Social Anxiety to Social Confidence

Public toilets seem to prove problematic for many people who experience social anxiety. Self-consciousness about performance, noise, smells, size, etiquette, time and technique can all be a source of anxiety potentially making this basic need significantly challenging. Understandably, such issues are often embarrassing for people to talk about meaning they do not realise that many others are struggling with them too and they often do not seek help to address them. The problems are generally associated with public toilets where privacy is more limited, but they can also extend to other situations such as using someone else’s toilet or using a toilet in shared accommodation.

One particularly common issue is that anxiety about going to the toilet can mean that it actually becomes physically impossible to go due to muscle tension. It’s a condition which has many names and applies to both urination and defecation. Being unable to urinate due to anxiety usually comes under the names of Paruresis, Shy Bladder Syndrome, Bashful Bladder, Urophobia and several other names, while being unable to defecate due to anxiety comes under the names of Parcopresis, Psychogenic Fecal Retention and Shy Bowel

As far as I know, being unable to urinate is a far more common problem than Shy Bowel and can be particularly problematic given that often we need to urinate several times a day. The problem can end up causing a restrictive lifestyle for a person meaning they do not travel far from their home or meaning that they do not go out for too long in case they need to urinate. People may also develop unhealthy habits such as restricting their fluid intake to manage how often they need to go. In more severe cases people may be so unable to urinate that they still cannot go even when they are in pain and in some cases this can cause damage meaning complications for them in the future.

Research seems to indicate that this problem is equally split between men and women, although it seems men are more likely to seek help with it. Although essentially the problem is the same for men and women – anxiety causing tensing making it physically impossible to go – there are some distinct differences. This is mainly due to the differences in male and female public toilets. Due to the exposed urinals that are commonly found in men’s toilets, men are more likely to be concerned with issues such as performance, other people seeing their private parts, etiquette and technique, while women can be more concerned with issues such as being overheard and taking too long when there is a queue. There is an amusing game that I am sure many men can relate to on the UK Paruresis Trust website. Just click on this link to play it. For my friends in the US there is the International Paruresis Association, although unfortunately they do not have any games to play.

Some people may not have so much or an issue about being unable to go, but may just get anxious about using public toilets in general. This was an issue for me and was something I developed at school, although it also extended to using toilets anywhere, including my own home sometimes. I seem to remember it started when some of the boys at my school realised that it was quite amusing to push someone on the back while they were using the men’s urinal trough meaning they had to put their hands on the splash-back to prevent them falling into it. After experiencing this one or two times and seeing it happen to several others I started getting anxious about using the toilets. As a consequence I stopped using them and would only go when I was really desperate. I remember I would often try and go the whole day without going which was quite uncomfortable at times. I have also suffered with Paruresis at times meaning I could only go when a cubicle was available, when I was really desperate or when no one else was in the toilet room. That is probably more about me than you wanted to know, but hopefully it is helpful for those who have experienced similar issues.

Both Shy Bladder and Shy Bowel are both considered a form of social anxiety, although Toilet Phobia can be related as well as unrelated to social situations. If you are struggling with Paruresis then there is a book called Shy Bladder Syndrome: Your Step-by-step Guide to Overcoming Paruresis which you may find useful. You may also like to try contacting the UK and US organisations linked above who offer workshops and may be able to put you in contact with a support group. Typically the recommended treatment is Cognitive Behavioural Therapy, as it is with many issues relating to anxiety, although in the case of Paruresis there is an option to use a Catheter which is basically a tube that can be inserted into the urethra past the muscle that keeps the bladder closed meaning it can empty through the tube. Although this is not a very attractive option for many people, if you are desperate (literally) then it might be a serious consideration.

Eating. It keeps us alive and well, but what if you get scared when you eat around other people? For lots of people with social anxiety, eating in a presence of others causes a lot of anxiety and self-consciousness. Not all fears around eating are the same and it is usually not the food people with social anxiety are scared of, but rather the actual process of eating around other people. There are then lots of different aspects of eating and it might be just one of these that causes distress or many of them.

