Amplifying Positivity to Mitigate Social Disconnection

People experiencing social anxiety disorder fear that something bad will happen in social situations—that they might do or say something that elicits a negative response and rejection. They adopt avoidance strategies: They may not socialize at all, or they may use subtle behaviors when socializing like avoiding eye contact, not talking, or deflecting conversations by asking a lot of questions. In trying to mitigate their fears, however, such behaviors keep them from learning whether their fears are true or as bad as they expect.

Cognitive behavioral therapy (CBT) is the first-line psychosocial treatment for mental health conditions like anxiety and depression. In a CBT program I ran as a graduate student, we taught people experiencing social anxiety disorder to confront social situations and reduce their avoidance behaviors, so they could gather evidence about whether the real outcomes would be as bad as they feared. This was helpful—to a point.

One man had developed an elaborate set of strategies to avoid interactions, as he feared that others would criticize and reject him. When he joined our program, reduced those avoidance strategies, and tested out his fears, he realized they didn’t come true. In fact, people were responding to him very positively.

An odd thing happened, though: Partway through the program, he discontinued treatment. He said that, although his anxiety was diminishing and his fears were proving unfounded, he wasn’t enjoying the interactions or feeling a sense of connection the way he’d hoped.

The gold standard treatment was working exactly as it was supposed to. But it wasn’t enough. I needed to learn what was missing.

We know that social disconnection is increasingly common—that we are, in the words of one paper appearing in JAMA Psychiatry, “Battling the Modern Behavioral Epidemic of Loneliness.” Moreover, we know that loneliness has startlingly negative consequences: One meta-analysis—combining data across more than 300,000 participants—found that lack of social relationships has as much of an effect on a person’s risk of death as smoking, and even more so than inactivity or obesity.

What was missing from my patient’s protocol, it turns out, may have been positivity. Positivity is a fundamental building block of social connection.

People experiencing anxiety or depression tend to exhibit diminished positivity, in their thoughts, behaviors, and feelings. That compounds the trouble connecting that they would otherwise have—at the very time they need to connect most acutely. Their disconnection increases; their loneliness increases; their anxiety and depression increase. They can be trapped in a vicious cycle.

Worse yet, positivity isn’t fully improved by the current standard treatments for those mental health conditions, whether pharmacological or—as I saw in my CBT program—behavioral. .

This is what my research lab, the Positive Emotion & Anxiety Research Laboratory (PEARL), at the University of California San Diego is trying to achieve. We are investigating positive emotion strategies to treat anxiety and depression and improve social connectedness.

Because we know some of the factors that contribute to social disconnection, we can evaluate the effects of targeting those factors—real-world actions we can “prescribe” to help individuals improve their positive thinking, behaviors, and emotions, and, therefore, we hypothesize, their connections and mental health. We developed, and are continuing to test, an approach to fill the treatment gap we identified.

Brain imaging studies show that, when anticipating potential social reward (i.e., receiving positive feedback), there is a difference in the striatum between people experiencing an anxiety or depressive disorder compared with those who aren’t. The striatum is responsible for signaling whether something is valuable and worth pursuing; it guides behavior toward obtaining desired outcomes. This part of the brain is less active in people experiencing anxiety or depression in response to positive social cues, hinting at a possible source of social disconnection.

Anxiety Essential Reads

How to Grow Your Tolerance for Uncertainty

How Long Do Panic Attacks Last?

The neural data corresponds with other work in our laboratory, in which we pair a patient with a lab assistant for a social interaction involving answering questions and sharing information about themselves. We’ve found that people with anxiety or depression, compared to those without, are less likely to desire future interaction with their conversation partner.

And the feeling appears to be mutual. The assistant is less likely to desire future interaction, too. Both parties aren’t driven to connect with one another.

Anticipating social rewards and desiring future interaction are what drive us as humans to connect. We’re wired to see social contexts as an opportunity for belonging—or rejection. Although fears of rejection can certainly hold us back from connecting with others, so too can diminished positivity– that anticipation and drive towards positive social outcomes.

In anxiety and depression, the ability to experience positive emotions or to exhibit social approach behaviors like self-disclosure or responsiveness is diminished. So, too, are parts of the brain signaling when positive social outcomes are possible. Social positivity is dimmed.

Our treatment approach takes patients through weekly sessions in which they learn strategies to take home and apply in their daily life. Strategies include:

• Noticing positive events throughout the day while carefully noting various qualities about each event and one’s reactions to them.

• Amplifying positive events by applying a variety of tactics (e.g., savoring, reminiscing, sharing with others) to make them less fleeting and more impactful.

• Gratitude reflection through a journaling practice.

• Gratitude expression by sharing appreciation for others.

• Engaging in acts of kindness on a day (or days) of their choosing and then reflecting on them.

• Scheduling events that are pleasurable, meaningful, and engaging, and amplifying one’s response to those events.

Our initial protocol lasted 10 weeks (though we have since had similar results with a five-week protocol and are now studying the shorter version further). The primary outcome was an increase in positive emotions. Not only did we succeed in bringing our patients back to a level of positive emotions reported by people in the general community—something antidepressants and CBT do not always do—but the improvements lasted for at least six months.

In a recent extension of the initial study, we examined whether our program affected regions of the brain that are involved in anticipating social rewards. Brain activation in the striatum was indeed improved in the treatment group compared with those not receiving treatment. As with our initial study, patients in our program also reported improved social connectedness, decreased loneliness, and greater positive emotions.

This type of treatment, focused on social positivity, could work in conjunction with other interventions: changing an accustomed pattern of relating to one’s world by opening up to new perceptions and experiences of the everyday. Rigorous science is needed to answer questions about the effects of targeting positivity.

Positivity connects us. Diminished positivity disconnects us. Amplifying positivity may therefore boost social connection and help combat symptoms of mental health conditions like anxiety and depression.

Dr Charles Taylor

Source: Used with permission

Dr. Charles Taylor is an Associate Professor at the University of California San Diego, where he directs the Positive Emotion & Anxiety Research Laboratory (PEARL). Dr. Taylor’s research is devoted to improving treatment outcomes in anxiety and depression. His lab investigates why people prone to anxiety or depression feel socially disconnected and using that knowledge to develop and test interventions to enhance positive emotions, social connections, and well-being.