life experiences. They influence our intermediate beliefs which develop our adolescence. The onset of SAD aggravates our negative self-beliefs and images, which generate the fears and anxieties of a situation that form our automatic negative thoughts (ANTs). A corresponding intermediate confirmation of the core belief, I am undesirable, might be, I am unattractive and fat. A corresponding irrational intermediate resolution might be, If I diet and have my nose fixed, I will be desirable.
The negative cycle we are in may have convinced us that there is something wrong with us. That is untrue. The only thing we may be doing wrong is viewing ourselves and the world inaccurately.
Intermediate beliefs are the go-between our core beliefs and our automatic negative thoughts (ANTs). Despite similarcore beliefs, we have varying intermediate beliefs; they develop by way of our social, cultural, and environmental experiences ― the same things that make up our personality.
Intermediate beliefs establish our attitudes, rules, and assumptions. Attitude refers to our emotions, beliefs, and behaviors. Rules are the principles or regulations that influence our behaviors. Our assumptions are what we believe to be true or real which, in SAD, are irrational and cognitively distorted. Dysfunctional assumptions caused by our negative intermediate beliefs, and consequential to our negative core beliefs, generate our ANTs. Even when we know our fears and apprehensions are irrational, their emotional impact is so great, that our dysfunctional assumptions run roughshod over any healthy, rational response.
Automatic Negative Thoughts
Automatic Negative Thoughts (ANTs) are the involuntary, anxiety-provoking thoughts that occur in anticipation of or reaction to a feared-situation. They are unpleasant expressions of our anxieties and apprehensions ― manifestations of our irrational self-beliefs about who we are and how we relate to others, the world, and the future. (I am incompetent; No one will talk to me; I’ll say or do something stupid; they’ll reject me.)They are our predetermined assumptions of what will happen in a situation.
ANTs are the expressions of our dysfunctional assumptions and distorted beliefs about a situation that we accept as true. For example, the Situational automatic negative thought I am ugly and fat and no one will like me might result from the core belief I am undesirable, and the intermediate belief I am unattractive. This negative self-appraisal can elicit an endless feedback loop of hopelessness, worthlessness, and undesirability, leading to substance abuse, eating disorders, anxiety, depression, and low self-esteem.
ANTs are cognitively distorted emotions that can lead to maladaptive behaviors.
Cognitive Distortions
Cognitive distortions are the exaggerated, or irrational thought patterns involved in the onset or perpetuation of anxiety and depression. They are thoughts that cause us to view reality inaccurately. We all engage in cognitive distortions and are usually unaware of doing so. Cognitive distortions reinforce or justify our negative thoughts and behaviors. SAF convinces us these false and inaccurate reactions are the truth of a situation.
Cognitive distortions define the ANT. I am ugly and fat and no one will like me is a distorted and irrational statement. It is Jumping to Conclusions—assuming we know what another person is feeling and thinking, and why they act the way they do. There is also Personalization, and Labeling-Mislabeling distorting the statement. Cognitive distortions tend to blend and overlap like the symptoms and characteristics of many dysfunctions.
Prevalent in social anxiety disorder, ANTs are irrational, perceptual, and self-destructive. To challenge them, we need to interrogate them to understand their structure. Why do we have these self-destructive thoughts and where did they come from? Without a clear inventory of the causes and consequences of our negative thoughts and behaviors, we do not have a chance of defeating them.
Anxiety is an abstraction; it has no power on its own. We fuel it, giving it strength and power.
Love and Friendship
In unambiguous terms, the desire for love is at the heart of social anxiety disorder because of our inability to establish and maintain healthy relationships. Our fear of rejection makes social interconnectivity challenging. Our compunction to reject to offset the possibility of rejection is borne by our perception of undesirability. We crave companionship but shun the possibility due to the fear of appearing unlikeable, stupid, or annoying, which limits our potential for comradeship. Our low self-esteem and high self-criticism keep us from fraternizing with peers, and this avoidance prevents the enjoyment of being with others who share our hobbies and interests.
Friendship. Aristotle called philia one of the most indispensable requirements of life. A healthy friendship is a bonding of individuals with mutual experiences―a platonic affection that subsists on shared experience and personal disclosure. A core symptom of SAD is the fear of revealing something that will make us appear stupid or undesirable. Even the anticipation of interaction causes physical and emotional anxiety because of our anticipation of being found wanting.
Physical/Emotional. Eros is reciprocal feelings of shared arousal between people physically attracted to each other, the fulfillment expressed by the sexual act. Our dysfunctional self-image of unlikability, coupled with fears of intimacy and rejection, challenges our ability to establish and maintain romantic relationships. Studies show that, due to our fear of intimacy and sexual incompetence, we experience less sexual satisfaction than non-anxious individuals
Unconditional. Through the universal mandate to love thy neighbor, the concept of agape embraces unconditional love that transcends and persists regardless of circumstance. To love unequivocally, one must self-love in the same fashion, a quality challenged by our symptomatic self-disparagement and lacuna of self-esteem.
Family. The disruption in our natural human development due to childhood disturbance and subsequent onset impedes satisfaction of physiological safety and belongingness and love. As a result, familial love and protection, vital to the healthy development of the family unit is severely impacted, challenging our ability or willingness to recognize and embrace the family unit.
Playful and Provocative: Our conflict with the provocative playfulness of ludus is evident in our fears of criticism and rejection. We do not find social interaction pleasurable, always expecting the worst. Our self-perceptions of inadequacy generally manifest in awkward and inappropriate social behavior
Practical relationships are formed by mutual interests and goals securing a working and endurable partnership. They endure through rational behavior and expectation―a balanced and constructive quality counterintuitive to someone whose modus operandi is discordant thought and behavior. The pragmatic individual deals with relationships sensibly and realistically, conforming to typical standards of conduct. Our symptomatic fears are irrational and cognitively distorted
There is a large body of research linking healthy relationships with positive mental and physical health outcomes. Productive associations lead us to the recognition of our value to society and motivate us toward building communities for the welfare of others. These relationships are developed through social connectedness ― a central psychological requirement for better emotional development and wellbeing. Social connectedness is strongly associated with our level of self-esteem.
Comorbidity and Misdiagnosis
SAD is routinely comorbid with depression and substance abuse. It shares symptoms and characteristics with avoidant personality, panic, generalized anxiety, bipolar personality, obsessive-compulsive, dependent personality, histrionic personality, post-traumatic stress, and eating disorders.
Coupled with the discrepancies and disparity in SADs definition, epidemiology, assessment, and treatment, mainstream medical authorities point to the poor reliability of conventional psychiatric diagnosis. A recent Canadian study reported, that of 289 participants in sixty-seven clinics meeting DSM-IV criteria for SAD, 76.4% were misdiagnosed. The Anxiety Institute in Phoenix reports an estimated 8.2% of clients had generalized anxiety, but just 0.5% were correctly diagnosed. Experts cite the mental health community’s difficulty distinguishing the symptoms and traits of dysfunctions or identifying specific etiological risk factors due to the DSM’s failing reliability statistics.
The DSM changes drastically from one edition to the next, while the American Psychiatric Association swears by its credibility. Criteria change with each edition, often without evidence that the new approach is better than the prior one. The abundant revisions, substitutions, and changes from one edition to the next is never universally accepted. Psychiatrists, psychologists, and researchers who specialize in or survive by funding are justifiably protective of their territory. Even under the best circumstance with a knowledgeable and caring clinician, it is difficult to get a proper diagnosis.
But there is hope. We can learn to moderate those fears and anxieties that impact our emotional wellbeing and quality of life. A comprehensive recovery program guides us through the process of proactive neuroplasticity to restructure our neural network from the years of negative self-beliefs to an appreciation of our value and significance. An integration of science and east-west psychologies is necessary to capture the diversity of human thought and experience in recovery. Science gives us proactive neuroplasticity and psychobiography; cognitive-behavioral self-modification and positive psychology’s optimal functioning are western-oriented; eastern practices provide the therapeutic benefits of Abhidharma psychology and the overarching truths of ethical behavior. Included are targeted approaches to help us rediscover and reinvigorate our self-esteem.
Recovery takes persistence and perseverance to endure the deliberate, repetitive input of information necessary to compensate for years of negative core and intermediate self-beliefs. However, once we begin the process, progress is exponential. It is physiologically and psychologically felt as we implement and experience the tools and techniques of recovery.
WHY IS YOUR SUPPORT SO IMPORTANT? ReChanneling develops and implements programs to (1) moderate symptoms of emotional malfunction and (2) pursue personal goals and objectives – harnessing our intrinsic aptitude for extraordinary living. Our paradigmatic approach targets the personality through empathy, collaboration, and program integration utilizing scientific and clinically practical methods including proactive neuroplasticity, cognitive-behavioral modification, positive psychology, and techniques designed to reinvigorate self-esteem. All donations support scholarships for groups, workshops, and practicums.
Subscriber numbers generate contributions that support scholarships for workshops.
“Dr. Mullen is doing impressive work helping the world. He is the pioneer of proactive neuroplasticity utilizing DRNI – deliberate, repetitive, neural information.” – WeVoice (Madrid)
Cognitive distortions are exaggerated or irrational thought patterns that perpetuate our anxiety and depression. In essence, we twist reality to reinforce or justify our toxic behaviors and validate our irrational attitudes, rules, and assumptions. Our attitudes refer to our emotions, convictions, and behaviors. Rules are the principles or regulations that influence our behaviors, and our assumptions are what we believe to be accurate or real. Social anxiety and other emotional dysfunctions paint an inaccurate picture of the self in the world with others.
Consider this example. The entire office staff congratulates us on our promotion, except for one individual who looks the other way. Rather than embracing the support, we obsess over the shunner. That is Filtering – selectively choosing our facts to support our poor self-image by dwelling on the negative while overlooking the positive. While the number of cognitive distortions varies widely, there are thirteen that are primary. Jumping to Conclusions supposes we know what others are thinking. We are mind-readers. Emotional Reasoning is arriving at an emotional conclusion without considering other rational alternatives. When we engage in Personalization, we assume we assume that doings and events are directly related to us and that random remarks are personally relevant.
