“I don’t measure up.”
“I’m different than others and don’t fit in.”
“I’m socially inept / I’m bad at meeting people and making small talk.”
“I come across as nervous and awkward, which others see as weird and weak.”
“People find me uninteresting / unattractive.”
“In order to be accepted and liked, I must always meet others’ expectations of me.”
“I’m weird / not normal / not good enough.”
These are examples of common core beliefs among people who suffer from social anxiety disorder. These are distressing attitudes we maintain about ourselves, and about how we think others perceive us. Such core beliefs not only give rise to anxiety when interacting with others, but also to shame, rumination and often times, hopelessness and depression.
Social Anxiety: More than a Phobia
Social anxiety disorder is also known as social phobia. A phobia is an exaggerated fear of a type of situation / animal / interaction that is so anxiety-triggering that it makes it very difficult to pursue important life goals and activities. This is true of social anxiety, too: when the fear of judgment, embarrassment or rejection is so exaggerated that it makes it very difficult to pursue certain life goals and activities, eg.: socializing; making and pursuing friendships and romantic relationships; pursuing careers; interacting with strangers; speaking in groups; performing in front of others; asserting oneself; using public bathrooms; being sexual; etc.
Yet unlike all other phobias, social anxiety disorder typically stems from distorted, negative, shame-based beliefs about ourselves, including how we imagine we are perceived by others. Other phobias stem from distorted, negative beliefs we have about the animal / situation that we’re overly anxious about: dogs, rodents, elevators, heights, flying, driving on freeways or bridges, etc.
In this way, social anxiety disorder is fundamentally different than all other phobias: negative core beliefs about ourselves and the shame they induce is a driving, causal factor of social anxiety disorder for the vast majority of those who suffer from it.* This is not true of other phobias.
* It is possible for someone with social anxiety disorder to simply have a specific phobia about a certain type of situation or interaction, yet still have no negative beliefs about themselves and how others perceive them. But this is very uncommon.
Because of the fundamental role of shame in social anxiety disorder, strategies like exposure therapy—the gold standard for treating other phobias—need to be adapted to also challenge and modify the core beliefs that cause so much shame, rumination and often depression. Outcome studies demonstrate that traditional exposure therapy is moderately effective in treating social anxiety disorder. But it is not as effective as when exposures are approached as behavioral experiments to challenge our anxious thoughts and underlying core beliefs.
Why is this true? One key reason is that anxiety habituates (lessens over time) with exposure as we learn that our fears are greatly exaggerated. That is why exposure therapy is so effective for specific phobias. Shame does not habituate. You have to test and modify the beliefs that create the shame in the first place in order to feel better about yourself and to gradually replace shame with self-confidence and pride.
Shame, and its Relationship with Embarrassment, Rumination, Hopelessness and Depression
Shame is the feeling we have when we believe that there is something fundamentally wrong with us, both in our own self-view, and in our belief about how others view us. Shame is much deeper than its little cousin, embarrassment, which is the feeling we have when we believe we did something to appear foolishly / poorly to others. Someone can feel very embarrassed, even humiliated (extremely embarrassed) about a particular experience without feeling shame (ie. by viewing the experience to be an unfortunate blip, not a reflection of our worth.) Socially anxious persons frequently experience embarrassment, and then ruminate about it…leading to shame and sometimes depression.
Rumination is the act of spending extended periods of time focusing on disturbing thoughts. In the case of social anxiety, rumination comes in the form of worry about how we come across to others (either before or after an interaction, or both), as well as harsh self-criticism—beating ourselves up—over ways we think we embarrassed ourselves. Ruminating this way leads to shame: feeling badly about ourselves, not just about what happened. This type of rumination also increases our social anxiety for the next situation (because we think we handled the last one so poorly), fueling a vicious cycle that leads to further embarrassment, rumination and shame. And far too frequently, self-critical rumination leads to depressive mood and feelings of hopelessness: if we believe we are fundamentally deficient, why would we expect things to get any better?
Shame, hopelessness and rumination are very common features of clinical depression: both major depressive disorder (when the symptoms are quite debilitating and even self-dangerous), and also persistent depressive disorder (chronic depressive symptoms that erode the quality of our lives, but are not debilitating nor dangerous). This helps to explain why the rate of depressive disorders among persons with social anxiety disorder is two to three times higher than the rate of depression in the general public, and that the depression is usually secondary (caused by) the social anxiety, not the other way around.
Core beliefs about personal deficiency lead not only to social anxiety, but also to embarrassment, rumination, shame and sometimes hopelessness and depression. But even if you are fortunate enough to not suffer from hopelessness and depression, your social anxiety is probably intermingled with a heavy dose of shame, based on the deeply engrained idea that you are—or are perceived by others as—not good enough, weird or fundamentally different and not fitting in.
