There is a steady river of emerging new research on social anxiety.  So earlier this year there was the paper "Social phobia and subtypes in the National Comorbidity Survey-Adolescent Supplement: Prevalence, correlates, and comorbidity" with its finding that, in a representative sample of over 10,000 US adolescents aged 13 to 18, "approximately 9% met criteria for any social phobia in their lifetime".  The majority - 55.8% - suffered with the generalized subtype which the researchers reported is a "highly prevalent, persistent, and impairing psychiatric disorder".  In her paper "Which disorders rank highest on the misery meter?" Joan Arehart-Treichel commented that "Four affective disorders - dysthymic disorder, general anxiety disorder, social phobia, and agoraphobia - cause people even more misery than schizoaffective disorder, schizophrenia, or bipolar disorder."  And in "Functioning and disability levels in primary care out-patients with one or more anxiety disorders", the authors wrote "Anxiety disorders are the most prevalent mental health disorders and are associated with substantial disability and reduced well-being".  They compared over 1,000 primary care anxiety patients and found that social anxiety disorder (SAD) was even more impairing than panic disorder, generalized anxiety disorder and posttraumatic stress disorder.  Worst of all was the fact that most sufferers had more than one problem -"42% had one anxiety disorder only, 38% two, 16% three and 3% all four ... Functioning levels tended to deteriorate as co-morbidity increased".

So where's the encouraging research in all this?  Well, I'm aware of five emerging themes that look good.  One is the increasing evidence supporting the value of cognitive therapy for social anxiety disorder (SAD).  More narrowly there is the work on misperception of physiological change by social phobics.  A third finding is that in many situations people suffering from social anxiety are actually viewed more positively by others than people who don't.  There is exciting work too showing simple and effective ways of boosting self-confidence in people who fear that they won't be accepted by others.  And fifthly this spills over into the developing evidence supporting the finding that "The love you take is equal to the love your make". 

So firstly the increasing evidence supporting the value of cognitive therapy for SAD.  I have already written a recent post on "CBT is better than interpersonal psychotherapy for social anxiety disorder" and in this month's paper "Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis" the author particularly highlights the "strong evidence of superior efficacy of cognitive therapy in social phobia".  Books like Gillian Butler's three part "Overcoming social anxiety and shyness self-help course" can be very helpful.  I am particularly looking forward to a proposed online self-help course being developed at London's Insitute of Psychiatry from work at "The Centre for Anxiety Disorders and Trauma".  More narrowly there is the misperception of physiological change by social phobics that I have written about in "Fear of blushing is more a problem of hyperawareness than of facial temperature" and extended in "Particularly if you're socially anxious, try to stay task-focused rather than self-focused".

The third encouraging theme I mentioned is the finding that in many situations people suffering from social anxiety are actually viewed more, rather than less, positively than others.  So earlier this year Dijk & colleagues, in their paper "Saved by the blush: Being trusted despite defecting", showed that if you make a social mistake then blushing tends to lead people to judge you more positively and trust you more subsequently than if you make the mistake but don't blush.  This finding was described more fully by Feinberg et al in "Flustered and faithful: Embarrassment as a signal of prosociality".  They wrote "Although individuals experience embarrassment as an unpleasant, negative emotion, the authors argue that expressions of embarrassment serve vital social functions, signaling the embarrassed individual's prosociality and fostering trust. Extending past research on embarrassment as a nonverbal apology and appeasement gesture, the authors demonstrate that observers recognize the expression of embarrassment as a signal of prosociality and commitment to social relationships. In turn, observers respond with affiliative behaviors toward the signaler, including greater trust and desire to affiliate with the embarrassed individual. Five studies tested these hypotheses and ruled out alternative explanations. Study 1 demonstrated that individuals who are more embarrassable also reported greater prosociality and behaved more generously than their less embarrassable counterparts. Results of Studies 2-5 revealed that observers rated embarrassed targets as being more prosocial and less antisocial relative to targets who displayed either a different emotion or no emotion. In addition, observers were more willing to give resources and express a desire to affiliate with these targets, and these effects were mediated by perceptions of the targets as prosocial".

Commenting on these findings MedicalXpress said "A new study from the University of California, Berkeley, suggests that people who are easily embarrassed are also more trustworthy, and more generous. In short, embarrassment can be a good thing. "Embarrassment is one emotional signature of a person to whom you can entrust valuable resources. It's part of the social glue that fosters trust and cooperation in everyday life," said UC Berkeley social psychologist Robb Willer, a coauthor of the study published in this month's online issue of the Journal of Personality and Social Psychology. Not only are the UC Berkeley findings useful for people seeking cooperative and reliable team members and business partners, but they also make for helpful dating advice. Subjects who were more easily embarrassed reported higher levels of monogamy, according to the study. "Moderate levels of embarrassment are signs of virtue," said Matthew Feinberg, a doctoral student in psychology at UC Berkeley and lead author of the paper. "Our data suggests embarrassment is a good thing, not something you should fight." The paper's third author is UC Berkeley psychologist Dacher Keltner, an expert on pro-social emotions. Researchers point out that the moderate type of embarrassment they examined should not be confused with debilitating social anxiety or with "shame," which is associated in the psychology literature with such moral transgressions as being caught cheating. While the most typical gesture of embarrassment is a downward gaze to one side while partially covering the face and either smirking or grimacing, a person who feels shame, as distinguished from embarrassment, will typically cover the whole face, Feinberg said. The results were gleaned from a series of experiments that used video testimonials, economic trust games and surveys to gauge the relationship between embarrassment and pro-sociality. In the first experiment, 60 college students were videotaped recounting embarrassing moments such as public flatulence or making incorrect assumptions based on appearances. Typical sources of embarrassment included mistaking an overweight woman for being pregnant or a disheveled person for being a panhandler. Research assistants coded each video testimonial based on the level of embarrassment the subjects showed. The college students also participated in the "Dictator Game," which is used in economics research to measure altruism. For example, each was given 10 raffle tickets and asked to keep a share of the tickets and give the remainder to a partner. Results showed that those who showed greater levels of embarrassment tended to give away more of their raffle tickets, indicating greater generosity. Researchers also surveyed 38 Americans whom they recruited through Craigslist. Survey participants were asked how often they feel embarrassed. They were also gauged for their general cooperativeness and generosity through such exercises as the aforementioned dictator game. In another experiment, participants watched a trained actor being told he received a perfect score on a test. The actor responded with either embarrassment or pride. They then played games with the actor that measured their trust in him based on whether he had shown pride or embarrassment. Time and again, the results showed that embarrassment signals people's tendency to be pro-social, Feinberg said. "You want to affiliate with them more," he said, "you feel comfortable trusting them."

I'll write a further post on the fourth & fifth encouraging themes soon.