Understanding how we use cognitive distortions as subconscious strategies to avoid facing certain truths is crucial to recovery. SAD drives our illogical thought patterns. Countering them requires mindfulness of our motives and rational response. Because of their complexity and similarities, each cognitive distortion has its chapter. Our compulsion to twist the truth to validate our negative self-beliefs and image is powerful; we need to understand how these distortions sustain our social anxiety disorder. Cognitive distortions are rarely cut and dried but tend to overlap and share traits and characteristics. That’s what makes them difficult to clearly define.
The number of cognitive distortions listed by various experts ranges substantially. The following thirteen are comprehensive and sufficient. You will note similarities and overlaps among these distortions, even in this abbreviated list.
ALWAYS BEING RIGHT. Our need to be right protects the fragile self-image sustained by our fears of criticism, ridicule, and rejection. Being right is more important than the truth or the feelings of others. Thoughts or opinions that contradict are harmful to our emotional structure.
The core and intermediate beliefs of a person living with social anxiety are rigid; we dismiss new ideas and concepts. Even when our belief system is inaccurate, it defines how we see ourselves in the world. If the facts don’t comport with our beliefs, we dispute or disregard them. When we decline to question our beliefs, we act upon them as though they are valid and reasonable, ignoring evidence that contradicts – even if we doubt the veracity of our claims. Our insecurity is so severe, our maladjusted attitudes, rules, and assumptions run roughshod over the truth and the feelings of others.
We store information consistent with these beliefs, which generates a cognitive bias – a subconscious error in thinking that leads us to misinterpret information, impacting the accuracy of our perspectives and decisions. Our low implicit and explicit self-esteem keeps us on the defensive and compels the need to compensate for our perceptual lack of positive self-qualities. We ignore or contest anything that poses a threat, especially information inconsistent with what we assert to be true. The need to always be right can also reflect the narcissism evident in the irrational belief that we are the center of attention in any situation.
Because of our neediness to always be right, we tend to ignore what others are saying. We avoid recognizing anything that might lead us to conclude we are mistaken. Even when we know we are wrong, we find it hard to admit it because it exacerbates our fears of ridicule and criticism.
In situations where we are ill-advised to dispute our superiors or other authority figures, we subvert our need to be right. We bow to pressure and imply that we accept their truth, covertly convinced we are right, and they are not. This subservience forces us to give away our power, generating anger and resentment. We smile and agree with those who hold sway over us. but secretly envy their power, becoming irritated and bitter.
In our formative years, many of us were undervalued – subject to the circumstances of our childhood disturbance. Our parents may have been controlling or dismissive, our siblings overbearing. Some of us rarely experienced positive feedback or appreciation. As adults, we are driven to disregard thoughts and viewpoints that conflict with our own.
Always Being Right does not bode well for healthy relationships because we do not reciprocate shared issues or experiences. Counterfeit, ignoring, selective, and hostile listening devalues the relevance of others and inhibits the prospect of healthy connectivity. Being right is more important than establishing and maintaining friendships and intimacy.
Recovery promotes considered and attentive listening skills – active communication where we value what is being said by the other. In empathic listening, we seek first to understand and then to be understood.
BLAMING. Blaming is a negative thinking pattern where we wrongly assign accountability. There are two forms of this cognitive distortion. External blaming is when we hold others accountable for our behaviors; internal blaming is assuming responsibility for the thoughts and reactions of others or beating ourselves up for behaviors that are SAD-provoked.
External blaming. The burden of responsibility for our negative thoughts and behaviors can be overwhelming. Our defense mechanism impels us to hold others responsible for things we are unable or unwilling to manage emotionally. We convince ourselves that others are responsible for the feelings and behaviors caused by our anxiety. “She makes me feel stupid” or “My roommate makes me feel inferior.”
Our adverse self-beliefs and image elicit an endless feedback loop of helplessness and hopelessness that, by their very nature, literally pleads for assistance. We put the onus on the other, and if they do not support us to our satisfaction, then they are to blame.
Internal blaming, Social anxiety disorder comes with a mixed bag of irrational assumptions. Its symptomatic anticipation of criticism and rejection convinces us we have foreknowledge of the opinions and reactions of others. We are fortune tellers with the power to read other people’s minds. In fact, with our compulsion to self-fulfilling prophesize, we imagine we control their responses. Since those responses are subjectively negative, we have no one to blame but ourselves. That is internal blaming.
Persons living with SAD have significantly lower implicit and explicit self-esteem relative to healthy controls. Our SAD-provoked negative self-beliefs lead us to project our character defects and problems onto others. We then assume responsibility for them. If our roommate’s behavior is self-destructive, it subjectively reflects on us and we are, therefore, responsible.
There is another aspect of internal blaming, prevalent in social anxiety disorder, which is a particularly insidious form of emotional self-sabotage. Even though we bear no responsibility for SAD onset, we blame ourselves for our behaviors and our perceived character deficits. SAD thrives on our self-denigration and other hyphenated forms of self-abuse. We blame ourselves when we avoid interacting with someone out of fear of rejection. We have something noteworthy to share in class but are afraid to raise our hands. We want to join a conversation but are convinced our nerves will expose us. Then, adding insult to injury, we beat ourselves up because our symptoms get the better of us, causing us to self-characterize as stupid, incompetent, or unattractive.
Until we devise rational responses to our fears and social avoidance, we tend to assign blame for our negative thoughts and behaviors. The ability to look at our actions through the prism of intellectual awareness is a necessary component of the transformative act and indispensable to recovery. Rational response allows the flow of positive thought and behavior necessary for recovery, eliminating the need to blame. Until we master recovery, we will continue to search for avenues to unburden ourselves of responsibility.
CATASTROPHIZING. One morning, as Chicken Little was plucking worms in the henyard, an acorn dropped from a tree onto her head. She had no idea what hit her and assumed the worst. “The sky is falling, the sky is falling.” Catastrophizing is concluding the worst-case scenario when things happen to us, rather than considering more plausible explanations. It is the irrational assumption that something is far worse than it is. We prophesize the worst and twist reality to support our projection. If our significant other complains of a headache, we assume our relationship is doomed. When this happens again, our belief is confirmed.
A symptom of SAD is our tendency to expect negative consequences to things that happen during a situation. Because of our life-consistent negative self-appraisal, and inherent negative bias, we tend to assume the worst. Often, we justify our catastrophizing based on prior events, believing that catastrophe will ensue because we blew the former out of proportion. This is similar to Overgeneralization where one bad apple means the entire bushel is rotten. Our four horsemen of social anxiety disorder – helplessness, hopelessness, undesirability, and unworthiness aggravate our negative assumptions. Catastrophizing is often a consequence of our symptomatic fears of criticism, ridicule, and rejection. We take something we believe is inevitable and presuppose its actuality. We will be rejected and therefore, never find love. We will be criticized and, therefore, never be taken seriously.
Catastrophizing is paralyzing. It limits our interactivity and social engagement because we avoid situations that posit the possibility of disaster. Our fatalistic obsessions prevent us from experiencing and enjoying life. We express it in our SAD-induced automatic negative thoughts (ANTs). “What if no one talks to me?” “What if they criticize my presentation?” “What if they find me unattractive?” Worrying about something that hasn’t happened is an exercise in futility and supports our sense of hopelessness. It can negatively impact our entire outlook in life, causing issues of motivation and self-esteem that lead to self-disappointment and underachievement.
Considering the consequences of what can happen is a regular and rational part of determining our actions and activities. The compulsion to project the worst possible outcome, no matter how improbable, is self-destructive.
When those of us with social anxiety disorder find ourselves in a situation where we dread being criticized, ridiculed, and or rejected, the smallest incident, like a failed attempt at humor, can trigger the belief that the entire evening is a personal disaster. This projection can easily become a self-fulfilling prophecy because we are convinced of its inevitability.
Catastrophizing is closely linked to anxiety, depression, and self-pity, and is prevalent among individuals who have generalized anxiety, social anxiety, panic, and obsessive-compulsive disorder.
Again, the obvious remedy is to become mindful of our susceptibility to this distortion, rationally assess the situation, and consider plausible explanations for the incident that triggered our catastrophizing.
CONTROL FALLACIES. A fallacy is a belief based on unreliable evidence and unsound arguments. As we discussed earlier, we cognitively distort to reinforce or justify our self-beliefs and validate our irrational attitudes, rules, and assumptions – how we perceive, think, and behave.
A Control Fallacy is the conviction that (1) something or someone has power and control over things that happen to us, or (2) we hold that type of power over others. We either believe events in our lives are beyond our control, or we assume responsibility for everything.
When we feel externally controlled, we see ourselves as weak and powerless. We blame outside forces (fate, the weather, authority figures) for the adversity in our lives. We accuse our gender, race, sexuality, weight, income, and education rather than assume responsibility for our actions. A health scare becomes an act of god, the philanderer blames his wife for leaving him, and our failing grade is because our instructor has a personal grudge.
Conversely, the fallacy of internal control is when we assume unrealistic responsibility for everything. We believe we have power and influence over other people’s thoughts, emotions, and behaviors. We blame ourselves for their mishaps and misfortunes. It is our fault our friend turns to drugs because we weren’t supportive. Our supervisor suffers a heart attack because we continually miss deadlines.
Both external and internalcontrol fallacies correspond to our SAD-induced feelings of helplessness, hopelessness, undesirability, and worthlessness.
We believe external forces control us because we feel powerless over what happens to us. Our sense of hopelessness tells us any effort towards remedy is futile. “They think I’m incompetent.” “She finds me unattractive.” “I don’t belong here.” We subsequently feel guilty for our inadequacy, and shame for our weakness. We wallow in self-pity, convinced that attempts at happiness are pointless.
Our tendency to unjustifiably blame ourselves for our social anxiety disorder leads to internal control fallacies. Had we moderated our adolescent behavior, we claim, we could have prevented the onset. This leads us to believe we have control over other things we bear no responsibility for. “It’s my fault she’s unhappy.” “He drinks because I ignored him.” The belief we have let everyone down wreaks havoc on our emotional well-being and our sense of competence.
