The Census Bureau does something called a Pulse survey, where they take the temperature of our nation’s mental health, and boy, is it grim reading. In 2019, about 10 percent of the people who filled out the survey registered symptoms associated with generalized anxiety disorder, or GAD.
When that same poll was taken in 2020, it went up to 30 percent. And what was even more concerning is that for individuals who live alone, the number was 50 percent.
The end of the pandemic isn’t doing anything to lessen this. As I’ve seen in my therapy practice and in studies like this, there’s a preponderance of individuals who have been experiencing some degree of discomfort at the thought of returning to the interpersonal sphere of social interactions.
The pandemic and social distancing activated social anxiety for many people. Ordinarily, we have ongoing concerns about how well other people view us, whether we are thought about positively or negatively. We have ongoing social concerns that have been wired into us by evolution, and we have worries about social rejection.
If you have ongoing regular interactions with people, you get used to awkward social situations. You get used to awkward pauses in conversation, you get used to seeing people whose eyes or facial expressions you can’t quite make out.
What happens when we have ongoing social interactions is our fears of social rejection or being viewed as incompetent or worthless by others is overwritten by actual experiences. We have reaffirming positive interpersonal interactions that show us that we’re still solidly connected with others, which allows us to lessen our worries. It allows us to alleviate our concerns about any form of disconnection or rejection. But over the last year, we haven’t had those robust interpersonal interactions that can disprove our fears. And even if you did have those interactions, there was probably a mask over your face, and the other person’s face! So you couldn’t see the nonverbal cues that were being sent to you by others, the facial cues that help alleviate our concerns.
For the socially anxious brain, the threat is not a predator. It’s not starvation, it’s not the threat of being attacked. The threat for those of us with social anxiety is the sense that others will judge us, will view us as somehow flawed, or incompetent, or useless, or unworthy. This ongoing concern leads to a host of stressful states internally.
The first is we become hyper-vigilant and start monitoring other people’s facial expressions, looking for even the slightest hint that they are negatively evaluating us. That creates an ongoing challenge that’s actually quite stressful for working memory. While we’re trying to think of what we’re saying and doing, at the same time we feel the need to constantly monitor other people’s eye contact and expressions and body language for any sense of disapproval.
Social anxiety is notorious for activating self-conscious, ruminating thoughts along the lines of, after we say something, thinking, “Holy shit, was that a stupid thing to say?” It makes us awkward, we become stiff, we can’t relax, our bodies become tight, our heart rate increases. And we start to become aware, sometimes, if it’s really acute, of ourselves sweating, our heart pounding, or a sense of feeling overwhelmed. If this happens enough, it can turn into full social anxiety disorder, which is essentially a chronic, ongoing worry of embarrassing ourselves, or being judged as “less than” by others. It’s a hyper vigilance that never switches off, especially when we’re around others.
Over time, any form of social anxiety or general anxiety leads to avoidance coping, where we start avoiding situations and people that could trigger the anxiety. So the anxiety grows. And of course, the more we avoid social interactions, the scarier social interactions become, and the more anxiety it triggers. It’s a feedback loop. And on top of that, finally, over time, social anxiety can exacerbate core shame.
Core shame is an underlying feeling that there’s something wrong with us, something unlovable about us. It becomes a chronic sense that there’s something that we have to hide from others—that there’s something others will see in us that makes us unworthy of love.
Now, those facing social or any form of anxiety without any prior experience will struggle more, not less. This is because they’ve never had to manage the symptoms and the underlying roots of Anxiety Disorder. It can be very disconcerting for people who haven’t had much anxiety up until this point, or much underlying discomfort around groups of people, interpersonal events, interacting with colleagues, going back to an office, or whatever.
So what are the ways we address it?
Every cognitive behavioral therapist will espouse a very useful tool known as incremental exposure. Rather than jumping back into our life as the pandemic begins to fade away, rather than rushing back into the world and going into situations where we’re surrounded by others, or events where we have to perform or anything of the sort, we start by connecting with those who are in our inner circle. These are people we’ve associated with in the past and with whom we find it safe and comforting to be around. We can just start with small, interpersonal gatherings of one, or two, or three people. And then we reach out to individuals that we’re slowly warming up to and expand our social circle to include, eventually, some situations that trigger some nervousness or discomfort.
The goal of most approaches to anxiety is to take our time to socialize at our comfort level, and push ourselves each time to open the circle a bit wider or to include situations that are more challenging for us. Hopefully there will not be anyone in our lives trying to make us rush back into the world too quickly. Right now, May 2021, is the perfect time to start incrementally interacting with individuals.
