MOOD-JUICE - Shyness and Soc...

MOODJUICE - Shyness and Social Phobia - Self-help Guide http://www.moodjuice.scot.nhs.uk/shynesssocialphobia.
asp
Shyness
and Social
Anxiety
A Self Help Guide
1 of 21 6/20/2010 8:10 PM
MOODJUICE - Shyness and Social Phobia - Self-help Guide http://www.moodjuice.scot.nhs.uk/shynesssocialphobia.asp
"I dread going to places where I may have to talk to people. Before I set off I just
think I'm going to do or say something stupid, and that people will think I'm an
idiot. No one else seems to be like this and I really feel there is something wrong
with me. The only way I can face people is if my girlfriend is with me. It's not
fair, she is full of confidence ..."
"If I have to talk in a meeting I just can't cope. My legs go wobbly, I flush up and
I feel quite sick. I feel everyone is watching me closely. I know it is silly and
other people don't seem to have the same difficulty. I keep thinking afterwards
that they must feel I'm not really up to the job ..."
2 of 21 6/20/2010 8:10 PM
These are the thoughts of two people who have a problem with shyness and social
anxiety. This is a surprisingly common problem though people may not often talk about
it. This booklet aims to help you to:
recognise whether you may have a problems with shyness or social anxiety;
understand what is it, what can cause it, and what can help keep it going;
looking at ways you can help yourself to overcome shyness or social anxiety.
Shyness and social anxiety are common problems that affect both men and women.
Most of us feel shy or anxious in social situations at some point in our lives. This can be
a much more serious problem for some people however, who find that their lives are
made very difficult by their problem.
Do I suffer from social anxiety?
In order to check whether you may be suffering from social anxiety place a tick next to
those symptoms you experience regularly.
You feel a strong feeling of fear in social situations that won't go away.
You think you may act in a way that will be embarrassing in front of others.
What happens to your body

When you go into a situation with others you feel anxious may have some of the
following feelings in your body:
Heart racing and pounding.

Chest feels tight or painful.
Tingling or numbness in toes and fingers.
Stomach churning or butterflies.
Having to go to the toilet.
Feeling jumpy or restless.
Tense muscles.
Sweating.
Breathing changes.
Dizziness and feeling light headed.
Blushing.
What you think

You know that the fear is too much or unreasonable. You feel that others are
thinking badly of you.
You think others are judging you.
Before you go into social situations you think that things will go badly.
You think "I will make a fool of myself" or "I will look stupid".
You may think "I'm boring" or "I'm strange".
You may believe "If I get it wrong people won't like me" or "If I show I'm nervous
people will think I'm stupid" or "I must not look anxious".
You have a negative picture of yourself in your mind, which is how you fear other
people see you, this may be flustered, foolish, uninteresting, weak, timid etc ...
After you've been in a social situation you think "that was awful", "I looked so
stupid", etc.
3 of 21 6/20/2010 8:10 PM
What you do
Sometimes you go into social situations that you find difficult but find this very
distressing and become very anxious.
You avoid going into social situations that you find difficult, even if this is
inconvenient to yourself. For example, going out to buy sandwiches rather than having
to go into the busy staff canteen.
Avoid talking on the telephone.
Do things to help yourself in difficult social situations, such as rehearsing what you
are going to say, offering to help in social situations so that you can keep busy, talking
fora short time but then moving on to another location.
Cannot relax in social situations, drink more, smoke more, talk quickly, keep on the
move ....
If you have ticked many of the boxes then you may be experiencing social anxiety
or shyness.
What is shyness or social anxiety?
People who suffer from shyness or social anxiety often believe that other people will
think badly of them or that people will be judging them. They think that they are being
closely observed by other people and they would like to give a good impression. At the
same time they may fear that they are not as good as other people and can't 'come
up to the mark'.
They suffer symptoms of anxiety such as tension, rapid heart beat and light-
headedness when they are in social situations. They may blush or stammer or be
unable to speak.
Certain situations may seem to be more difficult than others. People may feel quite at
ease speaking to people they know but feel very anxious with strangers. Eating or
speaking in front of others can be very difficult, as can crowded places such as
canteens, pubs, shops or queues.
Some people will begin to avoid difficult situations, often leading to great inconvenience,
loss of social life or even career prospects. Other people will find ways of avoiding
making a fool of themselves by carrying out 'safety behaviours'. This can include not
looking people in the eye so as not to draw attention to themselves, sitting down,
holding on to something, staying close to someone they know, talking slowly and
deliberately, keeping busy, moving quickly from conversation to conversation.
In summary - People who experience social anxiety fear that other people will think
badly of them and believe that they are not as good as others. This makes social
situations very difficult or impossible for them.
What causes social anxiety?
Social anxiety is something that very many people experience in a mild form but some
people find themselves more seriously affected by it. It is not a sign of any more
serious physical or mental illness, but can be extremely distressing.
It is often related to 'low self esteem' or a poor opinion of yourself, which may have
begun in childhood. Some people seem to be naturally more anxious and have learned
to worry. Others may have had stressful life events that have led them to feel like this.
4 of 21 6/20/2010 8:10 PM
What keeps social anxiety going?
Sometimes people feel socially anxious when they are