For myself, the main fear I had around eating was noise. Could people hear me munching and crunching and was it really annoying them and even making them angry at me? I was not really clever enough to avoid noisy food and always used to end up with an apple, a bag of crisps or something else with a noisy bite or wrapper. I remember working in an office and sucking each crisp before I chewed it and trying to bite apples slowly so I did not make any noise. Another strategy I employed was to crunch quickly to get it over with. I used to imagine the people behind me getting more and more irritated by my crunching until they just wanted to explode and shout, ‘JUST SHUT UP WITH YOUR STUPID CRUNCHING YOU ****’. I did not want to draw any attention to myself, but of course I probably did through my unconventional eating habits because people tend to notice what is novel and blot out the rest. I really would have been much better off just eating normally.

As I said above, not all eating fears are the same and I have come to realise that my main eating fear was less common than the usual ones people have. Most common seems to be concerns over shaking or messing up when bringing the fork to ones mouth. People will often avoid difficult foods such as peas that might make their shaking more noticeable and stick to safe food such as mashed potato. Another common problem related to shaking is holding drinks and tea cups where the shaking might be more noticeable and there is a possibility of spilling tea everywhere. If shaking is a worry for you then you might find my ‘shaking and tension‘ post interesting.

Really anything that might cause embarrassment can be a problem, including slipping with your knife and shooting a tough bit of steak across the room, spilling soup down your front, making slurping noises,  and missing your mouth with your fork. People also commonly worry about etiquette like what to wear, what knife and fork to use, and am I eating too fast or too slow?

The consequences of all this are usually that the person starts to associate a lot of stress with meal time and starts to adjust their life around their fears. This might mean skipping meals, only feeling able to choose ’safe’ foods, declining invitations to restaurants, or eating in secret. This can then be noticed by other people who might be concerned or who might find it difficult when it affects their plans. Usually people do not want to explain what is really going on and sometimes even when they do other people might not understand the severity of their fears and that they cannot simply switch them off. This can then result in further stress being associated to eating fuelling the anxiety that surrounds it.

I hope by writing this post you can at least know that you are not alone with these fears and that they are actually very common. I am planning to address how to overcome them in my audio product, but I would encourage people to start seeking help with them now rather than waiting as since eating is so fundamental to our lives, such fears can have a big impact. Also, going hungry is known to make people more susceptible to feeling emotional and anxious, so skipping meals or not eating properly can heighten anxiety overall.

I’ve always liked the Carl Rogers’ quote, ‘the most personal is the most universal’. It is particularly relevant to social anxiety as when we are socially anxious we often try and hide everything that is personal about us. We can end up scared that other people might think our most intimate secrets and problems are strange or signs of weakness, but if we could really see into other people’s minds, I think we would find a great deal in common. I have certainly learnt this as I have changed and become more open about my thoughts and problems over the years.

We can agonise over keeping our most personal problems private, trying to not let others know the secrets. We may even start to shape our whole life around them. But then when the pain gets too much and we have no choice but to bring them out in the open, we grit our teeth and wait for the worst reaction only to be met with a rather surprised reaction of, ‘me too!’ or a more casual account of how the other person also used to have the same problem, or knew someone who did. I guess we are all just human after all, and humans are human like!

Social anxiety is a very common anxiety problem, but most people struggling with it think they are the only one until they are fortunate enough to stumble across a website on the internet or accidentally find out in some other way. People with social anxiety are very secretive about their fears, have often crafted a well rehearsed act to hide them, and many just do not go out and meet many people, so it is not really surprising that they each feel like they are the only one even though there are many others near by going through the same.

Research on the prevalence of social anxiety disorder has quite varied results, but even at the most conservative level of 2% of the population, that is 1.2 million people in the UK, 6 million in the US, and 134 million globally. Some estimates are almost four times this number. Suddenly this very personal problem does not seem quite so personal. This is echoed in the support groups I facilitate where although everyone’s fears are slightly different, there is also a huge degree of similarity, right down to the most intimate details.

