Editor's Note: Dr. David Moscovitch is a clinical psychologist and associate professor of psychology who has been studying social anxiety for over 15 years. He and his graduate student, Nick Zabara, are currently studying the possible costs and benefits of using various coping and safety strategies in social anxiety. This article presents some preliminary findings that are instructive for sufferers and clinicians.
Chances are you are familiar with social anxiety. Feeling your palms sweat before an interview. Your heart fluttering before a date. Stuttering a word or two during a speech. These are all symptoms of worry in social situations—worry about appearing socially awkward, being judged, evaluated, or becoming embarrassed. But are these worries abnormal or dangerous?
In fact, they are quite the opposite. Most people feel some level of social anxiety throughout their daily interactions, and this anxiety can be quite adaptive. Without any concern over what others think of you, your behavior may become offensive or socially unacceptable; certainly a negative outcome. Yet the outcome is even grimmer when social anxiety becomes overwhelming.
Sufferers of Social Anxiety Disorder—characterized by pathologically high levels of social fears—may struggle to interact with others at all. They can become isolated from the outside world, essentially imprisoned in their own homes and scared of reaching out to others for fear of being judged.
These pathological levels of social anxiety are often treated with Cognitive Behavior Therapy (CBT), a significant portion of which revolves around facing your fears. Indeed, psychologists have found that, for nearly all forms of anxiety, facing fears head-on is key for realizing that those fears are overstated and the real risks of facing them are much lower.
Is A Safety Net Really Needed?
Yet for this realization to occur, it is thought that people need to face their fears with no safety net, even though they often try to create one. With social anxiety, for example, people may avoid eye contact, bring friends with them to social events, or go over what they need to say in their minds to feel safer. These aptly named 'safety behaviors' are therefore seen as antithetical to successful anxiety treatment and most psychologists ask clients to stop using them in order for treatment to work. But is this always necessary?
Perhaps not. Anxiety researchers ran several studies with people suffering from panic attacks, specific phobias, and obsessive-compulsive disorder. They found that allowing patients to use some safety behaviors in early stages of treatment may improve their sense of control, increase treatment adherence, and make treatment appear less demanding. Yet it is unclear whether the same is true of social anxiety.
How Is SAD Different?
What makes social anxiety different from other anxiety disorders is the added complexity of interpersonal interaction; in other words, other people must be present whenever socially anxious patients face their fears. If a person who is afraid of heights feels safer by not looking down when crossing a bridge, the bridge will likely remain unaffected by this behavior. Yet, if a person who is afraid of social interactions feels safer by not making eye contact at a party, those around them might behave differently as a result. It is because of this complex interpersonal dynamic that the use of safety behaviors in social anxiety must be considered separately from other types of anxiety.
In order to determine whether safety behaviors in social anxiety can be useful or not, researchers will first need to figure out what types of safety behaviors are commonly employed by socially anxious people, how they are used, and how others react to them. The project currently underway investigates which safety behaviors are used most frequently and in which types of social situations. The researchers are also exploring which factors might set apart safety behaviors that are beneficial from those that are not.
Some Safety Behaviors May Be Helpful
While analyses of these research findings are still underway, the researchers have some hypotheses as to which safety behaviors may be more or less beneficial. As examples, an individual arriving at a social event and avoiding eye contact as a way of coping with his fear of social judgment may be perceived as aloof by others and may find that people are not being friendly or reaching out to him. Conversely, another person may choose to cope with her fear of social judgment at the same social event by bringing a close friend for comfort. While both avoiding eye contact and bringing a friend are traditionally conceptualized as safety behaviors, the latter might uniquely have the effect of making the socially anxious person appear more gregarious, inviting more socialization from others at the event.
Similarly, the researchers theorize that certain safety behaviors may be more useful for coping with certain types of social threats. Socially anxious people who are particularly concerned with demonstrating social competence may be more likely to over-rehearse presentations or perform other acts that strive to create a positive impression but ultimately appear socially awkward or unnatural and push others away. Conversely, those who are most concerned about hiding the physical signs and symptoms of their anxiety may use safety behaviors like concealing their shaky hands or hiding blushing with makeup or clothing - acts that may prevent them from learning their worst fears are unlikely to occur but which ultimately carry fewer negative interpersonal consequences. While the socially anxious individual's end goals in both of these examples may appear similar, differentiating between the consequences they carry may give researchers a leg up in tailoring treatments of social anxiety to individual patient needs and worries.
Already, preliminary findings suggest that safety behavior use may be a matter of perspective, with people evaluating safety behaviors they report using themselves as less beneficial than ones they observe others using. At the same time, certain safety behaviors appear to be most helpful within certain social situations, such as behaviors aimed at hiding symptoms of anxiety being rated as most helpful for individuals concerned about their physical appearance.
Implications For Clinical Treatment
These findings have important clinical applications for the treatment of social anxiety and for helping clinicians guide their clients in a data-driven manner. If certain safety behaviors can, indeed, have beneficial uses within social anxiety, it may be necessary to revisit clinicians' affinity for eliminating them as an integral part of treatment. While this may be a departure from most current Cognitive Behavioral techniques, it is important for therapies to be flexible enough to adapt to new scientific findings and rely on hard evidence for what is most helpful to clients.
While this research is still in its early stages, it promises to shed light on whether feeling too safe really is a problem for treating social anxiety. Ultimately, this research may help to provide socially anxious individuals with a road map for feeling safe in treatment while also pursuing the interpersonal connections they most desire and value.
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Date of original publication: July 13, 2016
Updated: May 25, 2017