First publication on social anxiety

My first journal article has been published in the journal Social Science and Medicine. The project prioritises the voices of people who have lived experience with social anxiety. This article considers how people actively live and cope with social anxiety and the particular strategies they employ to help manage distressing and disruptive anxious experiences. Request copy from author here.

Boyle. L.E (2018) The (un)habitual geographies of social anxiety disorder, Social Science and Medicine, DOI: 10.1016/j.socscimed.2018.03.002

Abstract:  This article investigates experiences of Social Anxiety Disorder (‘social anxiety’) with reference to recent geographical debates on habit. It considers how habit simultaneously captures (un)reflective modes of being in the world and the foreboding disruptive capacity of uncertainty as people attempt to adapt to, negotiate and manage everyday life with social anxiety. Drawing on lived accounts from online questionnaires and online interviews with people diagnosed, or self-diagnosing, with social anxiety, it uncovers the relational and embodied practices-and the inherent spatialities of such practices-that enable individuals to (re)gain control of their socio-spatial surroundings. It also considers the capacity for habits to become disrupted and displaced through pervasive anxieties and persistent rumination and anticipation, situated within the context of participants’ everyday lives. This analysis highlights the social, spatial and temporal dimensions of socially anxious experiences. Overall, by interpreting lived experience in this way, this article introduces a socio-spatial dynamic to otherwise extremely limited accounts of social anxiety found outside of the dominant biomedical framework.

 

Do we need to learn self-compassion?

There is some interesting new research being conducted about social anxiety.

In speaking to people with social anxiety, and being a member of community forums for a number of years, it has become apparent to me that there is a relationship between negative experiences and social anxiety. The level of self-doubt and critical self-reflection (and expectation! ‘I can’t do that/I’ve already failed’) that people experience is overwhelming. This is borne out of societal pressures as much as negative experiences but it is such an innate part of the experience of social anxiety. This self-fulfilling prophecy, where our negative expectations are confirmed by our perceived inability or failure to do something feeding into current fears and anxieties, reinforcing them and making future situations even more distressing – like ‘layers’ of anxiety. Many participants who took part in my research talk about ‘vicious cycles’ in which they feel ‘trapped’ by their anxieties that affect their self-esteem, belief, confidence and overall mental and emotional health and wellbeing.

What seems great about this study is that it is online. Sapach (the researcher) quoted in the article says the online element ‘will be extremely useful in rural areas where face-to-face care is impossible to find.’ While this is important, for me it goes beyond that. Going to a doctor or even speaking to a family member or friend is terrifying. Online methods were extremely important to my own research. This method might encourage people to participate because face-to-face interactions are distressing allowing them to focus on becoming less self-critical without the horrible sense that you are being watched and scrutinised by others.

However, I think it is a real challenge for people to recognise and put in place new habits without some form of external support. It can extremely patronising and frustrating when people say ‘be kind to yourself’ but I think it’s important that we recognise this ‘inner voice’ that is critical of what we do (or don’t do!) and the way we do it. The self-help movement and ‘recovery’ model are heavily criticised for pushing autonomous recovery that drives people away from already stretched mental health support services (which is a whole different argument in and of itself that I won’t get into here but see: cuts/austerity/reform). Unless implemented alongside other support services this tool could just be another in the ‘self-directed recovery’ toolbox that fails unsupported individuals as they struggle with their mental health. Equally, it could ‘ease’ social anxieties enough to enable them to seek further support.

These are some preliminary thoughts, it will be interesting to read more about the findings in the future.

Anxiety: Fashion statement?

I saw on Anxiety UK’s twitter this morning that they have launched a christmas jumper knitting pattern.

I was reminded about an article I read on Youth Focus years ago: Anxiety isn’t a fashion statement. It features a comment by Prof. Ron Rapee, a psychologist, who has contributed a tremendous amount of work to understanding social anxiety, about ‘trivialising anxiety’. And a more recent article by Sally Buchanan-Hagen, Mental Illness is not a Trend, who criticises the portrayal as mental illness as somehow ‘desirable’ or ‘advantageous’.

