Social anxiety disorder
The social anxiety disorder (DAS) is characterized by intense anxiety compared to common social situations. The diffusion of 6.8% within the general population (Kessler et al., 2005) makes it one of the most frequent disorders among psychopathologies.
People with social anxiety suffer from a serious, persistent and chronic fear of being judged by others and are concerned that what they do can be embarrassing, to the point of fear that the same anxiety may be a source of judgment.
This fear is often managed through theavoidance of social situations which, in addition to aggravating suffering, substantially compromises social, working and friendly functioning (APA, 2013; Morrison & Heimberg, 2013).
The role of shame
Shame is a social emotion strictly connected to social anxiety disorder. It is configured as an “self -conscious” emotion associated with the perception of possessing attributes, characteristics or behaviors that others will find unwanted and which could lead to social refusal (Gilbert, 1998).
Already in 2000 Gilbert connected the das with experiences of shame by interpreting it as a response of submission to contexts in which the person feels vulnerable to the loss of social appreciation.
In other words, perceiving a threat to its social image would activate an emotional and behavioral response, the shame, aimed at generating benevolence in the other.
Self -criticism as a pathogenic process
Typical of experiences of shame is what is defined critical self – That is, the experience of thoughts characterized by a “tone” and a content in which the person attacks himself for his own behaviors, emotions or characteristics.
Literature indicates self -criticism as a key factor in mental suffering in general (Gilbert & Irons, 2005) and in the Das in particular (Iancu et al., 2015).
Autocriticism is characterized by a chronic style of thought that is a barrier in access to positive emotions and ends the fear of relational intimacy.
The treatment of disoutrbo of social anxiety
To date the treatment Gold-Standard For the das it appears to be cognitive-behavioral therapy (CBT; Mayo-Wilson et al., 2014).
However, there are cases in which the effectiveness of this therapy appears reduced (Loerinc et al., 2015). A possible explanation lies in the high levels of self -criticism of some patients with das.
Literature indicates how these individuals respond less to standard CBT therapies which, for their directivity, can exacerbate some self -criticism processes (Marshall et al., 2008).
The compassion focused therapy
The compassion focused Therapy (CFT) is a third generation therapy that is characterized by a bio-psycho-social model of human functioning and integrates evolutionary and neuroscientific elements.
By integrating behavioral cognitive influences, affective neurosciences, attachment theory, evolutionism and Buddhist psychology (Gilbert, 2010) since its birth, the CFT has turned to people with high levels of shame and self -criticismsince these individuals have greater levels of difficulty in feeling safe and intimate in interpersonal relationships (Hofman & Bogels, 2006).
The purpose of the CFT is to increase the sensitivity for one’s own and others’ suffering by increasing the skills of conscious presence in the present moment without judging the internal experience. Also, aim to help the individual a mobilize inner social security signals generating sensations of heat and affiliation (Gilbert, 2010).
The CFT believes that human suffering is exacerbated and perpetuated by the constant critical self-diaologist that generates suffering and shame. The self -criticism incessantly stimulates a state of alarm (emotional system of protection from the threat) and a vision of the world and others as potential threats.
The ability to soothe and modulate the sense of threat is entrusted to the ability of the human being to create experiences of sharing, reassurance and interpersonal care (emotional care system) that mitigate the sense of threat.
This ability, although natural in humans, can be promoted, cultivated or on the contrary inhibited by First experiences of attachment. For example, experiences of shame, bullying or criticism of childhood can lead to a chronic inability to access images, thoughts and memories related to compassion/security.
Compassion Focused Therapy and Das
According to the CFT, social anxiety is generated by believing that one’s behavior can elicit in the other a refusal, a criticism or an aggression (Gilbert, 2001). This fear connects to the evolutionary need determined to maintain good social relationships with one’s own reference group.
The key element of the CFT for the DAS is, not only to reduce self -criticism, but encourage access to positive internal and external experiences Characterized by heat, care and self-abstunction.
In a study by Gharrae and colleagues (2018), it was highlighted how the CFT is effective in reducing both self -criticism levels and social anxiety symptoms. The CFT, therefore, is considered an effective possible treatment for the DAS like the standard CBT.
The structure of the intervention
A therapeutic path based on the CFT is by its nature flexible and structured according to the needs of the individual patient, however some macro-facts can be outlined that characterize the intervention.
A first phase focused on psycho-education with respect to shyness, shame and social anxietyas well as on the evolution of the brain and how it has evolved to guarantee survival through different emotional systems. At this stage the formulation of the disorder in CFT terms is outlined.
