public speaking anxiety

January 21, 2024

How to be Eloquent in Public

Public speaking is a little bit like getting undressed in a crowd. Your voice and face are naked, your ideas are exposed, perspiration is sliding down your nose, and flushing red makes you shine like a traffic light in the dark.

How do I know? I was that guy in my teens, better in my mid-20s, and a fine public speaker by middle age. No one needs to wait so long. Here’s what I learned and what can be observed in my 2013 speech above:

THE MOST IMPORTANT QUESTION!

Who do you want to be? Are you relieved when the teacher doesn’t call on you in class and the time runs out before you give your oration?

As terrible as this makes you feel, you can turn your misery around as a motivator of improvement. Think of yourself as the clay in a sculptor’s hands, waiting to be shaped.

You have something to triumph over — to master and delight in. Discomfort must be endured because you won’t give stem-winding talks at first. Take my dad’s advice: Every knock can be a boost. If you get pushed over, you will learn why you fell, arise, and do better.

Talking to a rapt audience is fulfilling and instills a sense of command within you. Offering a voice that captures attention is beneficial and lifts your ego. Most of those who suffer from public speaking anxiety don’t reveal the best they can be. Too many spend a portion of their lives avoiding opportunities with the potential for gratification.

Here’s an amusing example of someone who distinguished himself with talk:

Hale Boggs was the 17th Majority Leader of the United States House of Representatives. He’d given a speech — a smashing triumph, at least in his mind.

The Congressman and his wife were leaving the auditorium, driven away in a limo. Feeling more than a little puffed up, the fine fellow reflected on the ovation he received as he uttered:

You know Lindy, there just aren’t that many great men anymore.

Lindy Boggs, herself no wallflower, couldn’t bear the man’s overblown ego. Her response punctured his balloon:

You are certainly right, dear. And what’s more, there is one less than you think!

OK, you don’t have to be like the Congressman, but you can have more worthwhile reasons to admire yourself than you do now.

Here’s what you have to consider, one thing at a time. Improve your performance in moderate-sized steps. As noted, I model some of these steps in the video of a speech I gave in 2013:

  • Don’t overthink. Don’t say you will begin to strive for eloquence next week or next year. Start now. Set aside thought and take action.
  • Become used to listening to your voice by using a recorder. Read something you might enjoy. You can evaluate your strengths and weaknesses once you are accustomed to how you sound.
  • Attend to what you want your audience to take away, not what you are doing right or wrong. Recognize the opportunity to educate, entertain, and help them.
  • Write your speech and do your best to memorize it. Putting your head in the text diminishes how much you have your eyes on the audience, and they have eyes on you. Bring the manuscript along for security, but don’t refer to the page too often.
  • Now, dramatize the script. Exaggerate. Others are unlikely to think it is extreme. The alternative is a monotone, which you will achieve unless you mold and heighten what you are saying further than you are comfortable with. More, not less, is the ticket.
  • Weaving your material into a story is always helpful.

  • Listen to masterful speechmakers. FDR, JFK, Barack Obama, Martin Luther King Jr., Adlai Stevenson II, Ronald Reagan, Winston Churchill, and more are on YouTube. Imitate them if you wish. You will find your style in time.
  • Practice the way you play. The expression is used by elite athletes and those who train them. I’ve worked with some. The idea is to marshal all your skill and effort in preparation and focus as if on game day. Imagine the audience in front of you and act out your intensity. Speech-making must have drama.
  • Go to the auditorium or classroom and step on stage ahead of the event to establish familiarity and a bit of comfort. Make sure a lectern is available on which to put the written copy. If you require a microphone, inquire about this.
  • You need adrenaline! Some amount of anxiety is useful. If you begin to speak as if you don’t care what you say, you will bore the audience. They won’t listen to you if you don’t sound interested and alive.
  • Yes, too much juice (adrenaline) will cause jitters. Even so, the fear tends to disappear within two or three minutes. I’ve seen this in legendary musicians — the presence of nerves and mistakes and their disappearance. Missed notes happen even to the best. Most of those paying attention won’t notice them. If your pants slip down, that will get their attention. Be sure to wear a belt!
  • Wait! Once on stage, glance around, smile, and when you are ready, focus on the people in their seats. If they aren’t quiet, let them catch on by displaying your silent patience. Standing and pausing creates control of the assembly. Indeed, those who might be talking to each other are often quieted by those near them.
  • Try to fix your eyes somewhere in the center of the crowd and vary your gaze a little from time to time. Don’t put your head on a swivel. The thing might fly off!
  • Slow Down! Most of those who are anxious on stage speak too fast. 