So, while I think Anxiety UK do a great job advocating, and providing services, for people with anxiety – equally, not ignoring that this pattern is likely to be purchased by people who experience debilitating anxiety and the benefits people gain from being creative and crafting – there is a danger here that such products feed into a narrative that considers mental health problems to be a fashionable statement piece and, as Buchanan-Hagen states, ‘quirky’ and ‘eccentric’.

 

 

 

 

 

Radio Interview on Social Anxiety

anxious spaces

Last October I was invited to take part in a radio segment called ‘Sense of Place’ with Minelle Mahtani of Roundhouse Radio based in Vancouver, BC. I was discussing my research, where I explore people’s everyday lived experience of social anxiety paying attention to the specific interactions, situations and spaces that cause anxiety (and why?), and how they adapt to every day life with social anxiety.

I’ve been reluctant to share this. I still haven’t listened back to it. But I feel it’s important for others with social anxiety to know that people are working on this; listening, talking and sharing.

You can listen on the link below:

http://cirh.streamon.fm/listen-pl-5766

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Social anxiety: planning and rehearsing

Anxiety has the capacity to disrupt our daily lives making even the most inconsequential and mundane daily tasks seem impossible to complete. Throughout my research I have become increasingly interested in how people actively live with and manage their social anxieties often in ways that are extremely time-consuming and exhausting.  Participants discuss a wide range of skills, habits and practices in the vein of living with social anxiety (i.e. not strictly recovering from social anxiety).

One prominent example uncovers how anticipatory anxiety (i.e. the anxiety/feeling of dread leading up to an ‘event’) triggers extensive ‘planning’ and ‘rehearsal’ of everyday tasks, social interactions and itineraries in order to try to limit or avoid anxiety-provoking encounters:

I plan a lot to, sort of, limit what can go wrong or reduce the risk of embarrassing myself. I usually write out what I need to say [when] making call so I don’t get flustered or stutter [because] I get really anxious and stutter. It helps me build up some courage for it, you know? (Jo)

However, for some, this ‘rehearsal’ can contribute to feelings of self-doubt and be extremely debilitating:

[… S]ometimes the more I think about it the worse it gets. It’s praying on my mind that much –  it’s all I’m thinking about, trying to work out how I’m going to get through it* – I’ll just avoid it altogether. (Gillian)

Managing social anxieties often involves intense periods of time thinking through the potential consequences and outcomes of social interactions or performances and how to mitigate the risks. This, although immediately beneficial, may have longer-term impacts on individual’s health, wellbeing and wider social networks/worlds. For some people, they provide a path to live with social anxiety; for others, they have the capacity to further disrupt their everyday (and whole) lives (but, equally, need to be recognised to understand how people negotiate and make sense of their experiences with social anxiety).

*Gillian is referring to course requirements of her University course for example, giving presentations and working with others, and by extension, speaking to lecturers about the difficulties she faces. She often avoids them which has a detrimental impact on her studies.

 

 

 

 

 

 

 

Radio Interview on Social Anxiety

Last October I was invited to take part in a radio segment called ‘Sense of Place’ with Minelle Mahtani of Roundhouse Radio based in Vancouver, BC. I was discussing my research, where I explore people’s everyday lived experience of social anxiety paying attention to the specific interactions, situations and spaces that cause anxiety (and why?), and how they adapt to every day life with social anxiety.

I’ve been reluctant to share this. I still haven’t listened back to it. But I feel it’s important for others with social anxiety to know that people are working on this; listening, talking and sharing.

You can listen on the link below:

http://cirh.streamon.fm/listen-pl-5766

Can we stop talking about broken brains?