young but become more confident as they get older. For
other people it can just go on and on and become a
life-long problem. There can be a number of reasons for
this:
1. If someone has an anxious personality they will be

in the habit of feeling anxious and will have long term
beliefs that they are 'no good in social situations'.
2. Avoidance of social situations keeps the person from becoming more used to social
occasions. This stops them from learning that they can cope and feel fine. If a situation
is avoided it feels even more difficult the next time they try and go into it. Sometimes
people have safety behaviours that don't let them learn that they can cope. For
example always sticking with a friend.
3. The person with social anxiety often holds an unpleasant image of how they look
to others, in their mind. When mixing with others the anxiety tends to make them focus
on themselves more. They think of this image, feel anxious and believe that they look
terrible to others. They rarely look to see how the other person is really
responding to them. They make negative guesses about what the other person is
thinking and therefore never challenge their negative, unpleasant image of themselves.
4. 'Fear of fear' will sometimes take over so that the person will predict that they will
be anxious in certain situations and expect certain symptoms, "I know I will go bright
red when I speak", "I won't be able to get my words out" or "what if people notice my
hands shaking?".
These thoughts increase anxiety even before they go into the feared situation.
5 of 21 6/20/2010 8:10 PM
5. A vicious circle of social anxiety can begin which will look something like this:
In summary - social anxiety is linked to low self esteem and continues because
people hold long term beliefs that they are 'no good in social situations'. These beliefs
are never challenged because of avoidance safety behaviours and self focusing when
faced with social situations.
6 of 21 6/20/2010 8:10 PM
How can I help myself to overcome social anxiety?
There are a number of ways that you can begin to help yourself to overcome anxiety.
The approaches we will be using will be under the following headings:
Understanding social anxiety;

Negative beliefs and images in social anxiety;
'Self processing' reducing your focus on yourself;
Tackling avoidance and safety behaviours;
Tackling the physical symptoms of social anxiety;
Understanding social anxiety
i. some ideas about what is causing your social anxiety.

In order to understand it even better it may help you to
try the following exercises:
Think back to number of actual occasions that you found

difficult
over the last month then try and understand in more detail what was happening. It may
help to try and draw out your own vicious cycle of social anxiety - think of a recent
social situation you found difficult.
7 of 21 6/20/2010 8:10 PM
My long held beliefs are:

...................................
...................................
...................................
...................................
My negative automatic
After a social event my
thoughts before a social
negative thoughts are:
situation are:
...................................
...................................
...................................
...................................
...................................
...................................
...................................
...................................
My avoidance or safety
behaviours are:
...................................
...................................
...................................
...................................
Self Focus:
The negative picture of
myself which I hold in my
mind is:
...................................
...................................
...................................
...................................
ii. If you can't get a clear picture of your difficulties by thinking back, then it may help to
keep a social anxiety diary. For one or two weeks keep a diary of when you feel
anxious and what was going on at the time Keep a note each time of thoughts,
physical symptoms, avoidance or safety behaviours, what you did and what your
thoughts were afterwards.
Once you have a much clearer view of your own problems then you can begin to tackle
the various parts of it and break the vicious circle of anxiety.
8 of 21 6/20/2010 8:10 PM
How can I reduce my negative thoughts, beliefs and images?
We have seen the role that thoughts have in keeping going the vicious circle of social
anxiety. Thoughts can be words or they can be pictures in your mind. The following
examples may help you to identify your own thoughts and pictures. Examples:
Picture
Negative Automatic Thoughts
Image of self as small mousy
" I don't know what to say - people
creature
will think that I'm stupid."
"Image of self looking wobbly and
Everyone will look at me when I
others smirking."
walk in and I will shake."
Image of self flushed and sweating
"I will stammer and not find my
look of pity on faces of others.
words."
Image of self with high squeaky
"I sounded really pathetic when I
voice, others looking strong and
asked a question."
calm.
It may help to write down your own negative thoughts and images:
Thoughts Images
Once you know what they are you can Once you know what they are you can begin
to fight back and break the vicious circle.
9 of 21 6/20/2010 8:10 PM
In particular ask yourself if you are making the following thinking errors
1. Am I mind-reading ? eg "he/she thinks I'm boring" In this case you don't tend to
find out or look to see what the other person really thinks. You believe your own
negative views and blame it on them!, eg "he doesn't like me". This is a very
common problem for socially anxious people who assume their own negative
view of themselves, is also held by others.
2. Am I fortune-telling or catastrophising? eg, "it's going to be a disaster,

everyone will be laughing at me".
3. Am I personalising this? eg, "they are all laughing, they must be talking about
me" or "he looks tense its probably because he thinks he's got to sit with me".
4. Am I focusing only on the bad things eg, "I really clammed up when I tried to
speak to Jane" (ignoring that you had been able to speak easily to other people
that day).
These thinking errors mean that you don't view

yourself in social situations in a fair way. It may help
to begin to try and answer back to find a fairer
picture of what is happening. A good way of doing
this is to write two columns - one for your thoughts
that make you anxious and the other for a fairer more
balanced thought, eg:
10 of 21 6/20/2010 8:10 PM
Anxious Thought Balanced thought

"If I hadn't kept quiet I would have said "People would not have thought I was
something stupid and people would have odd, friends have said I always sound so
thought I was odd". sensible, I just expect people to be
negative about me".
"I just gabbled away all the time, I Balanced Thoughts

must look like an idiot". "No one seemed bothered by this.
People come over to talk, I can't be
that bad".
Write down some of your thoughts now and write as many answers or balanced
thoughts as you can. Look out for thinking errors. This question might also help, "what
would you say to a friend who was thinking that way?"
The aim is to get faster at catching these anxious thoughts and answering back almost
instantly. It takes a lot of practice, but really does work.
Anxious Thought Balanced Thought
How can I stop thinking that everyone is looking at me?
me? Research has shown that people with social anxiety tend to show an increase in
'self processing' in situations where they feel anxious. This means that:
11 of 21 6/20/2010 8:10 PM
They concentrate a lot on their own body especially looking for the symptoms
of anxiety, eg shaking, sweating, red face, difficulties in speaking.
They focus on their own thoughts with the negative images and views of
themselves mentioned in the previous section.
They have a strong negative image of how they look to others.
The image is not the way they appear to others.
They feel that they are the centre of attention and all this attention is critical
and negative.
Ways of reducing self focus are:
Do not 'monitor' yourself' in social situations, pay attention to what is

happening around you:
look at other people and the surroundings;
really listen to what is being said (not to your own negative thoughts);
don't take all the responsibility for keeping conversations going - silence
is OK, other people will contribute.
Begin to recognise that your physical symptoms of anxiety are not as