Carl Rogers quote of, ‘the most personal is the most universal’, is well demonstrated in Derren Brown’s Trick of the Mind 3 series, episode 1 (watch it here, 14 minutes, 55 seconds in), where he gives each person from three groups of people from three different countries a personal psychic reading. To their surprise it is very accurate, but then to their amazement, they all have exactly the same reading.

I promise not to make this a blog about the Britain’s Got Talent TV show, I am not even a great fan of TV, but both contestant Susan Boyle, and now Jamie Pugh, represent different sides of social anxiety that warrant some discussion.

Last Saturday, 37 year old Jamie Pugh, described as possibly ‘the most nervous contestant we’ve ever had’, sang ‘Bring Him Home’ from Les Miserables, and he sang it very well! He sufferers from severe stage fight (a common form of social anxiety) and wanted to go on the show to confront his fears. He gave the distinct impression that overcoming his fear of stage fright was much more important to him than winning the contest, although I am sure he would like to win too! I am sure anyone struggling with severe social anxiety knows only too well that overcoming it would be a bigger prize than singing in front of the queen. You can see Jamie’s performance by clicking on his picture below.

Some of you might be wondering that, if he has social anxiety, then how could he do something so bold? The answer to that really is, we do not know, only Jamie knows, but there are some distinct possibilities. Firstly, while some people with social anxiety find almost all social situations painful, for others only specific situations will fill them with fear and dread. They do not necessarily feel less anxiety though, it is just that they do not feel so vulnerable in other social situations. Secondly, while some people are mostly avoidant and hardly ever enter the situations they find most anxiety provoking, others will be determined to not let social anxiety hold them back and will endure experience after experience of painful anxiety to carry on with life. It sounds likely though that Jamie has been avoidant up until this point and now his desires to fulfil his dreams, and possibly a little encouragement from family and friends, has driven him to face his worst fears.

Like many people with social anxiety, Jamie’s worst fear is that his performance will leave him in a vulnerable position. He states that he fears he will just freeze and not be able to perform, but the fear will go deeper than this. Most likely he not only fears that freezing will mean he could miss his opportunity, but more so that he will be judged negatively and ridiculed for appearing vulnerable, which is actually quite possible given the judges comments to other contestants. But respect where respect is due and despite Jamie’s nervousness on stage, his talents are recognised by both the audience and judges. In fact, it is quite likely that his vulnerability will inspire compassion and the public will not only vote for his talent, but also because they want to see his life change for the better. It will be up to Jamie now to put in the work to boost his confidence as I suspect it will take more than one performance to shift his lack of self-belief, but I hoped to be proved wrong.

He will have to work hard on giving himself encouragement, having faith in his abilities, having faith in the public to be kind and trusting himself to cope with whatever is to come. It will most likely be a fear that he cannot cope with rejection that is the even deeper root fear that lies behind his fear of being judged negatively. Social anxiety is not so much a lack of trust in other people, but more a lack of trust in ourselves to deal with the situations that go wrong for us. When he can learn to take actions that reflect the mindset of self-belief his confidence will grow and his fears will fade. As with so many people struggling with social anxiety, Jamie obviously is very harsh on himself at the moment and this is reflected in his inability to accept and enjoy praise. You can see the disbelief on his face as he tries to process the extended applause the audience and judges give. It is such contrast to what goes on inside his head and how he views himself that it is almost hard for him to bare. He cries as for this this brief moment he feels loved enough to let his guard down and be vulnerable, I just hope for his sake that he can learn to leave it down and place trust in not only himself, but also other people. Best of luck to you Jamie.

I created this video to help encourage more people to come along to Social Anxiety West in Bristol, but I thought I would share it here also. I talk about what social anxiety was like for me, including feeling unable to speak and physical symptoms, and how I found a self-help group helpful.

While Christmas can be anxiety provoking with work parties, family get-togethers and present giving and receiving, New Year’s Eve can be a depressing time of year for those with social anxiety. I hope for all it is not, but unfortunately, for many it will be.

Our loneliness and isolation can be amplified when we know others around us are socialising and having fun. We may even feel jealous or envious with a sense of unfairness about the situation, and even though we know this is unhealthy, we may find it hard to shake the feelings.