  • The legendary orchestra and opera conductor Carlo Maria Giulini considered music akin to visual art. The Maestro conceived of silence creating the background and sound offering the foreground. Use tempo changes as you recite, adjusting the volume of the words and moments between the sentences as you proceed.
  • Make a forceful sound. Enlarge your voice and your presence. Consider the rostrum your domain. Stand tall. The auditorium is filled with people who want you to do well. Why would they wish for anything else?
  • Remind yourself that few people will pick up on the extent of any anxiety you experience. Fewer still will remember. Like all of us, the attendees have their own issues to fill their brains. If you are terrific, however, they will be pleased. Still, most will forget you unless they become your fans.
  • Talk back to disquiet rationally and decatastrophize your emotions by remembering you have survived much worse.
  • If you want regular practice and suggestions from peers (a sensational idea), go to Toastmasters.

The extent of success and congratulations might surprise you. Sometimes, the listeners will laugh at things you didn’t intend to be funny but think you did. Let them. Few of those listening believe they could do better. Indeed, many suffer from public speaking problems themselves.

You are beginning an incredible adventure in growth, self-confidence, and mesmerizing strangers.

Life is short. Turning a weakness into a strength can be a heady experience. Don’t let changeable limitations prevent you from enjoying it.

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The marvelously talented Michael Kaplan created and donated the video to the Zeolite Scholarship Fund.

The first watercolor is of John F. Kennedy, prompted by Neitha Hussain and generated by Midjourney AI.

Next comes Martin Luther King, Jr. Finally, a third watercolor was produced in the same way as the previous two, this one of Winston Churchill. They are all sourced from Wikimedia Commons.

October 8, 2023

Finding Your Voice: Anxiety and Our Place in the Living World

Mark Twain said, “A person who won’t read has no advantage over a person who can’t read.”

Might we all agree that someone who chooses not to speak lacks any superiority to one who is physically unable to do so?

Some of us are afraid to talk in a group or remember when we lacked the courage to voice our ideas, opinions, and knowledge. According to the National Social Anxiety Center:

The fear of public speaking is the most common phobia ahead of death, spiders, or heights. The National Institute of Mental Health reports that public speaking anxiety, or glossophobia, affects about 40% of the population. The underlying fear is judgment or negative evaluation by others. 

Think about those terrified of expressing themselves at parties, raising a hand in class, and voicing a difference of opinion. How many of us do not talk back to a critical parent or fail to say no to someone whose approval, affection, or assistance means everything to us?

Consider all the living creatures without words. They sometimes sting or bite, sing or chatter, bark or growl, lick our faces, purr, meow, cluck, or cuddle.

The wind may move a tree’s branches and rustle its leaves. Fish splash in the water, and flowers offer scent, but silence prevails.

Some are dangerous, but many are essential to continuing human life on our shared planet. Yet none use language to remind us of their importance in such activities as pollination or the food chain that sustains every creaturely link.

The Monarch Butterfly does not promote its disappearing beauty. Our nonhuman neighbors do not fight back despite the destruction of their habitat via deforestation, hunting, and climate change.

Our lack of action in deeds and words on their behalf is also a failure to defend ourselves in the world we both need and enjoy.

