Do you excessively worry attending a dinner party?
Or panic when asking for simplest things from your colleagues or friends? Here's my favorite: sitting in your car outside of an appointment, unwilling to leave your car because you're convinced that you have the date wrong... even though you triple-checked your calendar?
Social anxiety is real.
Research shows up to 40 percent of people face problematic anxiety at some point in their lives. But how do you know what's normal and what's "problematic"? Where do you go for help? What if you're too embarrassed to seek help? In fact, what if asking for help is the cause of your anxiety?
This stuff is no joke, and it's the exact kind of fear that slowly and steadily impacts your quality of life. Not in a good way.
I spoke with Dr. Russell Morfitt, a practicing psychologist and co-founder of Learn to Live. Learn to Live offers online programs for people with social anxiety and other mental health disorders. We talk about what social anxiety looks like, when to seek help and why combating your anxiety from your privacy of your personal computer may work just as well as face-to-face treatment.
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You started your career as a mechanical engineer. What was the moment that pushed you to pivot and pursue psychology?
Dr. Russ: I remember the afternoon when one of the other engineers in my group received a new piece of equipment and how thrilled he was with it. That look of excitement gave me pause; I began thinking about the parts of my job that inspired me, and it wasn’t equipment. I had worked in engineering for only a few years, but had been given the opportunity to supervise others in the organization. The parts of my job that truly inspired me most did not necessarily involve engineering per se, but rather helping people solve problems and plan solutions.
I also remember friends and family members who were encountering challenges, like stress, anxiety or depression. I wished I could be of assistance to them, but I didn’t have the training. When I actually did help them in some small way, I found those moments extremely rewarding.
I was living in California at the time and felt it was time for new experiences and new adventures, so I decided to explore psychology.
There are so many sub-categories in the field of psychology. Why did you decide to specialize in social anxiety?
Dr. Russ: The field of psychology is very broad and the corner of psychology that addresses human suffering seems only slightly less broad. Social anxiety is part of that corner.
In my clinical work and in Learn to Live, much of my focus has been on social anxiety. This is due in part, no doubt, to my own challenges in the area. I realized that even though I had been generally successful in my career, I had some difficulties with anxiety. I learned that many of my personal challenges were borne of my anxieties about how others perceived me. I became aware of the ways that my behavior patterns reflected that anxiety. So social anxiety has been a focus of mine by its nature as a personal challenge for me. I think that’s how it often goes; we tend to be especially fascinated with those areas in which we’ve personally experienced some difficulties.
How many people struggle with social anxiety? What does it look like? How does it feel?
Dr. Russ: The research shows that 13 percent of the US population suffers from diagnosable social anxiety or emotional distress, which is characterized by fear of judgment, criticism, or observation by others. Other research suggests that up to 40 percent of the population experiences problematic shyness at some point, [meaning] a level of social discomfort and impairment that may not be equivalent to social anxiety, but that still negatively impacts individuals on a regular basis.
Cognitive Behavioral Therapy (CBT) has proven to be the most successful treatment. But 75 percent will not seek treatment due to some combination of stigma, cost, and availability.
As for its manifestation, social anxiety involves excessive worry about social situations in which we feel observed, criticized or judged by others. At work, we may have difficulty delegating tasks, making requests, or confronting others. Social anxiety can impact performance or transactional situations, too. What if I sound stupid giving this speech? What is the cashier going to think of me if I make this return?
One of the additional challenges of social anxiety is that we worry that others actually notice our anxiety. In addition, by avoiding fully engaging with others we may appear as stand-offish or stuck up, so our prediction that they won’t like us may actually become a self-fulfilling prophecy.
Social anxiety typically involves avoidance patterns, like censoring our words or avoiding eye contact and conflict. Many people with social anxiety problems stay home as much as possible, or stay close to safe people they trust. It can affect family, friends, and career. People with social anxiety are less likely to seek out promotions or to solicit feedback for improvement.
What exactly does Cognitive Behavior Therapy mean?
Fundamentally, it means that people learn to change their thought patterns and their behavior patterns in a structured, systematic way.
The “cognitive” relates to thoughts, in particular learning to identify unhelpful thoughts, to challenge them, and ultimately to change them for healthier thoughts. In doing so, people start to realize that the objective danger is smaller than they thought – that either things that they feared are less likely to come true, or if they were to come true, that it might be less terrible than they initially imagined. So their knee-jerk assumptions or beliefs about the dangers out there may not be entirely accurate.
I think a lot of people believe they can “think” or “talk” their way out of social anxiety. I’m a smart person, I know I’m not in danger, so why am I feeling this way? What problems does that rationale create?