These Control Fallacies inform us we are not assigning blame in the appropriate ways. We need to stop taking responsibility for problems we do not create and assume responsibility for our actions. That is only logical. Unfortunately, SAD subsists on our irrational thoughts and behaviors. Those of us living with social anxiety frequently use cognitive distortions because we feel trapped in its vicious circle, restricted from living a normal life. A fundamental component of recovery is learning how to identify our cognitive distortions to devise rational responses.
EMOTIONAL REASONING is the catalyst for many of the other distortions. The irrational thought patterns that underscore our cognitive distortions stem from the SAD-provoked convictions we are helpless, hopeless, undesirable, and worthless (the SAD four horsemen). For example, when we engage in Filtering, we selectively ignore the positive aspects of a situation, because of our life-consistent negative self-beliefs. This unbalanced perspective leads to Polarized Thinking, where perceive things only in black or white. Because of our negative self-appraisal, we assume everything that happens is our fault, and anything said derogatorily is a reference to us. That’s called Personalization, which is very much like internal blaming. How our Emotional Reasoning relates to the cognitive distortions most relevant to our social anxiety will become more evident as we explore them, individually, throughout this book. We can safely state that Emotional Reasoning is the progenitor of all of our cognitive distortions as they are ruled by our emotions.
Emotional Reasoning is feeling without thinking – relying on our emotions over objective evidence. It is best defined by the colloquialism, my gut tells me… This emotional dependency dictates how we erroneously relate to the world. At the root of Emotional Reasoning is the belief that what we feel must be true. If we feel like a loser, then we must be a loser. If we feel guilty, then we must have done something wrong. All the negative things we feel about ourselves, others, and the world must be true because they feel true. Emotional Reasoning is an oxymoron. In recovery, resolving this opposition is the primary task at hand.
Emotions are the reactions that we experience in response to our situations. The type of emotion a person experiences is determined by multiple factors including our core and intermediate beliefs, experiences, and the situational fear that triggers the emotion. Emotions by themselves have little relevance to the truth of a situation. They are products of what we think or assume is happening.
We are hard-wired to hearken to our emotions. We consider them first because they are unconscious and automatic. It is more natural to base our conclusions on feelings than on facts. If we have distorted thoughts and beliefs, then our emotions will reflect those distortions. Emotional Reasoning is not only dichotomous but also irrational. When we pass judgments and make decisions based on our feelings without supporting evidence, we are likely misinterpreting reality.
We are all susceptible to Emotional Reasoning, and not all decisions made are wrong or destructive. It is healthy to stay in touch with our feelings assuming they correspond with reality. A balanced perspective embraces instinct, feelings, and experience as well as evidence. The challenge to us is that our SAD sustains itself on our irrationality, and our negative core and intermediate beliefs lead us to ignore evidence that contradicts them, compelling us to make poor decisions.
FALLACY OF FAIRNESS is the unrealistic assumption that life should be fair. It is human nature to equate fairness with how well our personal preferences are met. We know how we want to be treated and anything that infringes upon seems unreasonable and emotionally unacceptable. Fairness is subjective, however. Two people seldom agree on what is fair. The fact that those of us living with SAD are predisposed to personalize does not make things any easier.
We have been at our job longer, but the newer arrival gets the promotion. It may be the better management decision but, to us, it is blatantly unfair. The school bully is selected for the varsity team while we are sidelined to the practice squad. The fact he is a better player does little to mitigate our belief in the unfairness of the coach’s decision. Needless to say, these unsupportive decisions lead to anger, frustration, and self-pity. Envy is a common emotional reaction, especially when we compare ourselves to others who are more successful and feel life or circumstance has treated us unfairly.
The concept of fairness varies, based on our experiences, culture, and environment. It is a personally biased assessment of how well our expectations, needs, and wants are met by others, institutions, and nature. When real life goes against our perceptions of fairness, as it often does, it generates negative emotions.
The belief that all things in life should be based on fairness and equality is a noble but unrealistic philosophy. We can strive for such things, but life’s vicissitudes have a will of their own. The obvious reality is that much of life is inequitable. People are self-oriented, institutions alternatively focused, and nature indeterminate. Wanting things to work in our favor is normal; expecting them to do so is irrational.
We all have our ideas of how we like to be treated In personal interactions, but reciprocation is governed by the other, and it rarely comports with our expectations. As a result, we blame others for any adverse response rather than consider their expectations and our self-centered assumptions of fairness.
The problem is exacerbated in those of us living with social anxiety because it subsists on our irrational thoughts and behaviors, which means that our expectations are often irrational as well. Ironically, we are not surprised when they are not met because we symptomatically anticipate and project negative outcomes. This does not stop us, however, from blaming ourselves or others when our negative prophecies are fulfilled.
The Fallacy of Fairness is often expressed in conditional assumptions. “If my teacher knew how hard I studied, she’d give me a passing grade.” Conditional conclusions allow us to avoid delegating true accountability. Studying does not always lead to comprehension, and our teacher bases grades on test results. ”If my parents had treated me better, I wouldn’t have social anxiety disorder.” The direct cause of emotional dysfunction is indeterminate, and blaming our parents or ourselves is irrational given the evidence.
It is advisable to stand outside the bullseye – to emotionally extract ourselves from an undesirable situation and evaluate it from multiple perspectives. Fairness is subjective, based on personal beliefs and experiences. Mindfulness of the needs and experiences of others is a product of recovery. Moderating our fears of social interaction allows us to entertain other points of view, and reveals the narrow-mindedness of fairness, which is just a state of mind.
FILTERING. Our negative core and intermediate beliefs form in response to childhood disturbance and the onset of our emotional dysfunction. Core beliefs are more rigid in those of us living with social anxiety because we tend to store information consistent with negative beliefs. Our intermediate beliefs establish our attitudes, rules, and assumptions. These beliefs govern our perceptions and, ostensibly, remain as our belief system throughout life. Even if irrational or inaccurate, our beliefs define how we see ourselves in the world. When we decline to question these beliefs, we act upon them as though they are real and reasonable, ignoring evidence that contradicts them. This produces a cognitive bias – a subconscious error in thinking that causes us to misinterpret information and make irrational decisions.
To compound this, humans have an inherent negativity bias. We are genetically predisposed to respond more strongly to adversity, which aggravates our SAD symptoms. We anticipate the worst-case scenario. We expect criticism, ridicule, and rejection. We worry about embarrassing or humiliating ourselves. We project unpleasant outcomes that become self-fulfilling prophecies. It is not surprising that we readily turn to Filtering and Polarized Thinking to justify our irrational thought patterns.
When we engage in Filtering, we selectively choose our perspective. Our tunnel vision gravitates toward the negative aspects of a situation and excludes the positive. This applies to our memories as well. We dwell on the unfortunate aspects of what happened rather than the whole picture.
A person who consistently filters out negative information is someone with an excessively cheerful or optimistic personality. Conversely, a person who emphasizes gloom and doom is unhappy or defeatist. Those of us living with SAD tend to mirror the latter. We filter out positive aspects of our life, choosing to dwell on situations and memories that support our negative self-image. This creates an emotional imbalance due to the exclusion of healthy thoughts and behaviors. We view ourselves, the world, and our future through an unforgiving lens.
Negative filtering is one of the most common cognitive distortions in anxiety because it sustains our toxic core and intermediate beliefs. Our pessimistic outlook exacerbates our feelings of helplessness and hopelessness. We accentuate the negative. A dozen people in our office celebrate our promotion; one ignores us. We obsess over the lone individual and disregard the goodwill of the rest. By dwelling on the unpleasantness, we reinforce our feelings of undesirability and alienation.
To effectively challenge our tendency to filter information, we need to identify the situation(s) that provokes our anxiety and the corresponding ANTs (automatic negative thoughts). From there, we analyze the unsoundness of our reaction and devise a rational response. Initially, the conversion process is exacting, but with time and practice, it becomes reflexive and spontaneous. Cognitive behaviorists call it ARTs – automatic rational thoughts.
The term maladaptive behavior was coined by Aaron Beck, the pioneer of cognitive-behavioral therapy. It is prevalent in social anxiety disorder. Maladaptive means we tend to adapt wrongly (negatively) to situations. We must remain mindful that our symptoms encourage a negative perspective and adjust accordingly.
HEAVEN’S REWARD FALLACY is when we put other people’s needs ahead of our own with an expectation of reciprocation. Contrary to others who share this cognitive distortion, SAD persons are not seeking heavenly reward in the afterlife, but acknowledgment in this one.
We continually say yes to others while denying ourselves, We tell ourselves our motives are selfless, but we do it out of neediness and loneliness. We are consummate enablers trying to compensate for our feelings of undesirability and worthlessness. Rather than setting boundaries, we allow ourselves to be bullied and taken advantage of, seeking respect and appreciation. When we are denied, our disappointment leads to bitterness and resentment.
You are an exemplary office worker – always on time, and willing to go the extra mile. When your co-workers fall behind, you always offer to pick up the slack even if it means staying late or working on the weekend. Your desk is organized, you dress for success, and complete your assignments with diligence and efficiency. You eagerly anticipate a promotion at the end of the quarter.
The management hires someone from without the organization. Your disappointment turns to anger and resentment. When the company distributes the annual bonuses, yours does not reflect the recognition you think you deserve. Colleagues move on to better employment, but you have spent so much time ingratiating yourselves with management, you have not considered viable alternatives. You mire yourself in The Fallacy of Fairness and your resentment turns to sullenness and hostility.
People who engage in Heaven’s Reward Fallacy undervalue their worth and significance and have poor self-awareness. It is easier to take on the needs and responsibilities of others rather than face our fears and anxieties. Our actions are self-serving rather than noble. True altruism does not expect reciprocation.
Recovering our self-esteem is an essential element of recovery and cannot be second-tiered. Due to our disruption in natural human development, we are subject to significantly lower implicit and explicit self-esteem relative to healthy controls. Our negative core and intermediate beliefs stemming from childhood disturbance and onset are directly implicated. Our symptomatic fears and anxieties aggravate this deficit.
