Self-Consciousness and Cognitive-Behavioural Therapy
Self-Consciousness and Cognitive-Behavioural Therapy
Social anxiety is the generic term that psychologists use to describe nerves about public speaking and other interpersonal situations. When I was a teenager, I was very anxious about speaking. I remember asking my older sister, Sheila, to call an employer for me about a job interview because I was too nervous to do it myself. Over the years, it got much better, but the susceptibility to that form of anxiety often never disappears completely.
Some very common self-help techniques potentially do more harm than good.
Many years later, I trained as a cognitive-behavioural psychotherapist and ended up working with people suffering from a range of severe anxiety disorders, including what we call Social Anxiety Disorder or Social Phobia. I learned that there are many hundreds of scientific research studies on social anxiety that tell us how it works. Modern research has actually shown us how to treat social anxiety very effectively. However, it also shows that some very common self-help techniques can potentially do more harm than good.
How Anxiety Works
One of the most well-established findings in the entire field of psychotherapy research is that most anxiety abates naturally, given the right conditions. For example, animal phobias are often considered the simplest and purest form of anxiety. If you take someone who has a snake phobia and throw them in a room with snakes what will happen to their heart rate? Within thirty seconds, it will approximately double, from about 70bpm to about 140bpm. But what happens next?
Most clients with severe anxiety will actually be temporarily stumped by that question. They want to say it will get worse, or some catastrophe will happen, although they realise that can’t be right. What goes up must come down. If they wait, their heart rate will normally start to reduce. So how long does that take? It normally takes anything from five to thirty minutes for heart rate to go from its peak level back down to something approaching the normal resting level.
So what will happen next time the same person is exposed to a snake? Their heart rate will go up again but not usually as high as before, and it will reduce more quickly each time. So with repeated, prolonged, exposure, anxiety reduces following a pattern resembling the tail of a dinosaur. Eventually, it will be permanently extinguished, or return to a milder or “sub-phobic” level of unease. Psychologists have known this for over half a century and there are hundreds of research studies demonstrating the effect of what we call “Exposure Therapy” on phobias, a process technically referred to as anxiety habituation.
So if it’s that easy, why doesn’t everyone do it already? Well, what do people most want to do when their anxiety is spiralling? Run away! The drive to get out of the situation peaks alongside anxiety, and often anticipates it. So people either avoid getting into situations that make them anxious, or if they find themselves in them, they escape as quickly as possible. That means there’s often not enough time for anxiety to abate naturally.
The main thing that will keep someone in a situation, despite their wanting to flee, is the presence of another person encouraging them. With children, it’s typically a parent who motivates them to face their fears until anxiety goes away naturally. Adults who grow up without overcoming their phobias may have to enlist a therapist, to do something similar, using Exposure Therapy. Clinical studies show success rates of up to 90% for animal phobias, after as little as three hours of exposure. However, social phobia only has a 75% success rate after about 12–15 sessions of therapy. That’s still very good but the success rate is slightly lower, on average, and the therapy takes four or five times as long. So why would that be?
Making it Worse
There are several features of social phobia that explain why it’s usually harder to treat than animal phobia. However, I’m going to focus on the biggest one. Researchers have found an extraordinarily high level of statistical correlation between self-focused attention and social anxiety. Self-consciousness and social anxiety, it turns out, are virtually synonymous.
You might say that’s just common sense and we all know it already. However, what are the practical implications of that finding? Well, doing things that increase self-focused attention are likely to be toxic for people with social anxiety. In the long-run, focusing too much on themselves prevents speakers focusing on the other people who are triggering their anxious feelings, and that prevents natural habituation from taking place.
Often techniques that people have learned from older self-help books can actually be counterproductive.
Here’s the real problem, though. Many of the strategies people use to cope with social anxiety actually increase self-focused attention. Often techniques that people have learned from older self-help books can actually be counterproductive. For example, trying to relax the muscles of your body, or trying to use breathing techniques, while speaking. These can force you to focus more attention on yourself than on the audience. So can using “thinking strategies” like repeating verbal affirmations in your head, trying to visualise success, or even some forms of mindfulness meditation.
Even worse, some of these strategies increase what we call “cognitive load”, meaning they require extra brainpower. We know that increasing self-focused attention often causes people to hesitate, lose their place, and make more speech errors. If they’re also trying to say or picture “helpful” things in their mind that often doesn’t leave enough mental resources available for speaking fluently. It generally makes their performance feel more awkward. So don’t try to walk and chew gum, in other words!
Nowadays we know a lot more about how social anxiety works and, in particular, that some of the ways people try to help themselves may actually backfire. On a positive note, when people practice speaking and abandon their unhelpful coping strategies they will usually improve fairly quickly. In fact, more recently it’s been shown that actually training people to focus all their attention on the audience can halve the number of therapy sessions required to treat social anxiety.