The Latest Way to Conquer Social Anxiety Uses a New Mindset

A new study suggests putting a ban on the thoughts that heighten social anxiety.

Posted Oct 20, 2018

Roberts Photography/Shutterstock
Source: Roberts Photography/Shutterstock

You’ve been invited to a dinner with people you don’t know very well. The boss has put you on a guest list intended to wine and dine new customers, or a friend has asked you to attend her wedding rehearsal with her extended family whom you’ve never met before. The worries start to build up as the date approaches. Will you be dressed appropriately for the occasion? Who will you be sitting next to at the table, or worse, will the event be a stand-up affair where you have to balance food and drink in your hands? The idea that you’ll be with people you don’t know that well only causes your anxiety to heighten. If you were with close friends, it wouldn’t matter if you were dressed too formally or informally, and you certainly wouldn’t worry about a spill or two while you’re eating your meal. But with these strangers who you want to impress, the chances are far worse that a social faux pas will have negative consequences.

People with high levels of social anxiety are more likely to experience these feelings on a regular basis, even in situations that don’t have such high stakes and uncertainty. University of Sydney’s Matthew Modini and Maree Abbott (2018) believe that social anxiety is fed by rumination, or constant thinking about an upcoming event that leads to these worries. Running over and over again in your mind the many possible things that can go wrong not only causes you to be more anxious, but can also impact your behavior once you’re in the actual situation. You get the jitters when you pick up your cup of coffee, and of course, some of it will spill (into the saucer, preferably, and not your clothes). Now you feel that you have drawn negative attention to yourself. The cycle of worry becomes perpetuated, leading you to have even higher levels of worry for the next event to come along.

As noted by Modini and Abbott, “Negative rumination is one of a number of factors in the vicious cycle of social anxiety, and can be defined as an intrusive and detailed scrutiny of anticipated or perceived negative outcomes in relation to a feared social situation” (p. 72). The rumination doesn’t stop at the threshold of the feared situation, but can continue to persist long after the event has ended, as you go over and over it in your memory. The Sydney authors note further that despite the identification some 20 years ago of the effects of rumination in perpetuating social anxiety, there is relatively little research on how to help people with social anxiety, including those with a diagnosed disorder, from breaking the cycle of worry.

Cognitive-behavioral therapy is known to be an effective intervention for individuals with clinical levels of social anxiety, but according to Modini and Abbott, it’s not clear what aspects of this approach are the most helpful. Given the tendency of individuals with social anxiety to engage in pre-event rumination, it would seem beneficial, the authors argue, to provide a higher “dose” of an intervention that actually seeks to remedy this specific aspect of the disorder. This higher dose would focus on the performance and threat appraisals that lead socially anxious individuals to ruminate. The approach the authors wished to explore involves the “detached mindfulness” of looking not only at the thoughts people have about what can go wrong in a social situation (such as spilling that coffee), but also about their mistaken assumptions that rumination actually has benefits in preventing such outcomes. The worry about the coffee is a “Type 1” thought, typically targeted in cognitive-behavioral therapy. Detached mindfulness would involve looking at that maladaptive belief about rumination, a “Type 2” worry, and questioning its legitimacy.

You might believe, then, that you benefit by mentally rehearsing all the worst-case scenarios about what might happen in the threatening situation. Instead, if the Australian researchers were correct, you would be better off recognizing that you need to call a halt to all that rumination and realizing that it's getting in the way of your actual ability to successfully navigate the situation.

The study conducted by Modini and Abbott was carried out not on clinically diagnosed individuals, it should be recognized, but on undergraduate students. However, the students chosen to participate in the intervention (and control) condition received scores on a standard social anxiety measure high enough to place them in a clinical range. The 27 in the intervention and 25 in the control groups were comparable on all study measures, including social anxiety score, age, gender, and relationship status.

Over the course of the five-day study, participants prepared for what they believed would be a 3-minute speech on an assigned topic. Their speech, they believed, would be rated by evaluators watching a recording of their performance. The task, therefore, was one that could stimulate the threat of negative evaluation, a common source of rumination for people high in social anxiety. The intervention itself was relatively brief, and consisted of participants spending 15-20 minutes learning how to engage in that detached mindfulness. The instructions they received were as follows: “Perhaps you can say to yourself “’I've noticed I'm beginning to ruminate but I'm not going to engage with it as I know it serves no useful purpose’ and simply bring your attention back to the present task at hand.” Over the subsequent days 2 through 4 of the experiment, participants completed a brief questionnaire to assess whether they were engaging in ruminative thoughts.

As they predicted, Modini and Abbott indeed observed a decrease in ruminative thought among the students in the intervention group. The students receiving the intervention, additionally, felt they had more control over the anticipatory thoughts that would otherwise have gotten in the way of their performance, and felt less distressed when they did notice themselves ruminating. Levels of anxiety and fears about their performance in the intervention group did not seem to be reduced by the treatment, but the authors suggest that the 15-20-minute intervention may have been too brief to produce such effects. Supporting this interpretation, the authors also noted that the groups didn’t differ on their ratings after the event itself.

Another notable finding was that on the day prior to the speech task, even the participants in the intervention group returned to their levels of distress and rumination. The authors suggest that a way to counteract this rise as the event draws nearer would be a “top-up” in which individuals are exposed to the intervention again, so that they can exercise their detached mindfulness once again.

To sum up, if you’re someone who not only ruminates before an important event, but believe it’s helpful to do so, the present findings suggest that you consider a “ban” on this nonproductive thinking. Finding fulfillment even in the most challenging social situations may mean overcoming one of the biggest obstacles — your thoughts.

References

Modini, M., & Abbott, M. J. (2018). Banning pre-event rumination in social anxiety: A preliminary randomized trial. Journal of Behavior Therapy and Experimental Psychiatry, 61, 72–79. https://doi-org.silk.library.umass.edu/10.1016/j.jbtep.2018.06.009