noticeable as you think. Focus on your own body less and you'll stop noticing
these symptoms.
Begin to look at other people to see if they show symptoms of anxiety.
Begin to believe that people will not dislike you because you are anxious -
would you dislike someone just because they were anxious?
Begin to note that you are not the central focus of everyone's attention.
Try out some of these ideas and see if they work for you. Begin to challenge some of
your long term beliefs that you are no good in social situations.
12 of 21 6/20/2010 8:10 PM
How can I change my own behaviour?
Changing what you do is probably the most helpful way to overcome social anxiety. We
have already talked of how avoidance and safety behaviours keep social anxiety going.
It will help to be clear which behaviours you need to tackle. The following example may
help you to pinpoint your own avoidance and safety behaviours.
Avoidance Avoidance
(write your own list
Not going to places where you will meet people. here)
Asking other people to do things for you when you would
have to meet people.
Not talking to someone you would like to talk to.
Safety Behaviours Safety Behaviours

(write your own list
Avoiding looking people in the eye. here)
Say little or let someone else do the talking.
Plan what to say or rehearse words.
Grip objects tightly.
Go to a safe place/corners.
Look away.
Keeping very busy.
Speak quickly.
Don't speak about self.
Look for a safe person to stick with.
13 of 21 6/20/2010 8:10 PM
All of these types of avoidance and safety behaviours keep the problem going. It is
important to:
gradually reduce the avoidance and begin to face the things you fear.
Begin by making a list of all the avoidance and safety behaviours that you aim to
prevent. Next make an 'anxiety ladder' where those targets easiest to achieve
are at the bottom and your most difficult situations are at the top. It may help to
look at this example.
Fear of talking in front of a group of people

John is fearful of talking in front of a group of people. In the past he has avoided this by
using safety behaviours such as not looking at others, keeping busy, speaking very
quickly and staying next to a close friend who talks a lot. Recently he has stopped
going to the club, because of his fear. He really misses this. He has made up the
following anxiety ladder.
John will begin with step 1 and gradually work towards step 6. He will gradually reduce
his safety behaviours and make sure not to take on new ones!
14 of 21 6/20/2010 8:10 PM
Try this for yourself, make up an anxiety ladder.
1.......................................................................................................................
2.......................................................................................................................
3.......................................................................................................................
4.......................................................................................................................
5.......................................................................................................................
6.......................................................................................................................
7.........................................................................................................................
8.......................................................................................................................
9........................................................................................................................
10.....................................................................................................................
Take things one step at a time.
You will need to practise regularly to manage thoughts and physical symptoms of
anxiety using the skills you have learned in the other sections. You will gradually learn
that you can cope and feel comfortable in social situations. It is worth remembering that
many other people feel anxious in social situations too, it just doesn't show. You are not
the only one.
How can I reduce my physical symptoms?
Reducing Physical Symptoms

Relaxation
In order to reduce the severity of physical symptoms it is useful to 'nip them in the bud',
by recognising the early signs of tension.
Once you have noticed early signs of tension you can prevent anxiety becoming too
severe by using relaxation techniques". Some people can relax through exercise,
listening to music, watching TV, or reading a book.
For others it is more helpful to have a set of exercises to follow. Some people might
find relaxation or yoga classes most helpful, others find tapes useful. You can obtain a
relaxation tape from your GP, and there are also a wide number of relaxation tapes
available in the shops.
Relaxation is a skill like any other which needs to be learned, and takes time. The
following exercise teaches deep muscle relaxation, and many people find it very helpful
in reducing overall levels of tension and anxiety.
15 of 21 6/20/2010 8:10 PM
Deep muscle relaxation