Dr. Russ: A common misconception about Cognitive Behavioral Therapy is that we can just change our thoughts. And to be honest, it sometimes stops with that in the therapist’s office. But a more accurate picture of CBT recognizes the importance of examining and changing both thoughts and behaviors.
It’s important to identify specific thoughts we’re having, then examine them and choose more reasonable or useful thoughts. We might call it thought challenging or cognitive restructuring. But, it can’t stop there. Research has demonstrated that the most powerful elements of CBT for anxiety problems are the subsequent steps of reducing unnecessary precautions and facing our fears – the behavioral aspects.
At Learn to Live, we’ve built opportunities to not only challenge thoughts, but also to change behavior as members gather data on what happens around them. For example, making more eye contact or stop censoring our speech so carefully. Activities like fear-facing allow members to get that deeper, gut-level knowledge that they don’t need to be afraid.
When is a good time to seek out professional help?
Dr. Russ: The short answer is when motivation is high. If I’m frustrated enough about the limiting aspects of my suffering, I’m motivated to make the necessary changes. It could mean seeking out face-to-face therapy, medications from a primary care physician, or an online CBT-based program like Learn to Live. But the research is clear: change is more likely to happen when we’re highly motivated.
Tell me the story behind Learn to Live. Why did you create it? What specific gap in the marketplace does it fill?
Dr. Russ: I remember the moment when I first conceived of the idea for Learn to Live. I had just learned that yet another patient who was seeking therapy, someone open to making the long drive, just couldn’t accept the long wait time until my next opening. People suffering from social anxiety who finally muster the courage to make an appointment too often find out that the wait is too long, or that the provider does not provide the kind of therapy [they need].
Seventy-five percent of those who suffer from social anxiety don’t even reach out for help. I saw so many people helped by these CBT tools in my own practice and recognized the potential appeal of an online setting. I found that there was already a very strong body of research demonstrating that online CBT is powerful. So I reached out to some very gifted people in tech and business. They helped me realize my goal of bringing the benefits of CBT to more people.
The gap we fill addresses those who would not otherwise reach out for help, and those who need a place to start. We offer a solution for those who are too busy during the workday to make an appointment, too financially-strapped to pay all the copays for therapy, or too uncomfortable to make a face to face appointment.
What can a Learn to Live member expect from the program? How long does it last? What’s the commitment like?
Dr. Russ: Structurally, the Learn to Live Social Anxiety Program consists of eight interactive, multimedia lessons with practice exercises to complete in between. We recommend completing about one lesson per week. Periodic assessments help members to set goals and track their progress along the way.
Members quickly learn that they are not alone, which is very powerful. Throughout the program, they learn the key tools of CBT and how to apply them in their personal situation. Members also learn how to build up their social support network, a trusted group of friends or family that may support and encourage them throughout the program.
And it’s not just thought-challenges and fear-facing exercises. These are important, no doubt. But sometimes it’s the small things in our lives, the tiny avoidant habits that add up to unhelpful thoughts and behaviors. Members learn to identify these habits and work toward changing them. The overall process involves learning online, then applying that learning to one’s life. It’s really the real-world practice that creates results.
Once someone completes the program, what skills will they have in their proverbial tool kit to help de-escalate anxiety?
Dr. Russ: Our program teaches members a host of CBT tools and skills, among them to identify their negative thoughts, to challenge them, and to face their fears. Members build a toolkit of useful resources to help them overcome their anxiety issues.
Incidentally, the goal is not simply to eliminate anxiety. Anxiety itself is not a bad thing; it is, for example, a great motivator that gets us to practice so we do something well. The goal is to learn to live our lives fully, though we naturally also hope to reduce our anxiety to manageable levels where it’s serving a useful purpose again. Ideally, we want to learn to live with a certain amount of anxiety, without trying to cover it up.
Best thing that has come out of Learn to Live?
Dr. Russ: Without a doubt, the stories of people finding it possible to return to work, school, or friends.
It goes back to that question about engineering. I don’t get excited about equipment or things; I get excited about helping people to live better lives. Seeing people improve their quality of life is immensely satisfying to me. I am humbled and grateful to be even a small part of that.
What’s the most useful way to help a friend or loved one who’s dealing with social anxiety?
Dr. Russ: Let them know that whatever state they’re in, you’re there for them, that you will continue to care about them as a friend. You can also let them know about resources like Learn to Live. In fact, our program offers the opportunity for friends or family members to serve as a TeammateTM, someone to encourage the member and provide support. We all yearn to be cared about at a meaningful level.
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Want more stories on social anxiety? Oh boy, I've got lots of them. There's Jaimal's crazy-inspiring story of overcoming fear & anxiety (cool surfing stories included!), and remember Lucas's inferiority complex? And basically every other post on this entire website is about my own person experience with anxiety, so I encourage you to just start bopping around.
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