We rediscover and regenerate our self-esteem through the integration of historically and clinically practical approaches designed to help us become mindful of our inherent strengths, virtues, and achievements, and their propensity to replace our SAD-induced negative self-beliefs and image.
JUMPING TO CONCLUSIONS is when we judge or decide something without having all the facts to substantiate our conclusion. It is also fortune-telling and mind-reading. We jump to conclusions when we assume to know what another person is feeling or why they act the way they do. When we form our automatic negative thoughts (ANTs) we usually jump to conclusions because the only evidence we rely on is our fears and anxieties which are abstractions based on perceptions rather than reality. When we overgeneralize or filter our information to conclude “no one will like me” or “they will make fun of me,” we are Jumping to Conclusions. It is irrational to decide, without a crystal ball, how others will react to us or feel about us.
While our conclusions may be based on prior experience, assuming it will repeat itself in similar situations, while possible, is an implausible conclusion. Yes, we may say something stupid, or experience physical symptoms, but we don’t know that beforehand; we merely prophesize it will happen because it happened before. This is a common assumption among those of us with social anxiety.
Many of our other cognitive distortions are formed by Jumping to Conclusions. When we overgeneralize, we draw a broad conclusion or make a statement about something or someone that is not backed up by the bulk of evidence. When we label someone because of a single characteristic or event, we are Jumping to Conclusions. Likewise, when we personalize or take responsibility for something that has nothing to do with us.
A primary SAD symptom is the fear of situations in which we believe we will be negatively appraised. We jump to the conclusion we will be criticized, ridiculed, or rejected, usually in advance of the situation. This distorted thinking causes us to react defensively or to avoid the situation entirely. If we assume we are the center of attention, we are not going to let our guard down. Often, we predict a bad outcome to a situation to protect ourselves if it happens. It helps us avoid disappointment.
If our significant other is in a bad mood, we assume we did something wrong. If our manager slams the door to the office, we imagine it’s because we were talking on the phone. If a stranger passes us on the sidewalk, it is because we are unappealing.
When we jump to conclusions, we create self-fulfilling prophecies. We avoid interacting with others because we have predicted a negative outcome. We avoid relationships because we tell ourselves they will not succeed. We avoid recovery because we know it will come to naught. We expect the worst possible consequences of a situation because we jumped to the conclusion things will not end well. Over the years, SAD has convinced us we are helpless, hopeless, undesirable, and worthless. It isn’t much of a leap for us to conclude that we are.
LABELING. When we label an individual or group, we reduce them to a single, usually negative, characteristic or descriptor based on a single event or behavior. As a result, we view them (or ourselves) through the label and filter out information that contradicts the stereotype. Labeling others leads to false assumptions, prejudice, and ostracizing. “Because he talks about his neighbor, he is a gossip.”
Our SAD symptoms compel us to label others to support our preconceived notions about how others perceive us. Our conversational inadequacy might make us label the group as rude and dismissive. If we expect rejection, they are cold and untrustworthy. Because we feel like we are the center of attention, our social failure could lead us to label the entire room as mean or arrogant.
Labeling is common to SAD persons because we resent our symptomatic fears and anxieties, causing us to project our frustrations on those close to us. Labeling a friend or significant other can destroy relationships, especially when the label is for unintentional behavior. If we feel unsupported at a social event, we might label our companion cold or indifferent. In a similar vein, if a parent criticizes us at the dinner table, identifying them as cruel or hateful would not be inconceivable. Polarized Thinking, Filtering, Emotional Reasoning, Jumping to Conclusions, and Overgeneralization lend themselves to Labeling.
We know how distressing it can be when someone labels us. When we-self label, we sustain our negative self-beliefs. “I didn’t meet anyone at the party; I am unlikeable.” Negatively labeling ourselves invariably results in thoughts that support our self-image. “I gave the wrong answer in class; I am stupid.” Self-labeling like inadequate and incompetent supports our sense of hopelessness and undesirability, and we often find our subsequent behaviors support those labels.
Labels are irrational and myopic because they emerge from a single characteristic, behavior, or event and ignore the whole person or situation. Arbitrarily evaluating someone based on one isolated incident or behavior is almost always inaccurate. One negative behavior or incident does not define someone’s entire character. Rather than focusing on the specific element that generated the label, it is important to value the positive contributions of the person or group. We can observe ourselves and others with compassionate insight, recognizing the diversity of human thought and experience.
OVERGENERALIZATION. When we engage In this cognitive distortion, we draw broad conclusions or make statements about something or someone that are unsupported by the available evidence. We make blanket claims that can’t be proven or disproven. Everyone knows Suzie is a liar. To imply that everyone thinks Suzie is a liar is an exaggeration without consensus. A few colleagues may share our opinion, but not the whole world. We overgeneralize if our conclusion is based on one or two pieces of evidence while we ignore anything we know about to the contrary.
Overgeneralization supports our negative self-beliefs and image. Our self-doubt is so intense if someone rejects us, we assume everyone will reject us. Because we persuade ourselves it is unlikely anyone would be interested in getting to know us, we avoid situations where that might occur. That aggravates our SAD-induced fears of interacting or talking with strangers and avoidance of social situations.
Our automatic negative thoughts (ANTs) are usually overgeneralizations. “No one will like me.” “I’m a failure.” “She called me stupid.” “Everyone thinks I’m an idiot.” These self-defeating thoughts are based on our fears and anxieties rather than the available evidence. An example of overgeneralization would be the false assumption that, because you failed a test, you will never be able to pass the course.
We justify our prejudices by overgeneralizing. One bad apple in a group means everyone in the group is rotten. We make broad and inaccurate assumptions about that group based on this one person’s behavior. Overgeneralized thinking can cause us to wrongly judge entire groups of people, which is harmful to self and society.
This distortion inevitably leads to avoidance, limiting our willingness to experience things because we have self-prophesied what will happen based on it happening before. Similar to Filtering, where we ignore the positive and dwell on the negative, and Polarized Thinking, where we see things in black or white, overgeneralization is based on assuming the worst. Keywords that support this cognitive distortion include all, every, none, never, always, everybody, and nobody. Overgeneralization often tends to be a self-fulfilling prophecy and is associated with generalized anxiety, social anxiety, depression, panic attacks, PTSD, and OCD.
The rational response to overgeneralization is to (1) consider the accuracy of the statement and consider the available evidence, and (2) identify the situation, fears, and ANTs that compel the need to cognitively distort in the first place.
PERSONALIZATION. If someone says to us, “don’t take it personally,“ we are likely engaging in Personalization. When we engage in this type of thinking, we assume that doings and events are directly related to us and that random remarks are personally relevant. For those of us living with social anxiety disorder, Personalization is symptomatic as in our fear of being criticized or ridiculed, or our perception we are the glaring center of attention in a room.
Personalization is the stepping-stone to internal blaming and internal control fallacies where we wrongly believe we are responsible for things we have little or nothing to do with. As I cautioned earlier, cognitive distortions are not cut-and-dried but ambiguous and overlapping
Did you ever walk into a room, and everyone suddenly stops talking? If you assume they were talking about you, you are exhibiting an acute case of Personalization.
Those of us living with SAD have difficulty understand things from the perspectives of others. Our self-centeredness drives us to assume unassociated incidents involve us. We imagine the world revolves around us which only aggravates our fears of saying or doing the wrong thing and embarrassing ourselves.
Another aspect of Personalization is when we compare ourselves to the achievements of others. If a coworker receives a commendation, we feel inadequate because we were not honored. Our need to personalize is underscored by our concerns about how others think about us. If we do not receive the acclaim to which we think we are entitled, we believe we are being judged unfairly. The rational response to someone receiving a commendation is to recognize their achievements, but our low self-esteem makes us envious.
As children, we believe the world revolves around us, and fail to consider the viewpoints of others. We are cognitively incapable of considering the other probabilities. We assume our parents fight because we did something wrong. Most reasonable people grow out of this self-obsession, but SAD subsists on irrationality which makes us feel underappreciated and misunderstood.
Much of recovery focuses on the regeneration of our self-esteem through the renewed mindfulness of our character strengths, virtues, and achievements.
POLARIZED THINKING. One of the symptoms of SAD is our compulsion to overanalyze our performance in a situation, tormented by our mistakes, our inept interaction, or our poor conversation skills. We preoccupy ourselves – often for days on end – with everything we think we did wrong, obsessing over what we should have done better. We tell ourselves unless a thing is done to perfection, it is not worth doing at all.
Perfectionism is not just the desire to do well; it is the need to be infallible. If we can’t be perfect, there is little point in bothering. Perfectionism exacerbates our social anxiety. We worry about appearing vacuous or inadequate, fearing exposure to our imperfections.
In Polarized Thinking, we see things as absolute – black or white. There is no middle ground, no compromise. We are either brilliant or abject failures. Our friends are for us or against us. We do not allow room for balanced perspectives or outcomes. We refuse to give people the benefit of the doubt. Worse than our anxiety about criticism is our self-judgment. If we are not flawless and masterful, we must be broken and inept. There is no room for mistakes or mediocrity, “I failed my last exam; I fail at everything I try. I’m a loser.”
Like Filtering, Polarized Thinking is selective. To remedy our dichotomous perspective, we identify the anxiety-provoking situation and examine our corresponding fears and automatic negative thoughts (ANTs). From there, we analyze their inaccuracy and initiate rational responses.
It is important to consider the holism and multiple perspectives of life’s events and replace the myopia of Filtering and the rigidity of Polarized Thinking with the kaleidoscope of viewpoints, interpretations, and possibilities.
Words Have Meaning
Words have enormous power; they influence, encourage, and destroy. While positive words boost our self-esteem and self-image, the impact of negative words contributes heavily to our toxic neural input, which is counterproductive to our recovery.
