Hi, I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Today I'm talking about having a fear
of losing control and how it can lead to social anxiety.
Social anxiety disorder is a disorder
where you experience intense anxiety
when faced with a social situation
or needing to perform in front of others,
and in this case, performing goes beyond
playing an instrument on a stage or public speaking.
It can be anything that you need to do
in front of people, like ordering from a menu,
eating in front of people,
urinating with someone nearby,
or answering questions in class.
You may think these situations make me uncomfortable, too.
Does that mean I have social anxiety?
Not necessarily.
There's a certain amount of angst
or nervousness anyone can have doing
something in front of people.
Some people have more confidence with this than others.
The difference between normal social anxiety
and a disorder is people with social anxiety disorder
have an intense fear of being humiliated or judged,
and because of these fears,
they avoid situations like this at all costs,
like maybe skipping school or calling out sick
from work every time you need to present something.
Avoidance is one of those things
that reinforces the fear and makes it worse.
The more you avoid the situation,
the more anxious you become when you're forced
to deal with the situation.
Fearing uncertainty is one of the baseline fears
behind anxiety disorders, including social anxiety.
Some people are better able to tolerate
not knowing the future than others,
but another fear associated with social anxiety
is fear of losing control in front of people.
This is not a fear you would experience
to any significant degree
if you had normal social anxiety.
You essentially fear losing control
over your emotions, physiology, or your behavior,
and here are some examples.
You may fear that you'll suddenly snap
and start acting irrational in front of people.
You fear that you'll be triggered and lash out
at someone physically or you'll lose control
of your bowels in either pooping your pants
or make a lot of noise in the bathroom
and people nearby will hear you.
You may fear that you'll lose control
while you're driving and hit someone,
and this is a fear that some people
with OCD will have that causes them
to compulsively backtrack their path
to make sure that they didn't hit
someone while they were driving
or just stop driving altogether.
These fears would be considered
maladaptive beliefs about future outcomes.
That's how we look at it.
The reason they are not the usual thoughts
of someone with a normal level of anxiety
is that people with the disorder
of social anxiety have a negative bias
that skews your thoughts towards things
that confirm your negative assumptions.
So for example, after you engage in a social situation,
you review how things went
and overly focus on negative cues.
This is referred to as post-event processing.
For example, you can say,
"I saw this person in the corner yawn
while I was talking,
which means I was boring."
Or "When I walked out of the bathroom
people were laughing because they were listening to me.
I made a fool of myself and people are disgusted by me."
Through the post-processing,
you gather evidence that reinforces
your negative views of yourself.
I'm socially incompetent.
I'm not capable of pulling off a good impression,
people don't respect me, et cetera.
This process generates more anxiety
when you anticipate a new event.
You carry over these negative biases
onto the future event and believe
that you will humiliate yourself even further
when you lose control of yourself.
Another form this fear of losing control
can take is fearing you will lose your mind and go crazy.
Sometimes people with general anxiety can feel this.
Their general anxiety is not focused
on social situations or performing,
but they can feel that their internal anxiety
will continue to escalate to the point
that they just lose it and start acting hysterical.
Making someone think that they need to go
to the hospital or they can fear
that their loss of control may cost them
to sabotage a good thing that they have going
or even hurt themselves or someone else.
Usually the more intense the anxiety,
the more likely you think that you're going to lose it.
What's the difference between having this fear
and having an obsession?
It depends on how persistent the thought is.
It can be a subtle distinction.
Anyone can become obsessed
or over-focused on a single thought,
but people with obsessive compulsive disorder
have thoughts that are intrusive,
meaning they pop into your mind at unwanted times.
The person with general anxiety or social anxiety
can fear losing control,
but this is a belief that runs in the background
and informs their decisions about things.
You're not actively thinking about it all the time
and the fear doesn't necessarily overwhelm you,
but it can keep you from wanting to go places
or make you feel very anxious
when all eyes are on you for something.
You can think of an obsession
as a more active thought that interferes
with your other thoughts.
You can't easily distract yourself from it
so that you can just continue going on with other things
and this is where compulsions come to the rescue.
Compulsions are behaviors you engage
in to lessen the anxiety from the obsessions.
Also, with the obsessions,
there can be a mixture of pure thought
or fantasy and then images.
A fantasy would be me fearing
that if I go to this place tonight,
I might get triggered and become enraged.
I don't necessarily play out in my head
what would happen if I got that angry.
I just know that I don't want to go there,
but the obsession gets darker
if I see images of myself in a rage,
throwing things at people's faces.
I can even see an image of my superior looking shocked
while they're holding their bloody nose.
Then if I had OCD, I may fiddle with my hands
to offset the act of throwing something.
Doing this 10 times makes me feel less anxious
because I feel that my hands are occupied
and unable to do something bad.
So that's a hypothetical example of the difference
between having a fear that affects your behavior
and decisions you make versus an obsessional level
of fear that consumes you and results in compulsions.
Fear of losing control is something that anyone
with anxiety can experience,
but a new research study shows
that it may be something that can lead people
to developing social anxiety.
If you do have these fears, what can you do about it?
There's several approaches usually done best
with the help of a therapist.
One approach is called systematic desensitization
and this is a form of exposure therapy,
where you face your fears by placing yourself
in situations that resemble the situation you fear.
If I fear becoming hysterical
and out of control in a group,
I can test my assumption
by interacting one on one at first,
then moving up to a couple of people
or being around familiar safe people
and then being around strangers.
Another approach is to challenge your assumptions,
especially the ones you make
during the post-event processing that you do
after you've been in a social or performance situation.
For example, suppose I fear that if I speak in a group,
I'll start gagging uncontrollably.
The last time I went out,
I felt a lump in my throat,
which reinforced that fear.
Feeling a lump in your throat is a symptom of anxiety
so it's no surprise that while feeling
anxious in this group, I felt a lump.
But in my post-event processing,
I saw that lump as evidence that the gagging
was about to start if I hadn't left when I did
or that the lump was a warning sign
that the next step would be choking.
Kind of like being repeatedly exposed to something
if you're allergic.
The allergic reaction just keeps getting worse
every time you have another exposure.
It's a similar kind of thinking.
I had the symptom, next time,
it's just going to be tons worse.
That's the distorted rationale
I use to justify avoiding the situation the next time
and it makes sense in my head
because it supports my negative assumptions about myself.
But when I challenge the thought
with a rational mind, I see the lump
as simply an anxiety response that I can lessen
by practicing some anxiety reducing techniques
the next time I'm in that situation,
like grounding exercises, breathing
or making my vocal chords vibrate.
You can learn more about that in this video
called "Using Your Vagus Nerve to Calm Yourself."
I hope this was helpful.
Thanks for watching.
See you next time.