Case Study: Social Anxiety

Alison [name changed for anonymity] is a 29 years old commercial lawyer.

She feels anxious and inferior in social situations.

In my our first session, Alison tells me that she is unhappy with her social life. Ever since she has finished university and started work, she has had trouble meeting people.

On one level, it surprises me that she is anxious in social situations as she is very personable. However, I am reminded that a person is not necessarily the same in the therapy session as they are in social situations.

Exploring this further, Alison revealed that she avoids most social situations as they make her too anxious. She often can’t think about what to say and says stupid things. She considers herself as unattractive and does not expect men to be sexually attracted to her. Once again, I am surprised, as Alison is quite pretty.

With all my clients, I ask them to complete Schema Questionnaires.

Undertaking a Schema Questionnaire, Alison scored high in the Social Isolation Schema. She feels inferior in social situations, and consequently experiences a great deal of social anxiety. This anxiety comes from feelings of loneliness and inferiority. She constantly compares herself to other people … they are better looking … more interesting … smarter. She often feels this when she is in conversation … when she feels inhibited.

Alison is experiencing performance anxiety … it makes her feel socially awkward. Although she has good social skills when she is comfortable … in most situations she is too nervous … she loses her poise … she becomes shy and withdrawn.

Often psychologist who work with clients presenting with social anxiety … seek to address the anxiety through changing thoughts and behaviour. This can helpful. I wanted to go deeper to the root cause of Alison’s social anxiety – her Social Isolation Schema.

Social Isolation Schema refers to the belief that one is isolated from the world, different from other people, and/or not part of any community. This belief is usually caused by early experiences in which children see that either they, or their families, are different or inferior from other people.

Alison reported that as a child she was fat … and disgusting. Kids would make fun of her. As she got older and lost weight … and went to university she was had her first date with a boy. She reported that she compensated for this social exclusion by excelling at school and university. She developed an Unrelenting Standards Schema.  /This schema refers to the belief that whatever you do is not good enough, that you must always strive harder. The motivation for this belief is the desire to meet extremely high internal demands for competence, usually to avoid internal criticism.

We discussed the Alison tries to cope with her anxiety. She tends to escape or avoid activities or situations that make her anxiety triggered by vulnerable child mode. Schema avoidance refers to the ways in which people avoid activating schemas. As mentioned earlier, when schemas are activated, this causes extreme negative emotion. often act in such a way as to avoid situations that trigger schemas, and thus avoid psychological pain. Alison often acts in such a way as to avoid situations that trigger schemas, and thus avoid psychological pain by not attending work social or networking events. This limits her professionally and socially.

In schema therapy, I worked with Alison to:

• Identify schemas and schema modes;
• Identify and address coping styles that get in the way of her emotional needs not being met;
• Change her patterns of feelings and behaviours that result from schemas;
• Learn how to get her core emotional needs met in healthy more adaptive ways; and
• Learn how to cope (in a healthy way) with frustration and distress when certain needs can’t be met.

What was helpful for Alison was developing a flashcard for when she was experiencing anxiety in social occasions.

I know that right now I feel anxious, as if everyone is looking at me. I feel like I can’t talk to anyone. But it is my Social Isolation Schema being triggered. If I look around, I will see that people are not looking at me. And even if someone is, it probably a friendly look. If I start talking to people, in a little while my anxiety will grow less. People can’t really tell I’m anxious. Besides, other people are anxious too. Everyone is a little anxious in social situations. I can start by relaxing my body, looking around the room, and finding one person to talk to.

Alison’s journey to managing her social anxiety began from moving from loneliness to connection. Alison is now dating, enjoying herself at social functions, going out more regularly and is not able to engage at work.