It is good to know that some of the social anxiety sufferers I know are getting together this year to celebrate the new year and I hope that many other people with social anxiety have enjoyable celebrations lined up too, but I know there will also be many on their own, or who will feel alone while in the company of others.

I have had my fair share of New Year’s Eves that I do not wish to remember. Many of them were times when I felt very alone. If you are alone this New Year’s then I understand why you may be feeling sad or even depressed. Unfortunately, I cannot take that sadness away for you, but I encourage you to use it to your advantage.

There may not be enough time to find the confidence you need to fully enjoy this New Year’s Eve, but you have a whole year to make sure that next year’s is a different story. Use your sadness to drive you to start making steps towards building your confidence. You may not know how to yet, but when we have a strong need for something and start actively searching for answers, usually we will find them. It is quite probable that they will not be the answers you were expecting, so be prepared to search beyond what seems immediately obvious. When you step into 2009, make sure you have a plan to make this year different.

Make New Year’s Eve a time for you to reflect on the last year and put in place plans to make the next year your best to date. What better time than the last day of the year to plan for a life-changing year ahead. Others may be out having fun, but while they are out doing that, you could be taking the first steps towards something great. Make the last day of the year really count.

Whether you will be planning a new life or just enjoying the moment, I wish you all the best for the new year. I hope your plans for the year ahead will be all that you hoped for and more.

Unfortunately, I do not have any photo's of myself from the time

The hairdressers is something I used to dread. In-fact, I just did not go at all. My long untidy hair earned me the nickname of ‘Happy Hippy Hanlon’. The happy part was a sarcastic comment about my generally miserable demeanour at the time. Eventually a friend I made in the last year of school gave me an exceptionally stylish 90s undercut. This probably only slightly improved the situation, but I was grateful at the time. A year or so later my sister had a go which had better results I seem to remember.

While many fear the dentist, hairdressers seems to be a more common fears for people with social anxiety. Having your mouth stretched open with a mirror stuck in it seems much more preferable than having to make polite small talk while someone holds sharp pointy things to your head. Today, I do not mind either and shall be off to my Italian friend for a slightly overdue trim later, but I know that for many, deciding whether or not to go to the hairdressers remains an uncomfortable dilemma.

If you are a social anxiety sufferer then it is quite likely that there has been a time when it has felt like people are laughing at you. Sure, everyone gets laughed at a few times in their life, but the difference with social anxiety is that, it feels like people are laughing at you, but they are not.

I used to be so self-conscious and paranoid about how I appeared to others that I would frequently feel like people were laughing at me. Was I walking oddly? Was there something stuck on my back? Was my hair sticking up? Maybe my flies were undone? Or perhaps, did they think I just looked pain weird? I did not feel able to, for example, check if something was stuck on my back because it felt like I was playing into the joke or would just look odd checking nothing. I would end up trying to look in shop windows to check how I was appearing to others, but struggled to find a way to do it discretely. As with many people with social anxiety, my self-focus was not an act of vanity, I was trying to manage what felt like an intimidating and vulnerable situation.

Even though my appearance was not great, I now understand that there was nothing about myself that warranted other people to laugh at me and those people probably did not even notice me at all. My feelings felt very real, but as much as I tried to convince myself that they were probably laughing at something else, doubt kept in creeping into my mind. Eventually, though, I did overcome this problem. This was quite an ingrained problem and was one of the last aspects of my social anxiety to leave me.

Although not a complete solution, an important part of overcoming this paranoia is to look up at the people who are laughing. That can be hard to do as our natural response is often to be submissive and look down or away, but through looking away we starve ourselves of any information that may counter our paranoid assumptions. By looking up at the people who are laughing, we get to find out if they are really looking at us. As you might know logically, it is quite unlikely that they are, but by actually seeing for yourself you get real evidence, and that can have a powerful effect on your feelings. Of course, it may be that they really are looking in your direction and laughing (although this is rarely the case), but in this situation the exercise can still be valuable. What we see with our eyes is usually not as bad as what our imagination can create for us, so by looking up we still help ourselves.