If You’re Very Depressed or Haven’t Made Much Progress Yet
Cognitive-behavioral therapy (CBT) has been demonstrated in a great many outcome studies to be the most effective treatment for social anxiety disorder. In the following section I will describe a number of CBT strategies you can use to help you overcome the shame that pervades and exacerbates your social anxiety, and to change the unhealthy core beliefs that give rise to your shame and anxiety. But there are a couple of important factors to take into account before you attempt to utilize these strategies on your own:
- If you are very depressed—severely enough that it is hard to function in different areas of your life, or that you are considering ending your life—do NOT try these strategies on your own right now. Instead, find a cognitive-behavioral therapist to help you overcome your depression and then to work on overcoming your social anxiety and shame. Please also talk with your physician or psychiatrist about medication that may help you improve your mood.
- It is generally best to hold off on core belief change work until you’ve already started making progress in overcoming your social anxiety first. You will be in a much stronger position to tackle your shame-inducing core beliefs if you’ve already gathered a good deal of evidence against your socially anxious hot thoughts through having conducted a series of behavioral experiments / exposures first. If you are not there yet, I suggest you watch this series of free, NSAC self-help videos first, and follow their suggested practice exercises. Then, after making some progress, you can return to this article to do core belief change work to overcome your shame.
- Behavioral Experiments for Social Anxiety, a three-part series to help you test and change your socially anxious hot thoughts and feared predictions.
- Social Anxiety Safety Behaviors, which are important to eliminate or at least minimize when conducting behavioral experiments.
- External Mindfulness for Social Anxiety, a three-part series to help you get out of your head and into the moment when conducting your behavioral experiments, and whenever you’re feeling socially anxious.
Overcoming Shame and Building Self-Confidence and Pride Using CBT
Part 1: Identify Your Unhealthy Old Core Beliefs
Download these handouts and complete the Inventory of Self-Defeating Core Beliefs first. Make sure you follow the directions at the top: change the wording of any beliefs you check off so that they fit your thinking better; and double- or even triple-check the most important items so you end up with a list a just a few of your most important core beliefs.
Optionally, try completing the Peeling the Onion worksheet in this download (aka. the downward arrow technique) to help you identify the unhealthy core beliefs that give rise to your anxious thinking. List the 3-6 most common hot / distressing thoughts you experience when you are socially anxious at the top of different columns on the worksheet. Taking one column at a time, ask yourself: “if that thought were true, what would that mean about me / why would that be upsetting to me?” Write that answer down beneath the arrow, and repeat this process until you don’t have a new answer. As you work through multiple columns, you will typically see that your various hot thoughts converge into one or two underlying core beliefs. Read the sample Peeling the Onion worksheet before attempting to complete your own.
Part 2: Write a Draft of Healthy, Alternative New Core Beliefs
Follow the directions in the How to Write Healthy New Core Beliefs handout in this next download. Whichever options you choose to help you write alternatives to your unhealthy old core beliefs, make sure you do your best to meet the three criteria indicated toward the top of that handout: that your new core beliefs (CBs) counter all your old CBs; that you find each of your new CBs at least 51% believable to you; and that you word your new CBs in positive language—avoiding defensiveness and double negatives—but not so positive that you no longer find them believable!
You will find two moving examples of old and new CBs from former socially anxious clients of mine who gave permission to circulate these to interested persons. I am also including a cognitive restructuring worksheet (blank, sample and the key for two of its rows), in case you choose this option to write your new CBs.
Please don’t be perfectionistic here (which is a common theme of socially anxious core beliefs, after all!) You’re just writing a draft of new CBs here, which you’ll have plenty of opportunity to improve upon as you continue your work in the coming weeks. And if you’re stuck and feel unable to come up with alternatives to your old CBs that you find believable, try consulting with your therapist or good friend to help you come up with ideas. Or resume the basic CBT-for-social-anxiety work first (as linked in the previous gold-subtitled section), so you can make further progress before returning to tackle your old CBs.
Part 3: Behavioral Experiments to Test and Defy Old Core Beliefs
Conducting a series of behavioral experiments to test out the predictions based on our old CBs is a powerful strategy to weaken their power to cause us anxiety and shame. This strategy will help us learn from experience that these old attitudes are both distorted and self-defeating.
Read the handout in this download called Experiments to Test and Defy Unhealthy Old Core Beliefs. You may conduct straightforward experiments: choosing to do anything in line with your goals and values that triggers your social anxiety (eg. initiating and extending conversations with strangers, asking someone out, disagreeing with someone, speaking in a group). It is also quite therapeutic to conduct paradoxical experiments (aka. social mishap / decatastrophizing / shame-attacking experiments): where we paradoxically try to bring about the very thing(s) we fear in order to learn what really happens as a result. For example, we can deliberately: say something stupid; act clumsy; appear / act anxious; make mistakes; seek rejection / criticism, etc.
