People with social anxiety disorder,
fear negative criticism in social
and performance situations.
You fear that you will act in a way that's humiliating
or embarrassing.
And this fear causes you to do things,
to eliminate the possibility
of being humiliated or embarrassed.
I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Today, I'm talking about avoidance behaviors
that we call safety behaviors.
A safety behavior is something that you do to avoid, escape,
or reduce the severity of a perceived danger.
Performance is more than standing on a stage
and giving a speech or playing an instrument.
It can be talking in a small group of people.
Having someone look over your shoulder
and observe your work.
Or it can be taking a test.
Or even eating or using the bathroom in public places.
Some of these things can make anyone apprehensive.
But the key ingredient
that converts apprehension to a phobia is avoidance.
When you avoid something,
the monster behind the curtain grows larger
and takes on a life of its own.
You can get to where you have a massive amount of fear.
It just the thought of having to perform or interact.
For example, you can start feeling uncomfortable
around unfamiliar people.
And you can feel awkward.
And every time you make yourself go out,
you come home feeling completely depleted
and maybe even demoralized.
You spend a lot of time ruminating over past situations,
over and over in your head,
and convince yourself
that you made a total fool of yourself.
If you succumb to safety behaviors
that allow you to avoid the risk of humiliation,
you can get to the point that sitting at home,
thinking about interacting makes you have anxiety.
Before, it was only if you force yourself to go out,
but now, sitting in your home alone,
you can still feel anxious about what you're not doing.
It can take on more of a generalized anxiety picture
of always being tense instead of only being tense
when you have to perform.
So what are these safety behaviors?
Here are some examples.
Talking fast, or nonstop to avoid silence.
Looking down at your phone to keep people
from approaching you.
Talking very softly so you can easily be ignored.
Avoid sharing personal information.
Constantly seek approval, like asking, "Is this good?"
Or, "Am I okay?"
Holding your arms or hands stiffly by your sides
to hide you're shaking hands.
These safety behaviors can do more harm than good.
When you engage in them,
you believe that your actions have prevented you
from experiencing more anxiety or humiliation
during your social interactions.
And they can make you feel better and safer
in the short term.
But safety behaviors actually reinforce your fear
because they prevent you from getting accurate information
about the actual level of threat.
They can also cause you to experience the feared outcome.
Here's an example.
Let's say you go to a work-related social gathering.
Your biggest fear is people thinking that you look strange
because if you're trembling hands.
So you keep them pinned to your side all night.
And this is an event that involves alcohol and music.
So people are talking very loosely,
and there's a lot of close talking.
And someone says, "You look a little uptight,
are you okay?"
And you think, "How can they tell?
"I knew I shouldn't have come,
"but at least they couldn't see my shaky hands."
And this simple example, the safety behavior is
keeping your arms pinned to your sides.
And you may feel some relief
that no one saw your hand shaking,
but you don't appreciate that you look awkward
with your stiff arms by your side,
especially in a setting where other people are loosened up
from alcohol.
So in your attempt to look normal,
you make yourself look stiff
and reveal your social awkwardness.
And this is the very outcome that you feared.
Even if no one had said anything to you about your arms,
keeping them by your side, robs you have the opportunity
to see that maybe people really won't notice your hands.
Maybe your nervousness isn't as obvious as you think it is.
Especially if the only way that someone can tell is
by looking at your hands.
You don't get a chance to prove your fear wrong.
And the fear just gets inflated.
So engaging in a safety behavior and having it work for you,
reinforces your fear.
How do you break through the wall of avoidance?
You intentionally expose yourself to the situations
that make you anxious.
And this is called exposure therapy.
It works through the concept of extinction.
Extinction is based on learning theory
when an expected response goes away
because it's no longer reinforced.
So if you see a dog for the first time and it bites you,
you become afraid of dogs.
You may avoid dogs,
which reinforces your belief that they're dangerous.
You believe that staying away from them is
what kept you safe.
And you don't entertain the possibility
that not all dogs are dangerous.
If you are exposed to many different dogs that are friendly,
over time, your fear wanes and becomes extinguished.
The most effective way to do this is
under the guidance of a therapist,
who can help you design some situations
that involve your fears and perceived threats.
To do this on your own, though,
you would put yourself in situations
that you find threatening.
You can do this exposure gradually
by practicing the activity around people you know,
and are comfortable with.
And then gradually advance to more threatening situations
with unfamiliar people or authority figures.
To help you with the anxiety,
you can pair the activity with the relaxation activity,
like deep breathing.
Some people call this anchor breathing.
You imagine yourself as a boat, floating on the water.
The boat has an anchor to keep it in place.
And similarly, think of your belly, nose, mouth, and chest
as grounding forces that will keep you
from feeling overwhelmed.
You can spend just a few minutes taking deep breaths
before the activity, and then afterward.
And then the relaxation can neutralize
the anxiety of the situation.
When you practice the exposure,
you want to let go of your safety behaviors.
To recognize your safety behaviors,
ask yourself, are you doing anything
that stops the feared outcome from happening?
What do you do to make yourself feel more secure?
Then after each activity,
address the following questions in a journal.
What did you fear what happen?
What actually happened?
What did you learn?
You want to continue to do the exposure until
you don't experience the feared outcome.
That may happen after one try or it may take several trials.
There's a modern learning concept called
inhibitory learning theory.
The idea is that memories are stored in your limbic system,
in your brain, and they're not erased.
New related memories don't replace the old ones,
but lie alongside of them.
When you have an experience that's related to the memory,
there's a competition for which memory is retrieved.
So in my dog example, when I see a dog,
there's a competition for which memory I'll focus on.
The one where I was bitten?
Or the one where I was licked?
To get your mind to selectively work
with the positive memory,
you need to periodically practice the exposure exercises
to reinforce the new memories.
Think of it as giving yourself a reminder tune up.
Another thing that you can do
to extinguish the negative emotions around the experience is
to put your negative feelings into words.
This is called an effective labeling.
The part of the brain that's involved in this process
is the prefrontal cortex.
Engaging your prefrontal cortex
modifies your limbic response.
And what's your limbic area?
The limbic area is the part of the brain
that stores emotional memories.
So in my dog example, when I see a new dog,
I can say, "I don't trust this dog."
Or, "I feel mistrustful."
Or I could say,
"I feel unsure about this dog."
For more on social anxiety,
watch this video.
I hope this was helpful. See you next time.