It is not just the words we say aloud in self-criticism and conversations. The negative words we silently call ourselves are just as damaging. Those self-descriptions that SAD provokes us into believing, e.g., I am stupid, incompetent, ugly, useless …
We use them often. They are a part of our conditioning. By the age of sixteen, we have heard the word no from our parents, roughly 135,000 times. Statistics are fluid and ambiguous, but you get the drift. As best-selling author, Betty Eadie submits, “If we understood the awesome power of our words, we would prefer silence to almost anything negative.” The resultant neurotransmission of stress-provoking hormones impacts our neural network, affecting our logic, reasoning, and communication. Personalized negative words impair the parts of our brain that regulate our memory, concentration, and emotions. They are psychologically and physiologically destructive. Our brains are structured around an abundance of negative information.
Negative pronouns like no one, nobody, nothing, and nowhere substantiate our isolation and avoidance of relationships. Negative verbs like can’t, don’t, shouldn’t, and won’t support our sense of incompetence, while adverbs like barely, hardly, no, not, and never invalidate our commitment.
These negative words, whether in our thoughts or speech, impede recovery. A primary recovery objective is to deliberately feed positive information into our neural network to compensate for or overwhelm decades of negative information.
There are three categories of words important to recognize and eliminate from our thoughts and vocabulary: pressure words, negative absolutes, and conditional words.
Pressure Words like should and would equivocate our commitment. I should start my diet essentially means, maybe I will and maybe I won’t. Pressure words give us permission to change our minds, procrastinate, and fail. (We are either on a diet or will be on a diet.) The pressure comes from the guilt of having done nothing (I should’ve done that).
I shouldn’t drink at the office party. I will not drink at the office party.
Negative Absolute Words. The adverse impact of won’t and can’t is obvious. Our objective in recovery or empowerment is to replace or overwhelm toxic with healthy neural information – positive over negative. Consider the two statements: “I won’t learn much from that lecture” and“I will learn something from that lecture.” Which one offers the probability we will attend? Negative absolute words include never,impossible, and every time. “Every time I try…”
Hate is an extremely destructive sentiment. (I hate doing the dishes.) Do we really, or do we just dislike doing the dishes? Hate is an emotion; dislike is a feeling. Feelings quickly dissipate while emotions metastasize within us.
Conditional Words like possibly, maybe, might weaken our commitment. “Maybe I will start my diet” is not a firm commitment. Conditional words originate in doubt and manifest in avoidance and procrastination. Other examples include ought, must, and have to. Qualifying or conditional words or statements give us an excuse to opt out. “I will not drink at the office party” is a more robust commitment than “I will not drink at the party unless I get nervous.” Qualifying or conditional words or statements are also pre-justifications for our failures. (I might have won if only … )
These negative and conditional words impact the integrity and efficacy of our information. It is important to recognize the destructive nature of these words and eliminate them from our self-referencing thoughts and vocabulary as much as possible.
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Establishing a Wellness Model for LGBTQ+ Persons with Anxiety, Depression, and Comorbid Emotional Dysfunction
Robert F. Mullen, Ph.D. Director/ReChanneling
Firmly establishing wellness models in mental health requires nothing less than a reformation of language, power structure, and perspective throughout the mental healthcare community and beyond.
65 million U.S. adults and 18.5 million adolescents have major depression and anxiety. Estimates show that 60% of those with anxiety also have depression symptoms, and both are comorbid with substance abuse. The LBGTQ+ community is 1.5-2.5 times more likely to have anxiety and depression than their straight or gender-conforming counterparts. Similar numbers hold for LGBTQ+ persons with other mental and emotional disorders. Anxiety and depression are the primary causes of the 56% increase in adolescent suicide over the last decade. High school LGBTQ+ students are almost five times as likely to attempt suicide than their heterosexual peers, and 40% of transgender adults have attempted suicide in their lifetime.
Wellness must become the central focus of mental health because the disease model has provided grossly unsatisfactory results. Rather than obsessing on disease and deficits, wellness models emphasize the character strengths and virtues that generate motivation, persistence, and perseverance essential to recovery. Psychological science is there, but it needs positive implementation through program integration, positive evaluation, transparency, and information management. Empathy and communication must supersede etiology and misdiagnosis.
Wellness impacts more than mental health; it is a paradigmatic perspective that seeks to promote a state of complete physical, mental, and social well-being. This paper will show how the wellness model’s sociological emphasis on character strengths 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 with a mental illness.
To illustrate the wellness model’s potential impact, this paper focuses on LGBTQ+ persons with anxiety and depression disorders, which comprise 42% of diagnosable dysfunctions in the current Diagnostic and Statistical Manual of Mental Disorders (DSM). It posits what is learned can be applied to the remaining 58% of mental disorders that impact an LGBTQ+ person’s emotional well-being and quality of life. “There is an urgent need to develop and disseminate tailored evidence-based interventions that improve the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. (Wilkerson et al., 2016, p. 358).
Depression and anxiety are the two most common forms of mental dysfunction impacting millions of U.S. adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. Johns Hopkins (2020) reports that around 25 million U.S. adults have a depressive illness, and 45 million have anxiety. Adolescent numbers fluctuate between 8 and 18 million (CDC, 2020; NIMH, 2017); the actual number is indeterminate. Statistics are even less reliable for the LGBTQ+ community because large-scale mental health studies rarely include sexual and gender identity (NAMI, 2020b). “Federally funded surveys only recently have begun to identify sexual minorities in their data collections” (Medley et al., 2020, p. 1). Experts estimate the infection rate in the LBGTQ+ community is 1.5 to 2.5 times higher “than that of their straight or gender-conforming counterparts” (Brenner, 2019, p. 1).
Depressive illnesses tend to co-occur with anxiety and substance abuse (Johns Hopkins, 2020). “Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety” (Salcedo, 2018, p. 1). Anxiety and depression are the primary causes of the 56% increase in adolescent suicide over the last decade (Curtin & Heron, 2019). “High school students who identify as lesbian, gay or bisexual are almost five times as likely to attempt suicide compared to their heterosexual peers,” and “40% of transgender adults have attempted suicide in their lifetime” (NAMI, 2020b, p. 1).
Anxiety is the most common mental dysfunction, impacting the emotional well-being and quality of life of adults and children who find themselves caught up in a densely interconnected network of fear, worry, and apprehension. The psychological and sociological toll can be overwhelming. Physically, anxiety can cause sweating, trembling, fatigue, and rapid heartbeat, lower the immune system and increase the risk of heart disease risk. Persons with depression may experience a lack of interest and enjoyment of daily activities, significant weight fluctuation, insomnia or excessive sleeping, enervation, inability to concentrate, feelings of worthlessness, guilt, and recurrent thoughts of death or suicide. Anxious and depressed persons frequently generate images of themselves performing poorly in social situations (Hirsch & Clark, 2004; Hulme et al., 2012) for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers. Symptoms can be repressive and intractable, imposing irrational thought and behavior (Richards, 2014; Zimmerman et al., 2010) that govern perspectives of personal attractiveness, intelligence, and competence (Ades & Dias, 2013). Over time, these self-beliefs become automatic negative thoughts (Amen, 1998) that determine initial reactions to situations or circumstances.
Mental Health and LGBTQ+ Culture
Halloran and Kashima (2006) define culture as “an interrelated set of values, tools, and practices that are shared among a group of people who possess a common social identity” (p. 140). Culture determines how mental illness is perceived or diagnosed, how services are organized, and how they’re funded. It also affects how patients express their symptoms…and how they cope in the range of their community and family supports. (Daw, 2001, p. 1)
Studies and research indicate that mental health culture is underscored by the same interrelated attributions to mental health stigma: public opinion, media representation, family rejection, distancing, and the diagnosis itself. These attributions are also LGBTQ+ cultural influences along with heterosexualism and victimization. Both are impacted by history, while the disease model remains the primary contributor to mental health culture.
LGBTQ+ culture is defined by its sexual and gender identity as distinct from the heterosexual and cisgender community (NAMI, 2020b). Subcultures within the community comprise “a diverse set of groups, including distinct groups based on sexual orientation and gender identity” (Lewis et al., 2017, p. 861), each struggling to develop their recognition. LGBTQ+’s social identity is shaped by oppression and its role in overcoming it. The community faces “numerous challenges and instances of heterosexism and homophobia in their daily lives” (UW-Madison, 2020, p. 1), including “discrimination, prejudice, denial of civil and human rights, harassment, and family rejection” (NAMI, 2020b, p. 1). The contrast in social culture is underscored by 26 countries with legalized same-sex marriage versus 73 countries where homosexual activity between consenting adults is illegal (Equaldex, 2020) and 8 countries where it is punishable by death (ILGA, 2019). LGBTQ+ people worldwide are confronted by “violence, arbitrary arrest, imprisonment, torture, and execution, according to Amnesty International” (WEF, 2018, p. 1). Because of this cultural disparity, this paper limits its focus to LGBTQ+ mental health issues in the United States.
Transition to the Wellness Model
Working within a wellness model of mental health has become a central focus of international policy (Slade, 2010). As psychologist Kinderman (2014) writes, “we need wholesale and radical change, not only in how we understand mental health problems but also in how we design and commission mental health services” (p. 1). Decades of pathographic focus in psychological research and studies, negative diagnostic attributions, stereotyping and stigma, public and institution resistance, and a doctor-client power dominance factor in the need to transition to a wellness paradigm.
Firmly establishing wellness models in mental health requires nothing less than a reformation of language, power structure, and perspective throughout the mental healthcare community and beyond. Rather than obsessing on disease and deficits, wellness models emphasize the character strengths and virtues that generate motivation, persistence, and perseverance to recovery. Psychological science is there but needs implementation through program integration, positive evaluation, transparency, and information management. Empathy and communication must supersede etiology. This paper does not endorse a total dissolution of medical model approaches, but a review of their efficacy and the psychological effectiveness of their pathographic dominance is highly warranted.
Redefining Mental Health
Government agencies define mental illness as a “diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria” that can “result in functional impairment which substantially interferes with or limits one or more major life activities” (Salzer et al., 2018, p. 3). This ‘defective’ emphasis has been the overriding psychiatric perspective for centuries.
