Social Anxiety's Newest Theory and the 7 Links to Depression

A new study shows 7 key features shared by both social anxiety and depression.

Posted Dec 25, 2018

pathdoc/Shutterstock
Source: pathdoc/Shutterstock

You may feel that you will never be the life of the party, but you’d at least like to be someone who is able to get through social occasions without feeling stymied by anxiety. Indeed, you’d like to be able not only to make it through these situations, but actually have a good time. Unfortunately, your past record isn’t all that good. Recently, there was a celebration for a beloved office mate’s retirement, and you wanted to be there to honor this person, but you couldn’t overcome your fears that you might have to make a speech, and so you stayed home. At the last holiday family gathering, you were prepared to join in the fun, but the thought of sitting around the table with extended family members led you to opt out instead and spend the evening watching reruns of your favorite show.

People with social anxiety disorder experience extreme fears about being evaluated by others, causing them to feel so distressed that they readily can become loners. However, even without having an actual diagnosis of social anxiety disorder, which requires meeting a specific set of criteria, people who experience the symptoms of social anxiety can suffer from extreme self-doubts about how others will regard them. The accompanying unhappiness they experience may also border on feeling depressed and hopeless. In a new study by Washington University in St. Louis psychologists, led by Julia Langer (2019), the overlap among the symptoms of both sets of disorders was tested using a unique methodological approach. The findings of this study suggest ways that you can approach your own feelings of social anxiety and depression by addressing those symptoms directly.

According to Langer et al., social anxiety and depressive disorders are not only highly prevalent, but when they occur together, become the source of particularly significant impairment. Researchers who have attempted to unpack the relationship between these disorders have previously looked not at specific symptoms, but at the general factors that underlie both of them. The Washington University researchers believed that more could be gained by adopting the opposite approach, which is to see how specific symptoms of both disorders relate to each other. In their statistical modeling of the relationship between social anxiety and depression, they examined the overlap between each disorder’s symptoms to find out which ones bridge the relationship between the two. As they note, “a bridge symptom can be conceptualized as a stepping-stone in a pathway from one disorder to another; the presence of this symptom increases the likelihood that an individual will develop the secondary disorder” (p. 532).

Thinking now about those “bridge symptoms,” consider how the social anxiety symptom of not wanting to be around other people would connect to the depressive symptom of feeling sad. It makes sense that when you’re overwhelmed by the fear of being evaluated by others, you will also become more likely to have trouble sleeping. The night before that retirement party, as you feel paralyzed by the fear of giving a speech, you will probably also toss and turn rather than get a good night’s rest.

To test the validity of their model, Langer and her colleagues used a clinical sample of 130 women ranging in age from 18 to 59 (36 years old on average) who had diagnoses of social anxiety disorder and major depressive disorder. The women completed measures of social phobia/anxiety, depression, and a short version of the Five Factor Inventory, using scores on the neuroticism and extraversion scales.

Rather than simply examine correlations among the measures, however, the authors chose specific items that they believed would represent the “nodes” that would connect the symptoms. The seven nodes, then, were as follows:

1. Anxiety when in an embarrassing situation with a specific person (an authority figure, a stranger, or a possible romantic figure)

2. Anxiety when having to speak in front of a specific other person (same categories as above)

3. Intensity of feelings of depression

4. Inability to feel happy, as shown by not being able to laugh easily or to feel cheerful

5. Feelings of worthlessness

6. Irritability

7. Unstable mood, such as feeling that you’re “going to pieces” when you’re under a great deal of stress

In modeling the relationship between symptoms of depression and social anxiety, the authors identified connections among irritability, feelings of worthlessness, mood instability, depressed mood, positive affect, social avoidance, and social fear. The key “bridging” symptom in their model proved to be feelings of worthlessness. In contrast, social fear and depression, the so-called “hallmark” symptoms of each disorder, were not directly connected. However, worthlessness ratings related to social fears through the route of depressed mood and mood instability. It was impossible to tell, as noted by the research team, whether social anxiety causes depression or vice versa. The direction of relationships might also differ from person to person. You might be depressed because you are socially anxious, or your social anxiety can lead you to feel depressed. Worthlessness plays a central role in both disorders in either case, however. Once those feelings that you’re undeserving come into play, the other mood and anxiety symptoms may follow in turn.

In either case, the Washington University authors concluded that, based on their findings, it might be more effective for people seeking therapy to receive interventions that target specific symptoms of the disorders rather than look at them in a more global sense. Worthlessness, as the bridge symptom, might be an area that therapists can focus on, because of its central role in both disorders. As they note, “targeting a symptom that appears at the center of the network may facilitate reductions in symptoms of both disorders” (p. 537).

Once you feel that your symptoms can be addressed, you may be well on the road to finding your feelings of dread and sadness subside. Social occasions can be the source of great fulfillment, and by reducing your anxiety, that fulfillment will be that much more achievable.

References

Langer, J. K., Tonge, N. A., Piccirillo, M., Rodebaugh, T. L., Thompson, R. J., & Gotlib, I. H. (2019). Symptoms of social anxiety disorder and major depressive disorder: A network perspective. Journal of Affective Disorders, 243, 531–538. doi: 10.1016/j.jad.2018.09.078