It is helpful to read the instructions first and to learn them eventually. Start by selecting
quite a warm, comfortable place where you won't be disturbed. Choose a time of day
when you feel most relaxed to begin with. Lie down, get comfortable, close your eyes.
Concentrate on your breathing for a few minutes, breathing slowly and calmly: in
two-three and out two-three. Say the words "calm" or "relax" to yourself as you breath
out. The relaxation exercise takes you through different muscle groups, teaching you
firstly to tense, then relax. You should breath in when tensing and breath out when you
relax. Starting with your hands, clench one first tightly. Think about the tension this
produces in the muscles of your hand and forearm.
Study the tension for a few seconds and then relax your hand. Notice the difference
between the tension and the relaxation. You might feel a slight tingling. This is the
relaxation beginning to develop.
Do the same with the other hand.
Each time you relax a group of muscles think how they feel when they're relaxed. Don't
try to relax, just let go of the tension. Allow your muscles to relax as much as you can.
Think about the difference in the way they feel when they're relaxed and when they're
tense. Now do the same for the other muscles of your body. Each time tense them for
a few seconds and then relax. Study the way they feel and then let go of the tension in
them.
It is useful to stick to the same order as you work through the muscle groups:
Hands - clench first, then relax.

Arms - bend your elbows and tense your arms. Feel the tension especially in
your upper arms. Remember, do this for a few seconds and then relax.
Neck - press your head back and roll it from side to side slowly.
Feel how the tension moves. Then bring your head forward into a comfortable
position.
16 of 21 6/20/2010 8:10 PM
Face - there are several muscles here, but it is enough to think about your
forehead and jaw. First lower your eyebrows in a frown. Relax your forehead.
You can also raise your eyebrows, and then relax. Now, clench your jaw, notice
the difference when you relax.
Chest - take a deep breath, hold it for a few seconds, notice the tension, then
relax. Let your breathing return to normal.
Stomach - tense your stomach muscles as tight as you can and relax.
Buttocks - squeeze your buttocks together, and relax.
Legs - straighten your legs and bend your feet towards your face. Finish by
wiggling your toes.
You may find it helpful to get a friend to read the instructions to you.
Don't try too hard, just let it happen.
To make best use of relaxation you need to:
Practise daily.
Start to use relaxation in everyday situations.
Learn to relax without having to tense muscles.
Use parts of the relaxation to help in difficult situations, e.g. breathing slowly.
Develop a more relaxed lifestyle.
This relaxation exercise is available on tape from your GP. Remember relaxation is a
skill like any other and takes time to learn. Keep a note of how anxious you feel before
and after relaxation, rating your anxiety 1-10.
Controlled Breathing
Over-breathing: it is very common when someone becomes anxious for changes to
occur in their breathing. They can begin to gulp air, thinking that they are going to
suffocate, or can begin to breathe really quickly. This has the effect of making them feel
dizzy and therefore more anxious.
17 of 21 6/20/2010 8:10 PM
Try to recognise if you are doing this and slow your breathing down. Getting into a
regular rhythm of in two-three and out two-three will soon return your breathing to
normal. Some people find it helpful to use the second hand of a watch to time their
breathing.
It takes at least three minutes of slow breathing for your breathing to return to normal.
Distraction
If you take your mind off your symptoms you will find that the symptoms often
disappear. Try to look around you. Study things in detail, registration numbers, what
sort of shoes people are wearing, conversations. Again, you need to distract yourself
for at least three minutes before symptoms will begin to reduce.
Whilst relaxation, breathing exercises and distraction techniques can help reduce
anxiety it is vitally important to realise that anxiety is not harmful or dangerous. Even if
we did not use these techniques, nothing awful would happen. Anxiety cannot harm us,
but it can be uncomfortable. These techniques can help reduce this discomfort.
In summary - coping with social anxiety

