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.
His sweating had caused avoidance issues from a young age: For example, he became haircut-phobic due to his fear of sweating in the barber chair at age 12. Over time, his anxiety about the possibility of others seeing his excessive sweating led him to avoid interaction when at all possible. He had an overactive relationship with alcohol, self-medicating with it to ease the fear and pain. Here is what Bob wrote about some of the life experiences in his reservoir:
I felt flawed for many years because I had no family structure like normal people. For years, from the age of 14 on, I was extremely embarrassed/angry/sad about my family situation – the fact that my parents broke up, that my dad went bankrupt and was depressed, and gave up on his kids, that we had to live in cheap apartments with no electricity, and couldn’t pay our mortgage. I was especially embarrassed and angry that my mother behaved like a tramp around my hometown. I was flawed because my parents were…. and I felt their issues and lives defined mine.
Sherry and Bob functioned at different ends of the spectrum, but they exhibit many traits in common.
- In their reservoirs, was the source of their negative association with adrenaline and hyper-vigilance.
- In their reservoir was recycling anger and rage at different levels of consciousness.
- They were perfectionists.
- Their detachment, as a defense mechanism and adaptation from trauma, was very ingrained.
- Their psychophysiological (mind-body) response was ingrained.
- Their social anxiety can be considered a manifestation of post-traumatic stress.
The reservoir contains the basis for the anxiety sufferer’s negative association to adrenaline and the hypervigilance to perceived threats on personhood. Unless that basis is brought to the surface, resolution is impossible. Therefore, it is imperative for the therapist to use a strategy where the patient can bring relevant content to a conscious level and address it in order to channel the energy of anger into proactive behavior and productive energy. Naturally, the sufferer is resistant to this process because it creates discomfort and anxiety. But it is a critical step. When reservoir content is not conscious, it recycles and drives the anxiety and panic.
Another way to understand the anger/rage phenomenon for the social anxiety sufferer is to explore Mind States Balance. Borrowing from concepts of Transactional Analysis developed by Eric Berne and others, the Mind States framework offers a way of understanding the building blocks of personality as they contribute to social anxiety and overall mental health. There are five Mind States: Critical Parent, Nurturing Parent, Adult, Adapted Child, and Natural Child. All are present, and all are necessary. Of them, writes John Dusay in Egograms, “the Critical Parent ego state is the part of the personality that criticizes or finds fault.” (4) The Natural Child mind state, in contrast, includes curiosity, fun, exploration, and desire (p. 102). When the Critical Parent mind state inhibits the development of the Natural Child mind state, the result is frustration, anger, and rage. This occurs on a not necessarily conscious level because the over-adaptive behavior to avoid emotional pain may have led to detachment. The etiology of excessive critical script content is within a person’s reservoir.
When searching for treatment for social anxiety, it is important for the consumer to be aware that many therapeutic methodologies do not facilitate reservoir work. Almost four decades of clinical work with thousands of social anxiety sufferers of all ages has revealed clinical evidence that four pillars must be addressed to effect lasting therapeutic treatment for social anxiety:
- F = function (physiology)
- A = action (behavior)
- T = thinking (cognition)
- E= emotion
F.A.T.E. ensures comprehensive attention to the reservoir and all that it gives rise to. Therapeutic strategies that do not integrate the reservoir component where the etiology of emotional pathology exists are trivializing the problem and handicapping psychophysiological healing. Click here to access the library of clinical interviews offering insights into healing social anxiety on www.socialanxiety.com.
- Sarno, J. (1998). The Mindbody Prescription, New York: Hachette Book Group USA,16-17.
- Social Anxiety: The Untold Story. (2011). Andrew Kukes Foundation for Social Anxiety.
- Warren, L. (2012). “Parents’ Devastation as College Student Son, 20, Commits Suicide After Years of Struggling with Uncontrollable Blushing.” Daily Mail. July 11.
- Dusay, J. (1977). Egograms: How I See You and You See Me. New York: Harper and Row.