For as long as I can recall, trepidation, hesitation, self-consciousness, shame, and the attached insecurity have been considered personal matters, silencing the afflicted first and motivating trips to therapy after much unhappiness. They singled out one person at a time. These days, they no longer begin and end with us alone.

PUBLIC SPEAKING ANXIETY

The late Mari Ruti wrote, “We live in a world of fragile things.” We are touched by the delicacy of many of them, not least those found in our immediate surroundings.

Most of us have a residence we care for along with our small, treasured, non-living objects and necessary spaces. Even a desk in a cubicle at the office.

From a larger perspective, however, our home doesn’t end at our doorstep, garden, or on a neighborhood walk with our beloved children and pets.

Indeed, every goodness exists only because we live within a web of attachments, so long as those attachments survive, so long as we — each of us — ensure their survival and bolster our security and joy by making it so.

As John Donne wrote 400 years ago,

          No man is an island,
          Entire of itself.
          Each is a piece of the continent,
          A part of the main.
          If a clod be washed away by the sea,
          Europe is the less.
          As well as if a promontory were.
          As well as if a manor of thine own
          Or of thine friend’s were.
          Each man’s death diminishes me,
          For I am involved in mankind.
          Therefore, send not to know
          For whom the bell tolls,
          It tolls for thee.

Global study of 71,000 animal species finds 48% are declining

Fact Sheet: Global Species Decline

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The two photos are the work of the superb photographic artist Laura Hedien, with her permission: Laura Hedien Official Website.

The first is a King Penguin Profile on South Georgia Island, 2022.

The second is a Male Prairie Chicken, Wisconsin Rapids, May 2023.

October 12, 2014

The Worry of Waiting and the Pain of Procrastination

Animated-Tourbillon

We wait. When we were small and Christmas was ahead, the calendar was stationary and the clock immobile. Kids “can’t wait” until the day comes, but they do. No choice.

We watch the watch too much for our health, whether the second hand moves fast or slow. The Algebra exam is tomorrow and you aren’t ready. An evening first-date comes on a “bad hair day” that makes you want to enroll your mane in obedience school, better to follow your comb’s commands.

I had my own battles with waiting and managed to create personal solutions, effective at least a portion of the time. In so doing, I realized some of our problems of waiting and procrastination are self-imposed. Time itself creates the others. I’ll begin with the former, but I hope you have the time to stick around for the latter.

I remember calling a high school beauty for a date. This wasn’t my first date, but among the earliest. I sat near the telephone. I looked at it. The phone peered back at me. The event became a staring contest. Who would break first? Would the phone disintegrate and vanish or could I muster courage and call. Minutes seemed like hours in agony. The longer I waited, the longer the suffering continued. I finally called. The bright and pretty blond said, “Yes.”

The solution to reduce my anxiety was already clear, but inexperience blinded me. The more I put off action, the more time I spent in a state of nervousness. I eventually recognized that, for myself at least, procrastination held no benefit. By taking challenges on with minimal postponement, I gained confidence and so reduced the disquiet associated with hesitation. The pool of cold water doesn’t get any warmer by looking at it and so it’s best to jump in.

The dread of waiting usually involves some catastrophization. At 16, getting rejected is an epic calamity. In my example, the urge to have a girlfriend was greater than willingness to accept a life without female contact. Unfortunately, for some, loneliness is the preferred choice. Put differently, anxiety is paralyzing and action seems impossible. Therapy can help with this, but watching the telephone will not.

A bit of courage is also required to take on the world’s #1 personal terror, giving a public speech. Not only is steadfastness needed to show-up for the presentation, but in managing the passage of time as you deliver the talk. Let me explain.

Imagine having been introduced. Restlessness among the listeners is apparent, perhaps even a few people are talking. Do you begin to speak over them or do you wait?

Experienced speakers allow time to look at the audience and to let the throng settle down. The inexperienced or fearful among us are prone to talk before everyone focuses on the podium. By waiting for them, they will understand the unsaid request for quiet, even in an auditorium filled with teenagers.

