Look Around and Look Within

The Science and Art of Human Behavior

When Fear Gets in Your Way

Mindfulness may hold promise in treating social anxiety.

Ever feeling scared when about to give a public talk – whether that is a toast, a lecture or just asking a question in a room full of people?  They say for many people giving a talk is more frightening than the idea of dying.  Having suffered from performance anxiety myself, I know well the feeling.  And while many people get nervous before public presentations, people with Social Anxiety (around performance) have a fear so unbearable they avoid situations that elicit it or suffer tremendously in the face of it.

Social anxiety disorder is when a fear of being scrutinized by others is so severe it causes impairment.  It is a common psychiatric condition affecting millions of people defined by an “intense fear of evaluation in social or performance situations”  (Goldin et al., 2009).

People with this condition habitually think of themselves in a negative light or think other people are doing so.  This is called ‘self-referential processing’ and it may be at the core of the disorder.   There are elevated fears of being ‘judged’ negatively by others and often an exaggerated amount of self-focus and negative thinking about oneself.  This Self-Referential Processing is heightened during social and performance situations and can lead to difficulties in ‘reading’ social cues which may further increase the fear of such situations.

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In efforts to treat people with Social Anxiety Disorder, researchers have been studying mindfulness training – a method of learning how to observe experiences (like thoughts, feelings, and bodily sensations) in a present moment fashion with a neutral stance of attention. 

Mindfulness may hold promise in treating social anxiety.  Patients given a mindfulness course improved clinically whether the program was delivered live or online but didn’t do quite as well as the traditional form of treatment for this condition (i.e. cognitive behavioral therapy).

To understand how mindfulness might help with social anxiety, researchers at Stanford University used fMRI to study the brains of 16 subjects with this disorder before and after an 8-week mindfulness course.  They specifically studied whether symptoms changed, self-referencing changed from negative to positive, and how the brain changed as well. 

There were clear improvement in symptoms and changes in self-referencing (with patients seeing themselves more positively after the mindfulness course than before).   Furthermore, the brain changes suggested that there was less activation of what is called the ‘narrative’ brain network (the circuit in the brain we use to ‘talk’ about ourselves internally) and more activation of the attentional network. 

In a separate study, the scientists looked at how attention influences social anxiety by again studying the brains of patients (using fMRI) given mindfulness training and then right after practicing a simple breath meditation practice.   They specifically looked at brain changes during an emotion regulation task where subjects were shown statements like “I am ashamed of my shyness”, or “People always judge me”.  During the task, subjects were then given instructions to either ‘attend to the breath’ or ‘count back from 168 (called a distraction condition).  Then they were asked to rate their feelings (e.g. ‘how negative do you feel right now?).

Overall, mindfulness training led to a more automatic use of attention to reduce emotional reactivity and this was reflected in lowered amygdala activation (a part of the brain involved in fear and emotional responses).   And patients showed a decrease in their reports of  ‘negative feelings’ directly following the breath-focused practice.  

These studies suggests that mindfulness may help those with social anxiety, perhaps in complement with clinical treatment,  by improving attentional regulation, reducing emotional reactivity, and by improving positive content of self-referential processing. 

I know mindfulness helped me tremendously cope with my own performance anxiety and science is beginning to unravel why.

References:

Goldin, Ramel  and Gross  2009 Mindfulness meditation training and self-referential processing in Social Anxiety Disorder: behavioral and neural effects. J of Cognitive Psychotherapy: An International Quarterly Vol 23 (3) 2009

Goldin and Gross Emotion. 2010 Effects of mindfulness-based stress reduction (MBSR) on Emotion Regulation in Social Anxiety Disorder, Vol 10 (1) 83-91.

Susan L. Smalley, Ph.D., is a professor and behavior geneticist at UCLA Semel Institute and Founding Director of the Mindful Awareness Research Center (MARC).

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