There are two particularly creative strategies to choose and approach behavioral experiments to test the core beliefs that generate so much anxiety and shame:
- Rebel Experiments: Identify the behavioral rules (the dos and don’ts) dictated by your old CBs, then do a series of social anxiety experiments (whether straightforward or paradoxical) in which you deliberately break these rules and do the opposite. Rebel against the oppressive authority of your old CBs, similar to how Mahatma Gandhi and Martin Luther King, Jr. led movements of nonviolent civil disobedience to rebel against oppressive authorities. Disobey and defy your old CBs by doing the opposite of what they tell you, and see what you learn as a result! For example, if your old CBs tell you are fundamentally deficient and so you had better avoid or minimize interacting with people you don’t know well, disobey and defy that oppressive authority by initiating and extending conversations with whomever you choose! And if one person seems uninterested, that’s their loss, and initiate conversation with someone else instead!
- Act-as-If Experiments: Identify straightforward or paradoxical social anxiety experiments you want to do. Then read your healthy new CBs and ask yourself: “How would I act in this situation if I truly believed these new core beliefs completely?” Then act as if you believe these new CBs completely during the experiment, and see what you learn as a result! This is the other side of the coin as rebel experiments, and you’ll generally end up working on the same behavioral goals—eg. initiating and extending conversations with whomever you choose—regardless of which strategy you choose.
Whatever approach you take to choosing behavioral experiments, complete the first three columns of the Experiment Worksheet before your experiment, and the last two columns afterwards. As you can see in the sample worksheet in this download, write down the core beliefs—as well as the anxious predictions—you will test during the experiment, what you will do to test these beliefs and predictions, the evidence you’ve gathered from the experiment, and what you have learned.
Optionally, complete the Core Belief Action Plan in this download to plan out a series of behavioral experiments you would like to conduct to overcome your unhealthy old core beliefs, and the shame and anxiety they generate.
Part 4: Gathering Evidence Refuting our Unhealthy Core Beliefs
For most of our lives, our unhealthy old CBs have led us to engage in mental filtering and disqualifying the positive: to only recognize and value the “evidence” that appears to (falsely) confirm our old CBs, and to not notice or discredit contrary positive evidence. This negativity bias strengthens our conviction in our old CBs, thereby fueling a vicious cycle which keeps our anxiety and shame strong and persistent.
The behavioral experiments discussed in the previous section help to break this vicious cycle by generating concrete evidence refuting our old CBs, and confirming our new CBs. But our negativity bias is strong, so it is important to keep a record or this disconfirming evidence.
Every day, on your phone or in a journal book, make entries into an ongoing Positive Evidence Log: list evidence you’ve gathered from your experiments, as well as from other life experiences, that refutes your old CBs and confirms your new.
One approach to maintaining a Positive Evidence Log is to keep a Pride and Gratitude Log, where we list every positive life experience we can recall on a daily basis—certainly as a result of behavioral experiments we conduct, but also through ordinary life occurrences—and then identify your underlying qualities that each positive experience represents. For example, if you had a good conversation with a coworker or a store clerk, you’d list that in your Pride and Gratitude Log, and would indicate that this is evidence that you can be a good conversationalist, and that some people enjoy conversing with you. The handout in this download has further directions.
A daily Pride and Gratitude Log, or any other style of Positive Evidence Log, is aimed at breaking the vicious cycle fueled by our negativity bias, and also reinforcing our self-confidence and pride: the very opposite of social anxiety and shame.
This free NSAC self-help video has further explanation of the Pride and Gratitude Log. Also discussed in that video is a related strategy aimed at replacing self-critical rumination with self-affirming evidence, which I call Being a Good Parent to Yourself. Both are also described in this short blog article.
Finally, another approach to helping us gather evidence against our old CBs is called Then vs. Now. This strategy is aimed at helping us see how the socially anxious self-images and core beliefs we developed in reaction to painful, shame-inducing childhood and adolescent experience are disconfirmed by evidence of how we behave, and how others respond to us now in adulthood. This strategy is further explained and practiced in this NSAC video.
Part 5: Head-Held-High Assertion in the Face of Fears-Come-True
Social anxiety is based on an exaggerated fear, not an irrational fear. Judgment and embarrassment do, indeed, happen to everyone without exception, of course. Learning that we can handle our fears-come-true with our heads held high—through confident assertion and behavior—helps us diminish both the anxiety and the shame triggered by our exaggerated fear of judgment and embarrassment.
There is a strategy called assertive defense of the self which helps socially anxious persons practice self-confident assertion and behavior in the face judgment and embarrassment through the use of role plays, imagery and real-life behavioral experiments. Our shame and anxiety are gradually superseded by self-confidence that we can handle our fears-come-true in a dignified and effective manner.
This NSAC blog article describes this strategy. This NSAC clinical demonstration video #8 shows an example of this assertion strategy in action during a role-played therapy session. The Head-Held-High Assertion worksheet in this download gives examples of non-defensive, dignified assertions in the face of socially anxious fears-come-true. You may find it helpful to complete this worksheet about how you’d like to be able to confidently handle your own fears were they to materialize, supplanting shame with dignity.
Larry Cohen, LICSW, A-CBT
Cochair and cofounder, National Social Anxiety Center
Director, NSAC District of Columbia (Social Anxiety Help)
[email protected]; 202-244-0903