Sometimes when we are anxious and it feels like other people do not like us, then we can react in a negative way when there is actually nothing to react to. This can sometimes cause the situations we fear happening, to actually happen. So when you look up at people who are laughing, make sure you are operating from an attitude of curiosity rather than defence. Just take a quick look and do not stare. Also, if you make eye-contact, then give a quick smile and keep going about your business. It is always best to take the approach of innocent until proven guilty. It is often more our reactions to situations that give them meaning than people’s original intentions.

Everyone’s experience in unique, so please feel free to share yours by posting a comment.

As with blushing and sweating anxiety symptoms, shaking and jerky movements are caused by the increased sympathetic nervous system activity that occurs when we get anxious. During this process adrenaline is released that causes our muscles to become ready for physical activity. A side effect of this readiness is trembling or shaking. In addition to shaking, sufferers may also experience muscle tension. This tension can cause us to have uncoordinated clumsy movements that do not flow as naturally as they normally would. During very strong anxiety individuals may also experience involuntary jerks or spasms due to this muscle tension.

Shaking

The shaking some people experience during anxiety is usually most noticeable in the hands. Since social anxiety sufferers are often very self-conscious about others noticing their anxiety this can be a problem. Wobbling teacups, peas jumping off forks and shaking speech notes all make anxious shaking more visible and this can lead to sufferers avoiding these things when around other people. Shaking legs and quivering lips are also common visible symptoms.

The main worry of sufferers is that people will see their visible anxiety symptoms and then make a unfavourable judgement about them. The feared judgements will typically be that the sufferer is weird because of their odd movements or that they are weak because they are feeling anxious.

People will often do their best to try and hide their anxious shaking, but this tends to only worsen the situation. Anxiety sufferers are nearly always caught in vicious cycles where the ways they try to manage their anxiety only serves to worsen it. Fears about starting to shake in front of people leads to increased worry about the onset of shaking. This worry then increases anxiety levels during social situations which in turn leads to the actual shaking they are trying to avoid. Self-consciousness is increased because of this visible shaking which leads to more worry and more anxiety and more shaking creating a distressing vicious cycle.

In addition to this, sufferers will try to hide or control their anxious shaking, but this only adds fuel to the fire. A common strategy is to tense up to try and keep movements still, but this increased muscle tension only exaggerates the shaking. Another strategy is to try and hide shaking through avoidance or keeping hands out of sight, but this too will worsen the situation. Avoidance strategies like these reinforce the idea that we need to hide these symptoms and that revealing them could have negative consequences for us. They prevent us from finding out that, most of the time, revealing our anxiety will nearly always have no negative consequences for us and that doing so will prevent the anxiety from occurring in the first place.

Tension

Jerky uncoordinated movements resulting from anxious tension can cause social anxiety sufferers to find it difficult to move naturally. It can be harder for them to coordinate their movements and this can, in part, lead to them feeling self-conscious about the way they move. This increased self focus can then further interfere with coordination because it reduces their awareness of the space around them. For example, a suffer may be feeling self-conscious about how they are acting and then end up knocking over their drink. They become so distracted by their anxious thoughts that they are less aware of the objects around them and accidents are more likely to happen. An accident such as spilling a drink can feel very embarrassing for a social anxiety sufferer and this can mean more even anxiety and distress which can further interfere with they ability to function well in social situations.

As with shaking, often the very things we do to try and improve unnatural anxious movements tend to only serve to worsen them. Over the years I have heard many social anxiety sufferers report feeling self-conscious about the way they walk. They worry that other people think they are walking an odd way and have trouble moving naturally when other people are watching them.

This was also my experience, especially when walking in the streets around the general public. I used to worry that people would be making fun of the way I walked and would possibly laugh at me or think that I was odd. My strategy to deal with this at the time was a logical but unhelpful one. I used to make a conscious effort to walk more naturally. The problem was that natural movements come from unconscious behaviour, rather than conscious behaviour, and therefore rather than improving my walk, I only made my tense anxious movements even more uncoordinated and unnatural.

