Toward an Understanding of ‘Reservoir’ Implications in the Treatment of Social Anxiety
Social anxiety is a major mental health challenge impacting millions, yet the disorder has proven to be a significant challenge for the mental health community. The primary reason is that social anxiety is driven by the underlying emotions of shame, embarrassment, and humiliation. Most sufferers do not seek help because of these emotions, making social anxiety the quintessential “disease of resistance.” Those who do seek treatment often fail to thrive because many existing treatment modalities neglect to take into account the deep underlying causes of social anxiety.
The critical script that programs the pain of shame and embarrassment driving this resistance to treatment was created in the sufferer’s “reservoir,” which comprises pertinent emotional content from a person’s past, much of it unconscious. This concept builds upon the theory of John Sarno, MD, that “the anger, to the point of rage that exists in this reservoir leads the mind-body to produce physical symptoms as a diversion.” (1) The energy of this rage is so powerful that it inhibits the flow of oxygen into the bloodstream, resulting in the psychophysiological phenomenon we know as the anxiety response. According to Sarno, “inhibited or consciously suppressed anger contributes to the reservoir of rage in the unconscious.” In fact, he theorized that the mind-body actually produced pain to distract from intense emotional issues. Similarly, social anxiety suffers learn to disconnect from the thoughts and feelings associated with anxiety, becoming skilled at detachment as a defense mechanism. This disconnect or detachment enables them to repress this reservoir of content, prompting the physical symptoms of anxiety and panic.
Common physical symptoms of anxiety and panic include increased pulse, heart palpitations, shortness of breath, physical weakness, and upset stomach as well as an overall fear of losing control. The more observable symptoms of anxiety, however, are often the ones that themselves cause anxiety, because sufferers fear being “noticeably nervous”: blushing, hyperhidrosis (sweating), selective mutism (speech paralysis), voice stammering, and hand tremors. This fear of being noticeably nervous can create pathological feelings of shame and embarrassment. These emotions often lead to phobic avoidance or substance dependence to anesthetize the emotional pain. This pain should not be underestimated. Consider Andrew Kukes, who committed suicide because his social anxiety was so extreme; his parents established the Andrew Kukes Foundation for Social Anxiety in the hope of funding research and resources to improve both awareness and treatment success of this debilitating disorder. (2) Another tragic story is that of Brandon Thomas, who committed suicide because of his pathological blushing. (3)
The level of functioning among social anxiety sufferers can vary considerably. The following are examples of two 53-year-olds who experienced long-term social anxiety. One is high-functioning. One is low-functioning. At age 53, Sherry had no relationships that were not dysfunctional. She was on disability because of her anxiety and depression. After an early adulthood that included alcohol abuse, she had been in recovery for 27 years. She identified as struggling with selective mutism. In her journal, she articulates very clearly her internal critical script:
I’m afraid of the physical response to the fear, am I going to die or pass out, someone’s going to harm me, ridicule me, think I’m a freak, unworthy, undeserving, I don’t belong, unable to function in society, find out how incapable I am, validate what I believe about myself.
Sherry also identifies and vividly depicts her particular reservoir which was an important component of her treatment.
Our house was the house everyone would go to because my parents were seldom home. People were always partying. It was daily life. The partying interrupted everything. I was left alone to fend for myself. One night my brother overdosed and was in a coma. It was my job as a teenager to keep everybody alive. I thought everyone would die because of their self-destructive behaviors. One cat had kittens. One of my brother’s friends put it in a shoebox and buried it alive in the back yard. Utter terror and panic.
From the outside, it would seem that Bob, another 53-year-old patient, had little in common with Sherry. A self-described workaholic, Bob was a seven-figure-a-year earner who managed hundreds of individuals at work. Yet Bob suffered from public speaking anxiety. He was especially concerned about his hyperhidrosis (profuse sweating), which would make him noticeably nervous.