Moiré_Uhr_klein

Anxious orators often rush their words, believing they must fill the air with the alphabet lest people get bored. I take a different approach.

First, I memorize the speech. This takes a while, but allows for a security in knowing exactly what I want to say. I practice giving the presentation out loud. This is a performance, not a recitation of words dryly read from a text. The keynotes are drama and eye contact.

Some words should be louder, some softer. Portions of the speech are best when fast, others slow. Nervous orators are like long-distance runners who race as if competing in a sprint. They have nothing left for the final lap. Begin at an up-tempo and you can’t get faster. If, however, you start at a moderate pace, you can speed up or slow down as needed. Moreover, you won’t become breathless.

The speaker is wise to allow a few moments to pass without any words. Think of a landscape painting, one with foreground and background. Public presentation is like that, only the background is silence, so that the foreground (your words) stand out. This effect is created by a second or two of stillness, but takes some guts. The quiet might seem (to you alone) like eternity.

All of the above — whether waiting for Christmas or scared to make a phone call — have to do with time. While we can’t control time, we can control ourselves in relating to time.

Time can use us and mistreat us, or so we think. When we wish the hand on the clock to hurry up or slow down, time has the upper hand. For example, he punishes us when we want to be younger or older, when we are waiting in a long line, or when some important news is expected to arrive, whether not fast enough or too soon.

The alternative is to learn how to manage time, as I’ve tried to illustrate. We live “within” the passage of time. Each of us is a time traveler, like commuters on a train whose schedule we did not create.

Lacking control of this relentless force, we must come to accept him in the way of the Zen masters or the ancient Stoic philosophers. Fighting with time is like battling the whirlwind: he is an invisible enemy who evades the sting of our puny weapons. Life is, in part, a never-ending attempt to negotiate a truce in the war with time. The more we struggle by being impatient or terrorized, the more we waste him, or, he wastes us.

As an Indian friend once said to me, “Those of you in the West believe time is your enemy. In India, we think of time as our friend.”

What do you believe?

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You might also find the following post interesting: The Frustration of Waiting in Line.

The top image is an Animated Flying Tourbillion by Freewilly. The second picture is Moiré Uhr by Benedikt.Seidl. Both are sourced from Wikimedia Commons.

March 8, 2013

When You Don’t Know What to Say

Speaking too soon

Some people talk too soon, some too late, some too much, and some too little. Others pile up the sentences so fast you’d think they have to catch a train. Some talk too loud, soft, or close (in your face).

One of the most common regrets I heard in my clinical practice was from patients who believed they lacked the right word at the right time. Something had happened. Perhaps an offensive comment had been made, and they didn’t know how to respond.

The right words arrived by United Parcel Service (UPS) about three hours later. Others couldn’t imagine a good repost even after three weeks.

There are too many ways to go wrong in everyday conversation and even more in a public presentation if you don’t have much to contribute. Adlai Stevenson II told the following story.

It seems that a young and none-too-impressive new member of the British House of Commons approached his party leader and Prime Minister, Benjamin Disraeli:

“Now, Mr. Prime Minister, I’ve just come to the House; do you think it would be well if I participated in debate?” And the Prime Minister looked at him appraisingly for a moment and said, “No, I think it would be better if you did not. I think it would be better if the House wondered why you didn’t speak rather than why you did!”

Even though we don’t have the benefit of Disraeli’s advice, many of us have thought of ourselves as Disraeli did of the young member of Parliament: that we’d cause embarrassment by opening our mouths.

Well, sometimes we will, and indeed, all of us have done it before. Few will remember our blunders, however, and there is no chance of making an impression that is clever, thoughtful, kind, or enlightened without moving our lips.

No amount of potential eloquence does us any good if we forever have the mute button on.

Discussão.png

I’ve made some unfortunate comments myself.

