You’ve been invited to a party and you don’t know whether to go. It’s your closest friend’s 50th birthday, you want to help them celebrate and they’re expecting you to come. They invited you months ago and you’ve given every indication that you will be going. But you’re not having a good day today, and it needs to be a ‘good’ day for you to face people.
You have an interview for a job that you really want. You put your heart and soul into the application, it’s an excellent promotion on your current role with great future prospects. Unfortunately, someone has given you a strange look on the train and you can’t stop a tide of panic and paranoia from rising. You start to think of all the things that can go wrong in the interview, and why you probably won’t get the job.
You have a meeting at work. You’re giving a brief presentation about the recent quarter’s results. You’ve done this before, you’ve gotten used to it and you don’t normally get nervous any more. But today you’re feeling off because you had a date last night that went badly. You never do well on dates and this leads to a persistent feeling of inadequacy. You’re kicking yourself for having arranged the date for the night prior to this meeting, as you should have known this would happen.
All of these examples may sound minor, even trivial. For those who don’t suffer from anxiety it can be hard to understand the daily impact that such experiences will have on a sufferer’s life. The day to day vagaries of life are dealt with rationally by the majority of the population. Yet for those living with social anxiety and other anxiety disorders, common situations (particularly those involving other people) tend to trigger frequent and debilitating fear.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies social anxiety disorder as a condition, and certain treatment pathways are preferred in the psychological professions. People seeking help from their doctor are usually prescribed medication such as SSRI’s and referred for cognitive behavioural therapy to change their thinking patterns. Research has shown that the combination of medication and therapy is effective in the short to medium term. Depending on the severity of the condition and its root causes, longer term therapy can be equally beneficial.
Anxiety often stems from a fear of the unknown. Parties, job interviews and meetings come with intrinsic uncertainty, as do many other situations in life. What will happen in these arenas cannot be predicted with total accuracy. The balance of probabilities may suggest that things will go well, and in most situations there are lots of things we can do to ensure our success. Yet when it comes to social anxiety there is a disconnect between logic and feelings. Logic may say “of course you’ll be ok!” But no matter how many times you say that to yourself, if you’re living with a deep and chronic sense of doubt about the future, it will make little to no difference.
Approaches such as Acceptance and Commitment Therapy (ACT) are becoming increasingly popular as a response to social anxiety and other anxiety disorders. Instead of trying to overcome or get rid of the fear of uncertainty that is inherent to anxiety, ACT asks us to notice, accept and embrace inner feelings such as fear in order to more easily live with them. Similarly, ancient practices like mindfulness help us to step outside of our thoughts by noticing and observing them. In doing so, it is hoped that we will realise they are just thoughts and cannot harm us.
There is something counter-intuitive about stopping, noticing and accepting one’s negative thoughts and feelings, even after years of practicing mindfulness. I have always lived with social anxiety, hence I have always known the fear of the uncertain future that’s full of things I cannot control. Ultimately I think it is this uncertainty which we need to accept. Uncertainty about the friend’s birthday party – indeed, it could go badly, but equally it could be great fun. Uncertainty about the interview – you might get the job and equally you might not. Uncertainty about the presentation – it could be like all the times you’ve done it before, or it could be a disaster. There’s no way of knowing for sure what will happen tomorrow, and we must be prepared to live with that, to be ok with that. To know what whatever happens we will be ok. It’s a way of thinking that takes some getting used to.
Therapy can teach us to reassure ourselves in the face of fear. You can practice self-soothing techniques with your therapist; or you can get them from a book. Being able to calm oneself in uncertain and anxious situations is a valuable skill. “I will be ok, however this turns out” is clearly a helpful thing to be able to say to oneself. For anxiety sufferers it can take a lot of practice just to start doing this. With doubts and fears flooding one’s head it’s easy to forget the self soothing and let negativity take over. Practice is the key. Practice being ok with not knowing. It might go well.