The second tool is revealing to others that we’re anxious, not trying to conceal it. Why is this so important? When we fail to disclose our internal experience to others, that sets up a notorious feedback loop that makes anxiety worse. It’s like this: We try to seem natural and comfortable. Yet we have to monitor if other people notice that we’re not comfortable and relaxed. So we have to pay careful attention to the subtleties of their facial expressions, looking for the slightest cues that they have spotted something in our demeanor that is a giveaway of our lack of comfort or anxiety.
At the same time, we have to maintain an awareness of whatever it is we’re talking about, or whatever is going on. So that’s a classic menu or ingredients, I should say, for cognitive overload. It’s very difficult to be relaxed, present, and interactive if our brain is not only monitoring our internal state for anxiety, but also monitoring other people to see if they spot the anxiety. Then add in trying to be relaxed and funny and witty at the same time.
From a personal angle, I can say that there are many social settings where I don’t feel particularly comfortable, as I’ve noted quite a number of times over the years. If there is a least favorite thing for me to do, it’s going to people’s weddings. There’s no excuse for throwing a big wedding.
I find them to be just a horrific experience. Because what happens? You get seated at a table with seven complete strangers who you don’t know. And generally in my case, because I’m a Buddhist pastor and I’m tattooed, people will put me at a table with the strangest oddballs in their entire family because they decide, Josh is a Buddhist, he’s weird, he can accept and deal with pretty much anyone. And then they’ll put Uncle Maury who once went to India at the table with me because they think we’ll have something to talk about.
I’m just not gifted at wedding small talk. And the only way I can ever bond with people at weddings at the dinner table is when I say, “I find sitting at dinner tables at weddings really awkward.” Over the years, I’ve actually made quite a number of friends at weddings because they say, “Yeah, I really hate sitting at tables with strangers too.” And then we have all kinds of fun conversations. And then I don’t have to sit there hiding the fact that I find the experience rather difficult.
One study showed that when people disclose that they have anxiety in public speaking, it was the most efficient way to regulate their heart rate and their skin valence. Disclosure is the best way.
The third tool is shifting the spotlight. Attention is like a spotlight. What we focus on grows bigger and more prevalent in our life.
Here’s the problem with attention. If we don’t take hold of our attention, focus it and learn to guide it, then very often, our attention will be pinned to the most distressing sensation or internal experience in any setting. And that will focus our attention first on our anxiety, and then on the automatic thoughts associated with our anxiety.
So the key is to focus your attention on something that’s not stressful—to orient to safety keys in the environment. This requires practice. Most people only guide their attention very little on any given day. Most of the time, they just allow the unconscious mechanisms of the brain to guide attention.
So we’re prone to stressful default thinking. To alleviate anxiety, we have to learn to guide our attention to the safe, useful sensations and experiences. For example, if you don’t focus your attention, and you’re giving a talk, you will find the person who is giving you the least friendly expression and pin your attention to that one person. You would think your brain would not want to focus on the one person who’s frowning or giving you a negative expression. But remember the right brain, which controls attention when we’re not actively guiding our attention, will look for the single threat.
The heart of reducing anxiety is focusing away from our internal rumination, away from the sensations of our heart fluttering, or our stomach churning, and finding something soothing in the environment. It could be a nice painting in a room, it could be looking out of a window, it could be someone who’s actually looking at us smiling, it could be anything, as long as we’re resting our attention on something that is pleasant.
It’s very important to view anxiety not as something to be pushed away, but to allow ourselves to be scared. As we say in the dharma world, what we resist persists.
The dharma focuses on learning to be with fear rather than trying to hide it or conceal it. One of the oldest Buddhist teachings is the five daily recollections: I’m of the nature to grow old, become sick, to die, to be separated from those I love and all that I own, and that I own all of my actions. But we could add to that list, “I am of the nature to be anxious at times.” Rather than view it as a mistake or something to be ashamed of, this is just another part of being human.
One way I’ve also put it in my own practice is trying to move from “but” to “and.” “But thinking” is, I would like to travel, but I get anxious when I’m on a plane, so I can’t travel. “And thinking” is, I like to travel, and I get anxious, so I still do it.
Even though we know we will experience anxiety, we welcome it. We don’t try to push it away. And in doing so, we actually mitigate the feelings of anxiety, we focus less on it, and we’re more likely to focus on other sensations. Remember, even if it seems that other people are relaxed and eager to get back to life in the world, we can’t see their internal experience. We are generally comparing our insides with their outsides. That’s never going to work. No one’s been through a pandemic before, so there’s no right way to do it. There’s no right way to go back into the world either.
Adapted from Josh Korda’s dharma talk, “Addressing Anxiety After Social Distancing.”
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