In my teens, I visited a cousin whose mother had died after a long and grueling struggle with cancer. I extended my condolences, and, as often happens during such visits, we discussed other things.

Indeed, I forgot the sad occasion for a moment and mentioned a recent minor mishap, characterizing it as a “fate worse than death.”

Oops.

Too late to suck it back in. No way to un-ring the bell.

I apologized, of course, and my kind relative forgave my mistake. She was dealing with the real thing, death itself, not something trivial and stupid such as my comment. Years later, she couldn’t recall it.

Tactless remarks arise, as uncomfortable as they are. As I said earlier, we often wonder why we didn’t know what to say.

For a lucky few, their command of language comes as a genetic gift. They also have the confidence to deliver a line that others might keep to themselves.

While I can’t give you natural eloquence, I have a few suggestions to increase the possibility of saying the right thing and avoiding the wrong one:

  1. Make a recording of yourself as if you were chatting. There is nothing like hearing how you sound to discover what might be imperfect about how you converse. Yes, it could fuel your self-consciousness temporarily. But the project of self-improvement rarely comes without courage and pain.
  2. Have at l least one joke in hand that isn’t dirty or politically incorrect.
  3. Cut out “stance adverbs” and participles when beginning to talk or as interjections. I’m speaking of “uh,” “um,” “like,” “so,” and “you know.” Limit how often you say “awesome.” And never put these words altogether: “So, uh, you know, like, um, it was awesome!” Don’t say “fail” when you mean “failure” and “reveal” when you should use “revelation.” You will sound 20% more intelligent once all this is accomplished.
  4. Wait a bit before answering, at least sometimes, to create the opportunity to formulate what you have to say. The conversation isn’t a race to hit the buzzer on a TV game show.
  5. Part of the reason for waiting is to grasp what your partner means, display respect, and understand his point of view. Repeating what has been said to you can be helpful. Identifying and acknowledging his ideas is essential if you wish to have friends and loving companions. Fewer disagreements will be one of the benefits.
  6. If you expect a wise guy to put you down (because of your history or his), prepare some comebacks in advance. There are books on this sort of thing, so you don’t have to be original. Don’t forget, however, that sometimes the best put down is to ignore it, and ending the relationship occasionally is necessary.
  7. Try to sound au courant (a French expression meaning “up to date” or “fully informed”). A good start would be to read something other than an internet story on the life of the Kardashians.
  8. Discover some new words. Thirty Days to a More Powerful Vocabulary has been around since 1942 and is a worthy place to begin:
  9. Don’t circumambulate (circle the idea you are trying to express). Get to the point so as not to lose your listeners.
  10. If you are in the habit of using lots of pronouns, be sure the pronoun comes right after the formal name of whoever the “he” or “she” you are referring to is. The listener might think you are talking about someone else if you don’t.
  11. In general, especially in public utterances, wait until you have the attention of others. Trying to talk over people is frustrating, and those who specialize in preventing you from completing your thought are rude.
  12. Asking dinner partners to stop texting should happen much more often than it does. It is not impolite to tell them you will wait until they are finished.
  13. Most people who are nervous tend to rush what they have to say. Instead, think of your oral communication as a landscape painting, where the words become the foreground, and the silence becomes the background. It will help if you allow seconds of quiet to put your words into relief.
  14. Consider going to Toastmasters. It is an organization whose meetings are “learn-by-doing” workshops “in which participants hone their speaking and leadership skills in a no-pressure atmosphere.” And they’ve been doing it since 1924.
  15. Unless you are gifted in delivering an unrehearsed speech in front of an audience, try to memorize your address or at least bring an outline.
  16. One last piece of advice comes from an anonymous author:

Be careful of the words you say,

Keep them short and sweet.

You never know, from day to day,

Which ones you’ll have to eat.

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The cartoon is called Conversation by Richard Melo da Silva, sourced from Wikimedia Commons.

The revised edition of Thirty Days to a More Powerful Vocabulary was published in 2022.

