(This & next week's social anxiety blog posts are available as a PDF file or a Word doc - you may need to 'save' the latter before you can open it)

"At bottom every man knows well enough that he is a unique being, only once on this earth; and by no extraordinary chance will such a marvelously picturesque piece of diversity in unity as he is, ever be put together a second time."         Frederich Nietzsche

It's over ten years since research began to show that fear of blushing is more a problem of hyperawareness than of facial temperature.  One of the early papers was by Mulkens & colleagues - "Fear of blushing: fearful preoccupation irrespective of facial coloration" - where the authors reported "Women, with high (n = 29) and low (n = 28) fear of blushing, were exposed to a mild social stressor (watching a television test card in the presence of two male confederates) and to an intense social stressor (watching their own prerecorded 'sing' video, in the presence of two male confederates). Facial coloration and facial temperature were measured and participants rated their own blush intensity. No differences in actual blushing emerged between both groups. Meanwhile, high fearful individuals' self-reported blush intensity was significantly higher than that of low fearful individuals. Thus, fear of blushing seems to reflect a fearful preoccupation, irrespective of differential facial coloration."

Subsequent work has shown similar results.  So Gerlach et al, in "Blushing and physiological arousability in social phobia", wrote "Blushing is the most prominent symptom of social phobia, and fear perception of visible anxiety symptoms is an important component of cognitive behavioral models of social phobia. However, it is not clear how physiological and psychological aspects of blushing and other somatic symptoms are linked in this disorder. The authors tested whether social situations trigger different facial blood volume changes (blushing) between social phobic persons with and without primary complaint of blushing and control participants. Thirty social phobic persons. 15 of whom were especially concerned about blushing, and 14 control participants were assessed while watching an embarrassing videotape, holding a conversation, and giving a talk. Only when watching the video did the social phobic persons blush more than controls blushed. Social phobic persons who complained of blushing did not blush more intensely than did social phobic persons without blushing complaints ..."

And socially anxious people are inaccurate as well when estimating other physical symptoms besides blushing.  So, in their paper "Self-reported and actual physiological responses in social phobia", Edelmann & Baker noted "The aim of the current study was to compare physiological reactions and self-reports of bodily sensations for social phobics, clinically anxious and non-anxious controls across four tasks ... Two were designed to be demanding, either physically (riding an exercise bicycle) or mentally (mental arithmetic task), while two, a mental imagery task (personally relevant situation) and a social conversation, were designed specifically to be anxiety provoking ... Of the 54 participants, 18 were generalized social phobics, 18 were clinically anxious but not socially phobic (8 with panic disorder, 6 with generalized anxiety disorder and 4 simple phobics), and 18 were non-anxious. Heart rate, skin conductance, and facial and neck temperatures were recorded continuously during four different tasks and rest periods with corresponding self-report ratings of bodily sensations taken to reflect 13 sampling points.  Results: There were no group differences on any of the physiological measures during any of the four tasks.  However, there were a number of between-group differences with regard to ratings of bodily sensations.  Both clinical groups had higher ratings of racing heart than the non-anxious control group during the imagery task.  In addition, social phobics had significantly higher ratings of racing heart during the social conversation in relation to both comparison groups.  With regard to ratings of body heat, the anxious group had greater ratings than the non-anxious controls during the imagery task.  Finally with regard to ratings of sweaty hands, both clinical groups had higher ratings than the non-anxious controls during the social conversation.  All three groups were generally inaccurate in their ratings of bodily sensations.  Conclusions: Social phobics do not experience a unique physiological reaction during social threat but report their heart rate as being greater than is the case for non-social phobics during such situations.  It is noteworthy how inaccurate perceptions of body state were for all groups in this study.  What appears important in social phobia, then, is not actual body changes in social situations but the perceptions sufferers have."

Subsequent research has continued to show a similar picture.  People with fear of blushing show some relatively minor differences in triggers, colouration and duration of increased facial blood flow, but the really big differences are in hyperawareness and also in negative beliefs - that blushing will mean they will judged to be inadequate in some way.  I'll write a further post soon highlighting that people who blush are, in many situations, actually judged as more trustworthy and generous than people who don't, however blushing phobics don't realise this.

This work has obvious treatment implications.  If you're frightened of blushing (or other anxiety related symptoms), you can correctly remind yourself that a.) humans are very inaccurate at estimating the real degree of physiological changes like increase in facial redness (you're probably not blushing as much as you think you are).  b.) there is little difference between how much you get red and how much someone not phobic of blushing gets red in challenging situations (many people flush a bit in some social situations, but a high proportion don't rate it as a problem).  c.)  the problem really is one of hyperawareness much more than of actually going red or not.  So what does someone, who occasionally flushes a bit but who isn't particularly concerned about it, pay attention to if they are not hyperaware of facial temperature & colour as a social phobic might be?  The difference is that they're likely to be "task-focused" rather than "self-focused".

Next week I'll continue this theme with "Particularly if you're socially anxious, try to stay task-focused rather than self-focused".