The pathographic or disease perspective of diagnosis and recovery focuses on the history of an individual’s suffering to facilitate diagnosis. Schioldann (2003, p. 303) defines pathography as a historical biography from a medical, psychological, and psychiatric viewpoint. It analyses a single individual’s biological heredity, development, personality, life history and mental and physical pathology, within the socio-cultural context of his/her time, in order to evaluate the impact of these factors upon his/her decision-making, performance, and achievements. (Kőváry, 2011, p. 742)
One only needs the American Psychological Association’s (APA, 2020) definition of neurosis to comprehend the mental health community’s pathographic focus. The 90-word overview contains the following words: distressing, irrational, obsessive, compulsive, dissociative, depressive, exaggerated, unconscious, conflicts, anxiety, disorders. DSM-3 abandoned the word ‘neurosis’ in 1980, but it remains the go-to term in the mental health community. Coined by a Scottish physician in 1776, neurosis defined itself as functional derangement of the nervous system. Pathography focuses “on a deficit, disease model of human behaviour (sic),” whereas the wellness model focuses “on positive aspects of human functioning” (Mayer & May, 2019, p. 159).
Studies and research portray the mental healthcare community as drowning in pessimism (Henderson et al., 2014; Khesht-Masjedi et al., 2017; Pryor et al., 2009). “There is evidence to indicate the problem may be endemic in the medical health community” (Gray, 2002, p. 3), and universally systemic (Knaak et al., 2017). Noted psychologist Alison Gray (2002) argues that more disordered persons would seek treatment if psychiatric services were less stigmatized and stigmatizing. Patients commonly report instances where a staff member was inordinately rude or dismissive. They cite coercive measures, excessive wait times, paternalistic or demeaning attitudes, treatment programs revolving around drugs with undesirable side effects, stigmatizing language, and general therapeutic pessimism (Henderson et al., 2014; Huggett et al., 2018). Clients with more severe complications or illnesses are often deemed “difficult, manipulative, and less deserving of care” (Knaak et al., 2017, p. 2). Nurses and clinicians cite a lack of collegial support, insufficient knowledge and training, and the fear of client self-harm (Henderson et al., 2014), leading them to over-diagnose and over-prescribe (Huggett et al., 2018).
Transitioning from the disease model’s pathographic language to the optimistic and encouraging language of wellness models is everyone’s responsibility in the mental health community―its institutions, associations, practitioners, researchers, media, and clients. In the growing opinion of clinical psychologists, empathy and communication must take precedence over etiology.
We must move away from the disease model, which assumes that emotional distress is merely symptomatic of biological illness, and instead embrace a model of mental health and well-being that recognizes our essential and shared humanity. Our mental health is largely dependent on our understanding of the world and our thoughts about ourselves, other people, the future, and the world. (Kinderman, 2014, p. 3
Language and Perspective
Language generates and supports perspective, and linguists agree that the relationship between language and power is mutual (Ng & Deng, 2017). Language influences thought and action. Terms like incapacity, deceit, unempathetic, manipulative, and irresponsible describe DSM-5 traits for various disorders. The argument is not that these descriptions are invalid; they are overwhelmingly negative and perceptually hostile. Judging by public opinion, media representation, and mental health stereotypes and stigma, these words help frame the perception of a person with a mental disorder (DeMare, 2016; Pinfold et al., 2005; Pryor et al., 2009).
Realistically, we cannot eliminate the word ‘mental’ from the culture. The disease model’s guide for 70 years is called the Diagnostic and Statistical Manual of Mental Disorders. Unfortunately, the word ‘mental’ is a limited description of a disorder, and its negative implications support perceptions of incompetence, unworthiness, and undesirability. It is the dominant source of stigma, shame, and self-denigration. Psychologically, the word mental defines a person or their behavior as somehow extreme or illogical. Adolescents derisively assign the term to the unpopular, different, and socially inept. The urban dictionary defines mental as someone silly or stupid.
Hostile and demeaning language is pervasive throughout mental healthcare promulgated by the disease or medical model’s pathographic undercurrent. This perspective influences public opinion, study and research, media representation, the doctor-patient power structure, community interrelationships, and client self-beliefs and image. Transitioning from the disease model to wellness models requires constructing a more reasonable mental health perspective by addressing misunderstanding, misinformation, and the overriding focus of the disease model on diagnosis, disorder, deficit, and denigration.
Misinformation is generated by the psychological community’s difficulty finding agreement due to changing criteria, “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” (Nagata et al., 2015, p. 724), and the intractability of the American Psychiatric Association. There are four common misconceptions about mental disorders. They are (1) abnormal and selective, (2) a consequence of behavior, (3) solely mental, and (4) psychotic. These are corrected by universality, age of onset, complementary, and the clear differentiation of psychosis from neurosis.
Universality
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, p. 1). It is a part of natural human development. One-in-four individuals have a diagnosable mental disorder. According to the World Health Organization, nearly two-thirds of people who believe they have a mental disorder reject or refuse to disclose their condition. Include those who dispute or chose to remain oblivious to their dysfunction, and we can conclude that mental disorders are common, undiscriminating, and universally impacting.
Age of Onset
The onset of a disorder is a consequence of early psychophysiological disturbance, according to Mayoclinic (2019). Perhaps parental behaviors are overprotective or controlling or do not provide emotional validation (Cuncic, 2018). The receptive juvenile might be the product of bullying, abuse, or a broken home. “LGBT youths experience greater stressors from childhood into early adulthood, such as child abuse and unstable housing, that exacerbate mental health problems” (Mustanski et al., 2016, p. 527). LGBTQ+ youth experience disproportionately high rates of verbal and physical harassment and other types of peer victimization (Berlan et al., 2010; Reisner et al., 2015). “Gender minority youth had approximately four-fold higher odds of experiencing any bullying or harassment in the past year” (Reisner et al., 2015, pp. 35-36).
Childhood/adolescent exploitation or abuse are generic terms to describe a broad spectrum of experiences that interfere with a youth’s optimal physical, cognitive, emotional, and social development (Steele, 1995). Any number of situations or events can trigger the susceptibility to onset; it could be hereditary, environmental, or some traumatic experience (Mayoclinic, 2019; NIH, 2019). Statistically, the LGBTQ+ community is at “a higher risk than their heterosexual counterparts for traumatic life experiences such as childhood physical, psychological, and sexual abuse” (Bandermann, 2014, p. 3).
Despite the implication of intentionality in the words’ abuse’ and ‘exploitation,’ a toddler might sense abandonment and develop emotional issues when a parent is preoccupied (Lancer, 2019). The child/adolescent is not accountable for their dysfunction; there is the likelihood no one is intentionally responsible. Similarly, with the scientific affirmation that, while sexual and gender-based identities may have a genetic or biological basis, they are not chosen, and the LGBTQ+ person is not accountable; unlike mental illness, there is no implicit or explicit responsible party.
Undoubtedly, this sociological model conflicts with moral models that claim, “mental illness is onset controllable, and persons with mental illness are to blame for their symptoms” (Corrigan 2006, p. 53), and sexual and gender-based orientation is a choice.
Complementarity
In early civilizations, mental illness was the domain of supernatural forces and demonic possession. Hippocrates and diagnosticians of the 19th century looked at the relative proportions of bodily fluids. Lunar influence, sorcery, and witchcraft are timeless culprits. In the early 20th century, it was somatogenic. The biological approach argues that neuroses are related to the brain’s physical functioning (McLeod, 2018), while pharmacology promotes it as a chemical or hormonal imbalance. Carl Roger’s study of the cooperation of human system components to maintain physiological equilibrium produced the word ‘complementarity’ to define simultaneous mutual interaction. Mind, body, spirit, and emotions work in concert. The same mutual interaction is evident in sexual and gender-based identities as it is in all persons.
Psychosis and Neurosis. There are two degrees of mental disorders: neuroses and psychoses. When someone sees, hears, or responds to things that are not actual, they are having a psychotic episode. While few persons experience psychosis, everyone has moderate-and-above levels of anxiety, stress, and depression. Neurosis is a condition that negatively impacts our emotional well-being and quality of life but does not necessarily impair or interfere with normal day-to-day functions. Since the overwhelming majority of mental disorders are neuroses, humans are all dysfunctional to some extent.
“Language reveals power, reflects power, maintains existing dominance, unites and divides . . . and creates influence.” (Ng & Deng, 2017, p. 15). The similar impact of the wellness model on the mentally ill and the LGBTQ+ person is evident. Revising negative and hostile language to embrace a positive dialogue of encouragement and appreciation generates new perspectives that positively contribute to self-beliefs and image, leading to more disclosure, discussion, and, in the case of mental illness, recovery-remission. The self-denigrating aspects of shame should dissipate; stigma becomes less threatening.
Accepting that mental illness and sexual and gender-based identities are ubiquitous and non-discriminating should make it easier to embrace the subject within the family structure. Realizing their proximity and general susceptibility should mitigate the desire to distance and isolate. Accepting their social pervasiveness should alleviate the prejudice, ignorance, and discrimination attached to mental illness (Khesht-Masjedi et al., 2017; Pescosolido, 2013; Pinfold et al., 2005; Wood & Irons, 2017), as well as sexual and gender-based identities (Adamczyk & Liao, 2018; Dodge et al., 2016; Lewis et al., 2017). Recognizing that neither the mentally ill nor the LGBTQ+ person is accountable disputes the belief that they are weak or amoral and their condition a reflection of behavior. (Condition is herein defined as the state of something with regard to its quality.)
Resistance to Recovery
The term stigma-avoidance defines those who fear that public disclosure could, potentially, stigmatize and discredit them. Statistics from the National Bureau of Economic Research “find that survey respondents under-report mental health conditions 36% of the time when asked about diagnosis” (Bharadwaj et al., 2017, p. 3). A recent study by Salzer et al. (2018) reveals that only one-third of disordered persons were in recovery-remission in 2017. The lower recovery-remission rates may be partly due to the inability to afford treatment due to anxiety-induced financial and employment instability (Gregory et al., 2018). More than 70% of social anxiety disorder patients, for example, are in the lowest economic group (Nardi, 2003).
The LGBTQ+ community’s resistance to disclosing a mental disorder, seeking treatment, or accepting a diagnosis is due to the same attributions that underscore general reticence: stigmatization, victimization, public opinion, media representation, family rejection, and the diagnosis itself.