June 26, 2012

Fooling Yourself Into Failing Yourself: The Trap of Anxiety and Avoidance

File:Fear of a blank planet.jpg

“But I just don’t like to do that.”

That is what she told me — the young woman who said she didn’t want to go to a restaurant alone. “Why should I do that? I’d much rather eat with someone and be able to talk at dinner. Eating alone wouldn’t be any fun.”

True. Most of us would prefer a dinner companion. It probably would be more enjoyable to dine with a friend. But there is an important distinction here. It is between being able to do something that you might prefer not to do, and being unable to do the thing because it is uncomfortable for you; maybe even frightening. And, it is between deluding yourself into thinking that the activity might be boring or stupid when the truth is that you are afraid to do it.

Deluding and denying. We do it all the time. “I don’t like to do that. Why would I want to do that? Why do I have to do that?” And so we persuade ourselves that we can live without certain experiences, side-stepping the things we don’t know about or haven’t done — the small and large challenges of life.

But what are we really doing here?

http://upload.wikimedia.org/wikipedia/commons/thumb/4/4a/WeirdTalesv36n1pg068_Shocked_Woman.png/240px-WeirdTalesv36n1pg068_Shocked_Woman.png

For the young woman in question, her repeated need to be accompanied to places — her fear to act alone — caused her to be dependent upon people, especially boyfriends. As a result, she found it difficult to be without a male companion for very long and, when she did find one, discovered that she wanted (and needed) to be with her lover more than he wanted and needed to be with her. Thus, her insecurity about being alone and her avoidance of doing things alone made her dependent upon others.

Eventually, the “clinging” drove her boyfriends away. Then she really was alone. Finding herself abandoned and rejected, she turned her reliance on family or friends; if she had those friends, that is, because she had spent so much time with her boyfriends that she’d neglected making platonic friends, along with the work required to keep them.

Some people who are avoidant don’t realize how anxious they are — how much fear dominates their lives. After all, if you turn down invitations to parties because of underlying social anxiety, you manage to avoid getting nervous as you think about the party, dress for the party, drive to the party, walk in the door, and then try to fit in.

The fact that you don’t feel anxious doesn’t necessarily mean that you don’t have anxiety problems. In fact, sometimes a better way to determine whether you have a life-compromising form of anxiety is to make a list of the things you will not do unless forced to at gun point.

  • Things like giving a public speech, raising your hand in class, traveling to the downtown area of a big city, driving on the expressway, making a phone call, going to a party where you know few people, and eating at a fancy restaurant or any place where you are not familiar with the cuisine.
  • Things like going to a movie, play, lecture, or concert alone; flying, sending a poorly prepared dish back to a restaurant’s kitchen, saying “no,” returning an item at the store, etc.
  • Things like trying some new activity on your own or voicing a strong opinion that just might be criticized by someone else; and not looking for a new job for fear of the interviewing process.

Please notice that I’m not talking about some of the very commonly experienced fears such as spiders, high places, and confined places: the phobias we call arachnophobia, acrophobia, or claustrophobia and the like. Rather, my focus is on the anxieties that make for daily difficulties — that make a life so narrow that it begins to look a little bit like this:

http://upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Toledo_narrow_street.jpg/240px-Toledo_narrow_street.jpg

To the avoidant, anxious person, the narrowly confined life seems safer. It is fraught with fewer frustrations and failures. It demands less. It feels less foreboding.

If you are heavily invested in social media, you can even persuade yourself that your electronic social life of texting, instant messages, blogging, tweeting, role-playing games, and hundreds of Facebook friends is better than the real thing. And what might the real thing be? Dedicated time unmediated and uninterrupted by technology spent with a person who is right in front of you and within the reach of an outstretched hand.

Can you approach social situations without a preliminary drink or joint? Are you certain that the alcohol or marijuana you use to unwind is recreational rather than an effort to self-medicate your anxiety? Yes, we are pretty good at talking ourselves into just about anything rather than seeing ourselves as we really are.