Understand all the parts of your anxiety the physical symptoms, the thoughts and
beliefs and your safety and avoidance behaviours.
Reduce negative thoughts by looking for and challenging thinking errors. Use
balanced thoughts to get a fairer picture of yourself.
Reduce self processing try not to monitor your own physical symptoms and
thoughts. Look to what is going on around you.
Reduce avoidance and safety behaviours by gradually facing situations you fear
whilst reducing safety behaviours.
Tackle the physical symptoms of social anxiety using relaxation and other methods
described.
18 of 21 6/20/2010 8:10 PM
Where can I get further help?
We hope you will find this guide helpful. In order to get the maximum benefit, it is best
to continue the exercises described here over a period of several weeks, as problems
usually take some time to overcome. These approaches are tried and tested and most
people find them beneficial if they persist. You are learning new, healthy habits which
will stand you in good stead for the future. It is a good idea to keep this guide handy so
that you can keep referring to it from time to time.
If, after a few weeks, you feel you are making little progress, then seek help in
overcoming your problem. Your GP is the best person to talk to first. Your GP may
suggest a talking treatment or tablets or both. He or she may suggest you see a mental
health worker who can offer expert help with your problems.
If you feel so distressed that you have thoughts of harming yourself or you feel
you are at risk of harming others, then visit your doctor as soon as possible and
explain to him or her how you are feeling.
Further Information and Resources
For further information and self-help resources go to Moodjuice online:
http://www.moodjuice.scot.nhs.uk
Moodjuice Forth Valley is a web site designed to offer information and advice to those
experiencing troublesome thoughts, feelings and actions. From the site you are able to
print off other self-help guides covering conditions such as depression, anxiety, stress,
panic and sleep problems. In the site you can explore various aspects of you life that
may be causing you some distress and obtain information on organisations, services
and other self-help materials, that can offer you support and information which will allow
you to help yourself.
19 of 21 6/20/2010 8:10 PM
Some Useful Organisations
The Samaritans
Samaritans provides confidential emotional support, 24 hours a day for people who are
experiencing feelings of distress or despair, including those which may lead to suicide.
You don't have to be suicidal to call us. We are here for you if you're worried about
something, feel upset or confused, or you just want to talk to someone.
Phone: 08457 90 90 90
Address: P O Box 9090 , Stirling
Web Site: http://www.samaritans.org
20 of 21 6/20/2010 8:10 PM
Written by Lesley Maunder and Lorna Cameron with contributions from healthcare staff
and service users in Northumberland
© 2003, Northumberland, Tyne and Wear NHS Trust
21 of 21 6/20/2010 8:10 PM

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MOODJUICE - Shyness and Social Phobia - Self-help Guide http://www.moodjuice.scot.nhs.uk/shynesssocialphobia.

A Self Help Guide

Do I suffer from social anxiety?

What happens to your body

Heart racing and pounding.

What you think

What is shyness or social anxiety?

What causes social anxiety?

What keeps social anxiety going?

Sometimes people feel socially anxious when they are

1. If someone has an anxious personality they will be

How can I help myself to overcome social anxiety?

Understanding social anxiety;

Understanding social anxiety

i. some ideas about what is causing your social anxiety.

Think back to number of actual occasions that you found

My long held beliefs are:

How can I reduce my negative thoughts, beliefs and images?

2. Am I fortune-telling or catastrophising? eg, "it's going to be a disaster,

These thinking errors mean that you don't view

Anxious Thought Balanced thought

"I just gabbled away all the time, I Balanced Thoughts

Anxious Thought Balanced Thought

How can I stop thinking that everyone is looking at me?

Ways of reducing self focus are:

Do not 'monitor' yourself' in social situations, pay attention to what is

Begin to recognise that your physical symptoms of anxiety are not as

How can I change my own behaviour?

Safety Behaviours Safety Behaviours

Fear of talking in front of a group of people

Try this for yourself, make up an anxiety ladder.

Take things one step at a time.

Reducing Physical Symptoms

Deep muscle relaxation

Do the same with the other hand.

Hands - clench first, then relax.

To make best use of relaxation you need to:

In summary - coping with social anxiety

Where can I get further help?

Further Information and Resources

For further information and self-help resources go to Moodjuice online:

Some Useful Organisations

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