Stigmatization
Mental health stigmais the hostile expression of the abject undesirability of the afflicted. 90% of survey respondents with a mental disorder claim they have been impacted by mental health stigma (NAMI 2020a). Stigmatization is deliberate and proactive, distinguishable by pathographic overtones intended to shame and isolate (Pryor et al., 2009). Disclosure of a mental disorder jeopardizes livelihoods, relationships, social standing, housing, and quality of life (Huggett et al., 2018; Pinfold et al., 2005; Sowislo et al., 2016; Wood & Irons, 2017). “The deleterious effects of stigma and prejudice on the health of sexual minority individuals have been well-documented across both physiological and psychological domains” (Dodge et al., 2016, p. 1).
For LGBTQ youth, the minority stress theory posits that their health is affected by the degree to which their social environment stigmatizes sexual and gender minorities and the extent to which LGBTQ+ youth in these environments are expected to hide their non-conformity. (Wilkerson et al., 2016, p. 359)
Mental health stigma is expressed within three categories:
Tribal stigma devalues.
Moral character stigma implies amorality and weakness.
Abominations of the body stigma refers to physical deformity or disease (Pryor et al., 2009).
Mental disorder occupies the last two categories. Ignorance equates a mental disorder with weakness or contributing behavior, while the medical model focuses on the disease and deformity aspect. The LGBTQ+ community’s sexual and gender-based identity is socially and culturally tribal.
Victimization
“Community-based samples of LGBT youths have shown that as many as 30% may experience psychological distress at clinically significant levels” (Mustanski et al., 2016, p. 527). A study of the effects of cumulative victimization on LGBTQ+ youth’s mental health found that they “experience greater mental health problems, such as depression, anxiety, suicide attempts, and posttraumatic stress disorder (PTSD) . . . than do heterosexual and cisgender individuals” (Mustanski et al., 2016, p. 527). Contributors include internalized homophobia, stigma consciousness, identity concealment, and experiences of heterosexism and victimization. (Heterosexism is the sociological term for discrimination or prejudice against gay people by heterosexuals who assume heterosexuality is the normal sexual orientation). Sexual and gender-identity minorities are disproportionally subject to bullying, harassment, and other peer victimization (Berlan et al., 2010; Reisner et al., 2015). The LGBTQ+ community is “one of the most targeted communities by perpetrators of hate crimes in the country” (NAMI, 2020b, p. 1).
Because of the greater risk of victimization in LGBT individuals compared with heterosexuals starting as early as adolescence, research is needed that examines how trajectories of sexual orientation-based victimization across development influence the risk for mental health problems for LGBT people. (Mustanski et al., 2016, p. 528)
Public Opinion
“Although recognition, attributions, and service use may reflect prejudice associated with mental illness, the heart of stigma lies in social acceptance” (Pescosolido, 2013, p. 8). The image of the dangerous, unpredictable, mentally ill person is still widely endorsed by the public (Corrigan & Watson, 2002; Pinfold et al., 2005). Stuart and Arboleda-Flórez (2012) analysis of two surveys (1990/2006) on public perception found, that “between 80-100 percent of respondents . . . favored involuntary hospitalization for that disorder when they thought that violence was an issue” (p. 7).
Attitudes toward sexual and gender-based identity became substantially more accepting between the 1970s, the most significant shift among 18- to 29-year-olds (Adamczyk & Liao, 2018; Dodge et al., 2016). “It is clear that Americans have become more accepting of same-sex sexual behavior and relationships, but it is unclear how universal those changes are and whether they are due to age, time period, or cohort” (Twenge et al., 2016, p. 10).
Persons tend to be more supportive, in part, “because gay men and lesbians are then seen as less responsible for their orientation” (Adamczyk & Liao, 2018, p. 4). An overwhelming share (92%) of the U.S. LGBTQ+ community believes “society has become more accepting of them in the past decade and expect it to grow even more accepting in the decade ahead” (Pew, 2020, p 1). However, many rights and benefits afforded to LGBTQ+ individuals depend on region, race and ethnicity, political persuasion, educational attainment, economics, and religiosity (Adamczyk & Liao, 2018; Dodge et al., 2016; UW-Madison, 2020). Religion is strongly associated with negative beliefs about the justifiability of LGBTQ+ “sexual behavior and marriage” (Twenge et al., 2016, p. 8). The degree of intolerance is denominational and subject to the frequency of attendance. Jews and moderate-to-liberal protestants are more tolerant than Baptists, fundamentalists, and Catholics (Adamczyk & Liao, 2018; Schnabel, 2016). The Pew (2020) study shows that 29% of LGBTQ+ persons have felt unwelcome in a place of worship.
Heterosexual women consistently demonstrate more positive attitudes toward sexual and gender minority groups than heterosexual men who are “traditionally expected to more rigidly conform to gender explicitly heteronormative norms and stereotypes” (Dodge et al., 2016, p. 4). Attitudes toward lesbians and gay men are significantly more positive than attitudes toward transgender people (Adamcyzk & Liao, 2018; Lewis et al., 2017), whereas “bisexual individuals commonly report experiencing stigma, prejudice, and discrimination from both heterosexual and gay/lesbian individuals” (Dodge et al., 2016, p. 1).
Education and interpersonal contact mitigate prejudicial attitudes and behaviors towards both the mentally disordered and LGBTQ+ individuals. Contact-based education has emerged as the most influential factor in public attitude and behavior towards people with mental health problems (Pinfold et al., 2005; Corrigan, 2006). “Multiple studies have found that knowing someone who is LGBTQ+ is associated with more supportive attitudes” (Adamczyk & Liao, 2018, p. 10), and “may increase knowledge, reduce anxiety, and increase empathy” (Lewis et al., 2017, p. 862). This benefit has not crossed over to transgender people, likely, because “personal contact is relatively small” (Lewis et al., 2017 p. 871).
According to the Pew Research Center (Pew, 2020), 30% of the LGBTQ+ community reported they have been threatened or physically attacked, 21% treated unfairly by an employer, and 58% the target of slurs or jokes. Heterosexism inflicts itself on individual, familial, institutional, employment, political, and cultural levels, and openly occurs in educational, career, religious, and social settings (Bandermann, 2014; Lewis et al., 2017).
While public opinion has drastically improved for the LGBTQ+ community, the perception of the dangerous and unpredictable mentally disordered person who should be isolated has not changed substantially in decades (Stuart & Arboleta-Flórez, 2012). A primary goal of wellness models is mitigating mental health stigma by changing the public perspective.
Media Representation
A 2011 study revealed that nearly half of U.S. media stories on mental illness mention or allude to violence (Pescosolido, 2013). News and social media, propelled by far-right politics, fundamentalism, and other fringe organizations, contribute to discrimination and prejudice. Analysis of film, television, and tabloid presentations identify three common misconceptions: people with mental illness are homicidal maniacs, they have childlike perceptions of the world that should be marveled at, or they are rebellious, free spirits (Corrigan, 2006). Portrayals of sexual and gender-based identity in the latter half of the 20th century were, generally, stereotypical exaggerations. “Beginning in the 1990s, some highly likable gay and lesbian television and media characters began to appear in the media” (Adamczyk & Liao, 2018, p. 10). Still, there is an abundance of gay-themed portrayals designed to arouse feelings of shock, betrayal, and titillation. Media coverage commonly promotes disinformation that negatively impacts the self-beliefs and image of LGBTQ+ persons.
Family Rejection
Family stigmatization is the rejection of an LGBTQ+ or mentally dysfunctional child or sibling. A 2008 literature review found around 38% of family members “attempt to hide their relationship in order to avoid bringing shame to the family” (Stuart & Arboleda-Flórez, 2012, p. 8). Another study showed that 34% of LGBTQ+ persons reported rejection by family members, 49% reported unfair treatment, and “52% were subject to anti-gay remarks from family members” (Bandermann, 2014, p. 3). The implication of familial undesirability impacts a mentally disordered and LGBTQ+ person’s sense of positive self, a devaluation more potentially “life-limiting, and disabling than the illness itself” (Stuart & Arboleda-Flórez, 2012, p. 3). “The difficulties of living with psychiatric distress are magnified by the experience of rejection” (Gray, 2002), which can lead to psychological and physiological health issues, substance abuse, and addiction.
Etiology and Misdiagnoses
Etiology and diagnosis drive the disease model. Which disorder do people find most repulsive, and which poses the most threat? What behaviors contribute to the disorder? How progressive is the disorder, and how effective are treatments? (Corrigan, 2006). It is essential to recognize how these attributions affect public perception, treatment options, and client self-beliefs and image.
“Until the 1950s, most homosexual persons studied by psychologists and others were prisoners or mental patients, so it was easy to conclude that these were linked” (McFarland, 2018, p. 1). In 1973, the APA announced homosexuality was no longer an illness. DSM diagnostic criteria change dramatically from one edition to the next. Lynam and Vachon (2012) cite therapists’ concern that criteria are “added, removed, and rewritten, without evidence that the new approach is better than the prior one” (p. 483). The social fears described in the DSM-II in 1968 became social phobia in the DSM-III (1980), and social anxiety disorder in 1994’s DSM-IV, resulting in the nickname, the ‘neglected anxiety disorder.’
Revisions, substitutions, and contradictions between DSMs are never universally accepted. Even under the best circumstance with a knowledgeable and caring clinician, it is difficult to obtain a proper mental disorder diagnosis. In addition to the nine types of depression, four anxieties, and eight obsessive-compulsive disorders, the current DSM lists five types of stress response and ten personality disorders, each sharing similar traits and symptomatology with varying degrees of impact. Bipolar personality disorder, for example, shares characteristics and symptoms with generalized anxiety disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder (Sagman & Tohen, 2009). The most common comorbidities associated with anxiety are major depression, panic disorder, posttraumatic stress disorder, and alcohol abuse/dependence. For example, social anxiety disorder is often comorbid with avoidant personality disorder, eating disorders, schizophrenia (Cuncic, 2018; Vrbova et al., 2017), ADHD, and agoraphobia (Koyuncu et al., 2019).
