What keeps social anxiety going

The loop in four steps

Psychologists David Clark and Adrian Wells described this loop in 1995. It is the basis of one of the best-supported therapies for social anxiety.

1. You expect danger. Before or during a social situation, you think something like “I’ll say something stupid” or “they’ll see I’m nervous”.
2. You turn your attention inward. You start watching yourself: your face, your voice, your hands. You build a picture of how you think you look from the outside, and it is usually worse than reality. Watching yourself like this makes you notice more of your own anxiety and makes you do worse.
3. You use safety behaviours. These are small things you do to avoid looking bad: rehearsing sentences, avoiding eye contact, holding a glass tightly, wearing a scarf to hide blushing, staying near the door.
4. Afterwards, you replay it. On the way home, you go over the conversation again and again, looking for mistakes. This is called post-event processing. It strengthens the memory of “I was awkward”, even when nobody else noticed.

Ronald Rapee and Richard Heimberg added one more piece: you compare how you think you come across with what you believe other people expect. The bigger the gap, the bigger the fear.

Why safety behaviours backfire

Safety behaviours feel like they save you. They cause three problems.

• You never find out the fear was wrong. If you rehearse every sentence and nothing bad happens, you think “the rehearsing saved me”, not “it was fine all along”.
• They can make symptoms more visible. Gripping a cup tightly can make your hand shake more. Holding your arms close can make you sweat more.
• They get in the way of the conversation. While you watch yourself and hold back, you have less attention for the other person. In an experiment, using safety behaviours and focusing on yourself turned out to be unhelpful in several ways.

In a small study of eight people, facing feared situations while dropping safety behaviours lowered anxiety more than facing them with safety behaviours still in place.

How therapy breaks the loop

One of the best-supported therapies for social anxiety targets each step of the loop. It is called cognitive therapy for social anxiety. In it, you:

• test predictions in behavioural experiments: you do something with and without a safety behaviour and see what really happens;
• move attention outward, to the other person and the conversation;
• watch a video of yourself, to compare how you felt you looked with how you actually looked;
• stop the replay, by noticing post-event processing and deciding not to follow it.

In one trial, 84% of people who had this therapy no longer had social anxiety disorder at the end, compared with 42% of people who had exposure and relaxation training.

What the loop does not explain

The loop explains why social anxiety stays. It does not explain why it starts. That depends on temperament, genes and experiences such as bullying, mostly in childhood and the teenage years. Why social anxiety starts covers that.