But if we are avoidant, there is a price:

  • The same things done over and over and that can be done only in the same places and in the same way; and sometimes only in the realm of electronically achieved distance and safety.
  • The need to rely on others who provide an emotional security blanket, or substance use upon which one is also reliant.
  • The self-doubt and the worry that accompanies thoughts of leaving our “comfort zone.”
  • Too much time spent looking at a television or a Smart Phone or a computer screen.

Avoidance offers no growth and no “life,” only the illusion of safety and the temporary relief that we all know from our school days when the teacher was sick and the test was postponed. I suppose that you can try to postpone the “tests” that life offers until the end of your days. Believe me, I’ve seen it happen. I’m talking about a life of challenges unmet, mastery unachieved — the narrow life that Thoreau described when he said:

The  mass of men lead lives of quiet desperation. What is called resignation is confirmed desperation.

And, in a companion quote often misattributed to Thoreau:

Alas for those that never sing,
But die with all their music in them.

But he also wrote:

Great God, I ask for no meaner pelf

Than that I may not disappoint myself,

That in my action I may soar as high

As I can now discern with this clear eye.

We live in “The Age of Anxiety” according to W.H. Auden. In any life there is a first time — a clumsy, unsure time — for everyone and every thing. We fear the judgment of others, the embarrassment, and the mortification of taking a chance and stumbling in public. We compare how we feel inside to the apparent (but not always real) serenity, calm, and self-confidence of others as we look at them from the outside. We condemn ourselves for lost time and opportunity, say to ourselves that we are “too late” or “too old” to take on a new challenge, and thereby guarantee that even more time will be lost; perhaps all the time we will ever have.

We tell ourselves that we can’t try a thing until we first feel better, calmer, and more confident; not realizing that “trying” is just what we need to do in order to feel better about the thing; failing to grasp that anxiety is not the biggest part of the problem, but that a failure to act in spite of the anxiety is.

If you are anxious enough or avoidant enough you might well avoid counseling, too. That is a shame, because there are very good treatments available in the realm of Cognitive Behavior Therapy (CBT). For a discussion of therapy for Social Anxiety Disorder, for example, you can look at this: Social Anxiety Disorder and Its Treatment.

Only if you fully realize that your avoidant coping strategies are costing you something of value will you call a therapist. Are you afraid to call? Is it less distressing to email? Did I hear you say, “Maybe tomorrow?” You may not detect the sound, but the clock is ticking.

As Eleanor Roosevelt said, “You must do the thing you think you cannot do.”

Now.

http://upload.wikimedia.org/wikipedia/commons/2/2e/RelojDespertador.jpg

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The top image is described as Fear of a blank planet, cover by Lasse Hoile Porcupine Tree Band 2005: http://www.porcupinetree.com/ “OTRS Ticket 2006082110002647.” The Illustration of a Shocked or Frightened Woman has been altered by AdamBMorgan from the original that appeared in Wierd Tales (September 1941, Volume 36, Number 1). The next image is One of the narrow streets in the old part of Toledo, Spain by Allessio Damato. Finally, An old style alarm clock captured by Jorge Barrios. All are sourced from Wikimedia Commons.

August 6, 2009

Social Anxiety Disorder and Its Treatment

http://upload.wikimedia.org/wikipedia/commons/4/43/VER_model.gif

Social anxiety isn’t unusual. Since you are reading this, you might well be wondering whether your own experience of anxiety (or that of someone you love) constitutes a Social Anxiety Disorder.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), such a condition exists when someone experiences a “marked and persistent fear of one or more social and performances situations in which the person is exposed to unfamiliar people or possible scrutiny by others. The person fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.”

The essence of this condition is a preoccupation with what others might think of you.

Now, we all are concerned with this some of the time.