In the second phase, self -criticism is addressed, its functions, and imaginative techniques are introduced aimed at Create sense of safety that balances the emotions of alarm and anxiety.
The third phase is centered on Promotion of self-compression and self-assessment skills. In particular, the therapy focuses on the construction of the Self-compliance as an alternative to self -criticism. In this phase, the skills, and any difficulties, of receiving compassion, proximity and care by others are also addressed.
In the fourth phase, the behaviors that DAS support are identified, whether they are protective avoidance or behaviors, and explored the values that could motivate the person to face the path to reduce such behaviors in order to increase their freedom in social situations. This phase, therefore, has characteristics that approach it to behavioral protocols.
The last phase is characterized by theIntegration of compassion skills in daily life Through systematic exposure to difficult situations as an opportunity to respond in a compassionate and supportive way to difficulties.
Conclusions
The therapy focused on compassion is characterized by a profoundly experiential approach connected to natural human physiology and, therefore, aimed at increasing the individual’s ability to access the resources inherent in the body and mind.
Being able to activate sensations and feelings related to interpersonal security, in fact, are the key elements to be able to reduce social anxiety experiences and get out of the das.
Bibliographic references
- American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5 ™ (5th ed.). American Psychiatric Publishing, inc .. https://doi.org/10.1176/Appi.books.978089042596
- Gilbert, P. (1998). What is shame? Some Core Issues and Controversies. In P. Gilbert & B. Andrews (eds.), Shame: Interpersonal Behavior, Psychopathology, and Culture (pp. 3–38). Oxford University Press.
- Gilbert, P. (2001). Evolution and Social Anxiety: The Role of Attraction, Social Competition, and Social Hierarchies. Psychiatric Clinics of North America, 24(4), 723–751. https://doi.org/10.1016/s0193-953x(05)70260-4
- Gilbert, P. (2010). An Introduction to Compassion Focused Therapy in Cognitive Behavior Therapy. International Journal of Cognitive Therapy, 3(2), 97–112. https://doi.org/10.1521/ijct.2010.3.2.97
- Gilbert, P., & Irons, C. (2005). Focused Therapies and Compassionate Mind Training for Shame and Self-Attacking. (2005). Compassion275–337. https://doi.org/10.4324/9780203003459-15
- Gilbert, P., & Miles, Jnv (2000). Sensititivity to Social Put-Down: It’s Relationship to Perceptions of Social Rank, Shame, Social Anxies, Depression, Angers and Self-Other Blame. Personality and Individual Differences, 29(4), 757–774. https://doi.org/10.1016/s0191-8869(99)00230-5
- Hofmann, SG, & Bögels, SM (2006). Recent Advances in the Treatment of Social Phobia: Introduction to the Special Issue. Journal of Cognitive Psychotherapy, 20(1), 3–5. https://doi.org/10.1891/jcop.20.1.3
- Iancu, I., Bodner, E., & Ben-Thaction, IZ (2015). Self Esteem, Dependency, Self-Efficacy and Self-Criticism in Social Anxiety Disorder. Comprehensive psychiatry, 58, 165–171. https://doi.org/10.1016/j.comppsych.2014.11.018
- Kessler, RC, Canc, WT, Demler, O., & Walters, EE (2005). Prevalence, Severity, and Comorbideity of 12-Month DSM-IV Distruders in The National Comorbideity Survey Replication. Archives of General Psychiatry, 62(6), 617. Https://doi.org/10.1001/archpsys
- Loerinc, Ag, Meuret, AE, Twohig, MP, Rosenfield, D., Bluett, EJ, & Craske, MG (2015). Response Rates for CBT for Anxiety Disorders: Need for Standardized Criteria. Clinical Psychology Review, 4272–82. https://doi.org/10.1016/j.cpr.2015.08,004
- Marshall, MB, Zuroff, DC, McBride, C., & Bagby, RM (2008). Self -Criticism Predicts Differential Response to Treatment for Major Depression. Journal of Clinical Psychology, 64(3), 231–244. https://doi.org/10.1002/jclp.20438
- Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, DM, Adhes, AE, & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systemic review and goal meta-analysis. The Lancet Psychiatry, 1(5), 368–376. https://doi.org/10.1016/s2215-0366(14)70329-3
- Morrison, As, & Heimberg, RG (2013). Social Anxiety and Social Anxiety Disorder. Annual Review of Clinical Psychology, 9, 249–274. https://doi.org/10.1146/annurev-Clinpsy-050212-185631