I’m writing a paper about how people with social anxiety live and cope with their experiences. Since I started writing, I’ve been antagonised by a few articles on Twitter suggesting that our socially anxious brains can be “normalised”. I have spent the last few weeks (also, years) looking through existing research about social anxiety. Frustratingly, accounts exist in predominantly biomedical, clinical and/or cognitive behavioural frameworks where the focus is on presumed brain abnormalities and distortions in cognitive processes. I was scrolling through Twitter this afternoon and this article in the New Scientist caught my eye: Fixing broken brains: a new understanding of depression. The title alone sent my eyes rolling so far into the back of my head as I tried to convey everything I wanted to in a 140 character re-tweet. I couldn’t.

This “new understanding of depression” sounds remarkably like the old: Your brain is broken. This perspective, pervasively biomedical in its outlook, is what cuts through attempts to address the stigmatising attitudes geared towards mental health experiences. Perspectives so ingrained with ideas of being weak, broken, in need of “fixing” and being “normalised”. These attitudes have been identified as one of the primary barriers and deterrents to people even attempting to seek help or support. These perspectives fail to take seriously the lived, social, cultural, environmental, spatial, emotional, affective dimensions that shape, and are shaped by, experiences of mental health. They also portray an extremely linear model between diagnosis, treatment and cure failing to recognise the everyday knowledges, routines and strategies put in place in the process of negotiating everyday life and living with mental health problems outside/instead of traditional treatment pathways.

So, can we stop talking about broken brains and dig a little deeper?

Where does social anxiety come from?

I found this article by counselling psychologist Bill Ramer: What Social Anxiety Feels Like and Where It Comes From? His focus on family systems as a causative factor for social anxiety is important. It shifts away from the dominant medical and clinical discourses I come across every day when reading about social anxiety towards an understanding of how our environments and relationships play important roles in shaping mental health and responses to perceived threats.

Internal Mirror Image

Many of those who have taken part in the research say they feel unable to participate in the social world due to the fear of shame, guilt, judgement, humiliation and/or embarrassment that particular encounters can generate. Their lives are disrupted by anticipatory anxiety, anxiety manifesting as symptoms (‘body-events’) (Smith 2013), negative self evaluations and avoidance behaviours, discussed by Ramer. Some also recognise their family systems as integral to their social anxiety, these negative experiences and/or relationships become internalised and play out across their social worlds:

“[my stepfather] has a very authoritarian personality and during the time I was around him growing up I think he massively shaped what I like to call ‘the other side of me’, imagine living with a military commander who watches your every move, criticises everything and over reacts to everything …

I find myself reacting overly fearfully when people raise their voices because of the way my stepfather used to shout, you know the phrase ‘sent me back to my childhood’, it’s like that”

                                                                                                                          (Anna,interview)

The processes through which this internalisation happens are unconscious but there is still a very conscious awareness of ‘where social anxiety comes from’. Sarah correlates current anxieties about people in authority, a common trait for social anxiety, with her childhood experiences and fear of her step-father.

Inner/Outer worlds

From a therapeutic point of view, focusing on ‘inner worlds’ offers a different perspective of ‘you’. People who experience social anxiety are often sensitised by the perceived inability to perform ‘correctly’ in social situations, which leads to negative self-evaluations:

It pulls me down because all social interactions make me feel shit about myself. Not Good Enough. Stupid. Selfish. Pathetic. Wrong. All of those negative judgements that I think of myself, and I perceive others are thinking of me, stick with me for a long time, if not forever”

(Sarah, interview)

Anxious experiences are a product of the perceived threat of what is going on internally, in our minds and through our bodies (i.e. thoughts, feelings and sensations which often feed the anxiety) and externally (i.e. interactions, situations and environments). These experiences have the capacity to reinforce a person’s poor self-image and results in a vicious cycle of negative self-evaluations, as seen in Sarah’s ‘self-talk’, that contaminates social interactions and increases the likelihood of engagement in avoidance behaviours – aspects I explore further in the research and will hopefully blog about soon.

References

Ramer, Bill 2016 What Social Anxiety Feels Like and Where It Comes From, GoodTherapy.Org, Published: March 31st 2016, Accessed: 5th April 2016.

Smith, N. 2013. The everyday social geographies of living with epilepsy. Unpublished PhD Thesis, University of Glasgow.