Think of hoping to get a job promotion or wanting to impress a potential romantic partner. But consider the language of the diagnostic manual carefully, especially the words “marked and persistent fear.” One hallmark of this disorder is avoidance. When the anxiety is so great that you do your best to get out of doing something (e.g. asking someone on a date, giving a speech, attending a party, returning an item to the store, etc.) then you very well may have a clinically significant condition that can benefit from treatment. In effect, you are trying to avoid both the uncomfortable situation and the feelings that you believe will come with it.

In addition to avoidance, the individual will commonly be aware that his fear is greater than that which would be experienced by most people in a similar set of circumstances, and that the condition is very distressing and/or interferes with his life in significant ways. In fact, one of the ways that Social Anxiety Disorder complicates one’s life is by making it difficult to do the things and have the relationships that would make that life interesting, enjoyable, and fulfilling.

Is it hard to take a compliment, be the center of attention, or talk to a stranger? Do you worry what others will think of how you look and sound? Is it hard to be spontaneous in a conversation and are you too distracted by your own worries to fully concentrate on what the other person is saying? Do you get tongue-tied when trying to make an impression or have the sense that your voice is quivering or that you are perspiring too much?

Do you hesitate to state a strong opinion for fear of sounding stupid or being rejected for your ideas? Do you try to prevent others from getting to know you very well because you believe they will eventually conclude that you are inadequate and reject you? These kinds of preoccupations are typical of Social Anxiety Disorder.

The good news is that with persistence, an accomplished therapist, and the right program of treatment, you have an excellent chance of significant improvement. On the order of 80% of those who receive a systematic cognitive-behavioral (CBT) program will likely experience such change.

A good CBT counselor first makes sure that social anxiety is your major problem. For example, its not unusual for people with a Social Anxiety Disorder to have had one or more panic attacks. If those episodes occur outside of social or performance situations and lead the person to focus on their physical health, they likely indicate that a Panic Disorder is present and that the panic itself should be the focus of treatment.

However, about 50% of people who have clinically significant social anxiety also have had panic attacks. Therefore, if your preoccupation is more about how you look to others and what they think of you than it is about the symptoms of panic, treatment is likely to target your social issues.

CBT assumes that bodily sensations (such as shakiness, blushing, or a lump in your throat), behavior (such as having difficulty making eye contact or avoidance), and thoughts (such as the belief that others will reject you or that you will lose your job) all interact to fuel your social anxiety problems.

Thus, for example, the more your thoughts focus on the belief that you need to be perfect or the likelihood that you will fail, the more you are likely to experience physical manifestations of your anxiety and behave in a way that betrays your insecurity. As a result, CBT attempts to help you change physical symptoms, behavior, and cognitions.

A good cognitive behavior therapy program for social anxiety will help you learn to counter irrational thoughts that tend to be self defeating (this is called cognitive restructuring), and gradually practice with the therapist (this is called role playing) those situations that are difficult for you, beginning only with those that produce a relatively small amount of anxiety, and then try out your new skills in the real world, again beginning with relatively easy kinds of social interactions and working toward the ones that are harder for you.

And, you will discover that if you can tolerate small amounts of anxiety rather than flee them, you will “habituate” to the anxiety in much they way that your nose adapts to a foul odor by adjusting so that after a short amount of time the smell is not nearly so strong; similarly, your anxiety will weaken if you stay in the uncomfortable situation, usually within 45 minutes.

Treatment typically takes somewhere in the neighborhood of three to four months, although it can take longer if other issues also need attention. When it is successful, the patient usually finds himself less troubled by physical symptoms, more assertive, less preoccupied with other people’s opinions, more optimistic, less awkward, able to receive compliments without discomfort, able to look people in the eyes, and less avoidant.

It can feel enormously freeing and lead to much better things in life, including more and better friendships, greater vocational success, and a more satisfying romantic life.

Persistence is essential and the program takes some courage. But if you want to change your life and be less encumbered by social anxiety, CBT for Social Anxiety Disorder has much to offer.

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