The Social Anxiety Institute (Richards, 2019) reports that an estimated 8.2% of patients had generalized anxiety, but just 0.5% were correctly diagnosed. A recent Canadian study by Chapdelaine et al. (2018) reported, of 289 participants in 67 clinics meeting DSM-4 criteria for social anxiety disorder, 76.4% were improperly diagnosed.
Self-Esteem
Maslow’s (1943/1954) hierarchy of needs reveals how childhood disturbance can disrupt natural human development. Healthy growth requires satisfying fundamental physiological and psychological needs. The experience of detachment, exploitation, or neglect may disenable the subject from satisfying their physiological and safety needs and or the need to belong and experience love, which can impact the acquisition of self-esteem.
If the child is criticized, overly controlled, or not given the opportunity to assert itself, it begins to feel insecure in its ability to survive, and may then become overly dependent on others, develop low self-esteem, and experience a sense of shame or doubt in its own abilities. (Vanderheiden & Mayer, 2017, p. 15)
Research on persons with depression and anxiety reveals how the disease model “diminishes hope, self-esteem, self-efficacy, empowerment, and quality of life.” (Garg and Raj, 2019, p. 124). LGBTQ+ youth rejected because of their identity have much lower self-esteem, are more isolated, and have less support than those accepted by their families (House, 2018).
Self-esteem determines one’s relation to self, to others, and the world. Self-esteem is the umbrella for all the positive self-qualities that structure optimal functioning, e.g., self -respect -resilience, -efficacy, -reliance, -compassion, -value, -worth, and other intrinsic wholesome attributes. Self-esteem provides the recognition that one is consequential and worthy of love. A grassroots poll by Unite UK (2016) found that 62% of LGBTQ+ persons believe they have low self-esteem. Exposure to historical alienation, ambiguous public opinion, adolescent bullying, heterosexualism, and other harmful elements, in time, will have an impact on an LGBTQ+ person’s self-beliefs and image (Unite UK, 2016).
Recovery
Recovery is an individual process. Humans have unique DNA and disparate sensibilities, memories, and abilities. One-size-fits-all approaches are inadequate to fully address the personality’s dynamic complexity and its owner’s uniqueness. Mental illness is ubiquitous and non-discriminating; dysfunction embraces every walk of life. Indeed, “the LGBTQ+ community encompasses a wide range of individuals with separate and overlapping challenges regarding their mental health” (NAMI, 2020b, p. 1).
Recovery is “about seeing people beyond their problems – their abilities, possibilities, interests, and dreams – and recovering the social roles and relationships that give life value and meaning” (Slade, 2010, p. 2). Recovery programs must be fluid, integrating multiple traditional and non-traditional approaches developed through client trust, cultural assimilation, and therapeutic innovation. Any analysis must consider the subject’s environment, hermeneutics, history, and autobiography in conjunction with their wants, beliefs, and aspirations. Otherwise, the personality complexity is not valued, and the treatment is inadequate.
Positive Psychology and the Wellness Model
In 2004, the World Health Organization began promoting the advantages of the wellness perspective, declaring health “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Slade, 2010, p. 1). The World Psychiatric Association states, “the promotion of well-being is among the mental health system” (Schrank et al., 2014, p. 98). As psychologists point out, “psychological well-being is viewed as not only the absence of mental disorder but also the presence of positive psychological resources” (Sin & Lyubomirsky, 2009, p. 468).
The wellness model’s chief facilitator is positive psychology (PP), which originated with Maslow’s (1943/1954) seminal texts on humanism; APA president Seligman legitimized it in 1998. Positive psychology and other optimistic approaches focus on the inherent ability, “not only to endure and survive but also to flourish” (Mayer & May 2019, p. 160).
Positive psychology is a relatively new field (since 1998) that, ostensibly, complements rather than replaces traditional psychology. Defined as the science of optimal functioning, PP’s objective is “to study, identify and amplify the strengths and capacities that individuals, families, and society need to thrive” (Carruthers & Hood, 2004, p. 30). Cultural psychologist Levesque (2011) describes optimal functioning as the study of how individuals attempt to achieve their potential and become the best they can be.
Studies support the utilization of positive psychological constructs, theories, and interventions for enhanced mental health understanding and improvement. PP interventions have “improved wellbeing and decreased psychological distress in mildly depressed individuals, in patients with mood and depressive disorders, [and] in patients with psychotic disorders” (Chakhssi et al., 2018, p. 16). As Carruthers and Hood (2004) point out, “The things that allow people to experience deep happiness, wisdom, and psychological, physical and social wellbeing are the same strengths that buffer against stress and physical and mental illness” (p. 30).
The academic discipline of positive psychology continues to develop evidence-based interventions that focus on eliciting positive feelings, cognitions, or behaviors (Schotanus-Dijkstra et al., 2018). Positive psychology offers promising interventions “to support recovery in people with common mental illness, and preliminary evidence suggests it can also be helpful for people with more severe mental illness” (Schrank et al., 2014, p. 99).
Positive Psychology 2.0
One of the early challenges of positive psychology was its inattention to the negative aspects of character. Recognizing this, psychologists advocated a more holistic approach to embrace the dialectical opposition of human experience. As one psychologist put it, “people are not just pessimists or optimists. They have complex personality structures” (Miller, 2008, p. 598). Positive Psychology 2.0 (PP 2.0) evolved as a correction to the singular focus on optimism to embrace a more inclusive and balanced perspective (Rashid et al., 2014).
The disease model of mental health bases recovery on the remission of symptoms or the suspension of substantial interference or limitation (ADAMHA, 2012; Salzer et al., 2018). The wellness model maintains that individuals with a mental disorder can live satisfying and fulfilling lives regardless of symptoms or impairments associated with the diagnosis (Slade, 2010). Schrank et al. (2014) describe recovery as people “(re-) engaging in their life on the basis of their own goals and strengths, and finding meaning and purpose through constructing and reclaiming a valued identity and valued social roles” (p. 98). By emphasizing wellness, the positive psychology movement aims to destigmatize mental illness by emphasizing “the positive while managing and transforming the negative to increase wellbeing” (Mayer & May, 2019, p. 163). Perkins and Repper (2003, p. 3) write:
People with mental illness who are in recovery are those who are actively engaged in working away from Floundering (through hope-supporting relationships) and Languishing (by developing a positive identity), and towards Struggling (through Framing and self-managing the mental illness) and Flourishing (by developing valued social roles).
Concluding Thoughts
Thomas Insel (2013), director of the National Institute of Mental Health, is “re-orienting its research away from DSM categories” (p. 2), declaring that traditional psychiatric diagnoses have outlived their usefulness (Kinderman, 2014). NIMH is transforming diagnosis based on emerging research data and a doctor-patient communication dynamic rather than on the current symptom-based categories. Kinderman (2014) suggests replacing traditional diagnoses with easily understandable descriptions of the issues.
A simple list of people’s problems (properly defined) would have greater scientific validity and would be more than sufficient as a basis for individual care planning and the design and planning of services. (1)
In mental health, recovery-remission is a realized, long-term mitigation of symptoms. Wellness impacts more than mental health; it is a paradigmatic perspective that seeks to promote a state of complete physical, mental, and social well-being. Its sociological emphasis on optimal human functioning, designed to counter the pathographic focus of other models, 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 with a mental illness.
There are many approaches to recovery. Psychology textbook author, Farreras (2020) cites 400 different schools of psychotherapy. Mayer and May (2019) characterize current positive psychology as “a balanced, interactive, meaning-centered and cross-cultural perspective” (p. 156) that considers equally “positive emotions and strengths and negative symptoms and disorders” (Rashid et al., 2014, p. 162). Positive psychology works best in conjunction with other programs (CBT, for example), and its mental health interventions have proved successful in mitigating symptoms of depression, anxiety, and other disorders. “Growing research suggests that a positive psychological outlook not only improves ‘life outcomes’ but enhances health directly” (Easterbrook, 2001, p. 23).
Training in prosocial behavior and emotional literacy might be useful supplements to specific interventions. Behavioral exercises enhance the execution of resilient and generous social skills. Positive personal affirmations have enormous subjective value as well. Data supports mindfulness and acceptance-based interventions to re-engage and regenerate positive thoughts, feelings, and memories. Castella et al. (2014) suggest motivational enhancement strategies to help clients overcome resistance. Ritter et al. (2013) tout the benefits of positive autobiography to counter destructive thoughts and behaviors. The importance of considering the nuanced and unique dynamics inherent in the relationships among emotional expression, intimacy, and overall relationship satisfaction for dysfunctional individuals and LGBTQ+ persons, should be thoroughly investigated (Montesi et al., 2013).
However, this paper balks at throwing out the baby with the bathwater, positing that the current diagnostic system should be utilized as a part of a more thorough analysis that embraces communication and emphasizes the character strengths that generate motivation, persistence, and perseverance toward recovery-remission. All “patients with mental disorders deserve better” (Insel, 2013, p. 2).
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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 are applicable to most emotional malfunctions including depression, substance abuse, ADHD, PTSD, 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.
Robert F. Mullen, Ph.D.
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 is 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.
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. Ritchie and Roser (2018) report 284 million SAD persons, worldwide, and the National Institute of Mental Health (NIMH, 2017) reports 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).
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, among other attributions:
1. general public cynicism
2. 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, Wong, Craig, Marker, & Peters, 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 are due to “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” (Nagata, Suzuki, & Teo, 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% were correctly diagnosed. A recent Canadian study by Chapdelaine, Carrier, Fournier, Duhoux, and Roberge (2018) reported, of 289 participants in 67 clinics meeting the 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 co-founder 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 characterized 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), 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, 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 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).
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), include: “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 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 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; 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 a 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 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.” 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 that 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. A SAD person’s 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 expectations 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 through 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 neighbors, 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 -resilience. 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 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 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 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, and stupid. The prisoners have formed a subordinate dependency on 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 (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, targeted in treatment, and changed, the resulting maladaptive thoughts, symptoms, and behaviors will also change.
Clinicians and researchers have reported the lack of a 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 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 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 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.
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