With all anxiety symptoms, including blushing, sweating, shaking and tension, they all disappear once the vicious cycles that keep them going are adequately broken and new ways to feel confident are learnt. In the product I am producing I will explain these vicious cycles in more detail and clearly show how to overcome them and gain that all important confidence.

Please note that shaking, muscle spasms and other physical symptoms mentioned in this article can be due to other medical conditions. If you are uncertain if your shaking relates to emotional states then you should seek the advice of a qualified medical practitioner.

How do anxiety symptoms such as shaking interfere with your life?

Blushing and Sweating are two common concerns of the social anxiety sufferer. To some, blushing is a sweet and endearing quality, but for the social anxiety sufferer it can feel like a nightmare. For them, rather than a slight pinkness in their cheeks, their blushing can often be more describable as looking beetroot red, feeling like their face is on fire and something that not only affects their face, but spreads in a blotchy manner to their neck and chest.

Likewise, for the social anxiety sufferer who is concerned about sweating, it is often not just a matter of a slight dampness under the arms on a hot summer’s day. Many report profuse sweating on the palms their hands, face, armpits and other areas of the body. This is usually exaggerated when in social situations where they least want it to appear and it can be particularly problematic for people whose job involves shaking hands a lot.

When we get anxious, our sympathetic nerve activity is increased. This results in various changes in our body, including blushing and sweating, which serve to help ready us for an adverse situation. In the distant past, most adverse situations usually involved a physical danger that needed to be run away from or fought off. This can still be true, but is less so in the world we live in today. Both running away and fighting involve physical activity and that produces excessive body heat. To make our bodies more efficient and increase our chances of survival, humans have evolved to start cooling themselves through sweating when danger is anticipated. This is great when the danger is a swarm of killer bees and you need to run as far as possible, but it is not so great when the danger is the potential rejection of your colleagues when giving a presentation.

Blushing seems to be less explainable than sweating. Scientists have not figured out exactly why we blush when we are anxious or embarrassed. It is possible that it serves to communicate our remorse to others which may mean we are treated less harshly when we get things wrong, but the exact reasons for it’s function remain elusive.

Although blushing and sweating is a natural and healthy part of being human, many social anxiety sufferers end up feeling very self-conscious and anxious about these physical traits. The big problem is that getting self-conscious and anxious makes one blush and sweat more rather than helping with the situation. People often get stuck in a vicious cycle where they fear the onset of blushing and sweating in social situations and then this causes them anxiety which then actually creates the very blushing or sweating that they feared happening in the first place. The thought of other people noticing this then causes more anxiety and consequentially more blushing and sweating and so on.

Although it often does not feel like it for the sufferer, the main issue that needs to be resolved is not the actual blushing or sweating, but rather the fact that they think something bad might happen if other people notice their blushing and sweating. Once these psychological issues are resolved and the cycles are broken, blushing and sweating will not be exaggerated by anxiety and they will cease to be a problem.

Often the ways that people have come up with to try and cope with these physical traits, such as habitually hiding them, tend to only serve to worsen the problem in the long-term. This can lead to people feeling like they are fighting a losing battle and like they are stuck with an excruciatingly embarrassing physical problem they cannot solve. This desperation is reflected in the increase in the number of people who risk irreversible surgery to reduce their visible anxiety symptoms.

For some, operations such as Sympathectomies can seem like the best escape route out of their suffering, but these operations can sometimes lead to worse problems that cannot be easily solved, or solved at all. These include permanently increased sweating elsewhere on the body and abnormal facial features. These risks can be avoided if people get the appropriate psychological help to address the root cause of their severe blushing or sweating.

It is fully understandable how when someone feels stuck with a problem, and when their own efforts to overcome it result to nothing, they turn to such drastic measures to seek relief. People considering this option should know that there are effective and risk free alternatives that actually address underlying psychological issues rather than just treating the symptom. Ponder the question: If someone has a spider phobia, would you treat them by killing all the spiders in the world, or would you work to help them come to terms with the fact that the everyday spiders they are scared of pose no threat to them?