Suffering In Silence

Social Anxiety Help

Larry Cohen, LICSW

Suffering In Silence


by Wendy Johnson
Washington Blade

Some therapists believe ‘social anxiety’
may be more prevalent among Gays

When he was single, Larry Cohen used to place personal ads in the Washington Blade when he wanted to meet prospective boyfriends. For Cohen, it created less anxiety around how he should approach people and was easier than enduring the superficial conversations that often took place in bars.

“It was always easier for me to meet someone that way,” recalled Cohen, now a clinical social worker. “You already know the person wants to meet you and you don’t have to wonder whether they are talking to you just to be nice.”

To some, Cohen may have seemed shy, self-conscious, or even aloof. But in reality, he experienced a phenomenon known to many both in and out of the dating scene: social anxiety.

Once known as “evaluation phobia,” social anxiety is the irrational fear that one is being judged negatively in social or performance situations. At its most temperate, social anxiety causes excessive nervousness and discomfort in social settings such as parties and organizational or work meetings.

Social anxiety is a clinical term which includes shyness,” said Cohen, whose own experiences have fueled his work as a social worker who treats socially anxious Gays. “If you have trouble asserting yourself, it’s because of anxiety. Just about everyone experiences some form of social anxiety in their lives.”

At its worst, however, social anxiety can cause anxiety so severe that one develops a phobia and dodges most social situations.

“It’s not about telling yourself to get it together and pull yourself up by your bootstraps,” said Jerilyn Ross, an expert on social anxiety and president of the Anxiety Disorders Association of America in Rockville, Md. “Most people suffer in silence because they’re embarrassed to talk about it.”

“It wasn’t until 1987 that the first paper was even written on it,” said Ross, who researched social phobia for her 1994 book Triumph Over Fear. “We do know that it is twice as common among women as men, she said.

The American Psychiatric Association has estimated that about 3 to 13 percent of the nation’s adult population experiences social phobia. And some experts believe that Gay people may be more prone to the more mild form of social phobia known as social anxiety.

“It’s based on how you think other people see you,” said Giao Tran, a researcher studying social anxiety at American University’s Agoraphobia and Anxiety program. “It increases your self-consciousness. I’ve heard from clinical people that it may be more prevalent among Gays and Lesbians.”

Cohen agreed. “[Being Gay] makes you more prone to social anxiety, because it’s the fear that you will be judged by others,” said Cohen, who believes social anxiety is more common among Gay teenagers than their straight peers. The onset of social anxiety is usually adolescence. That’s when many of us begin to feel that we’re not like others and we’re not the way we’re supposed to be. So if you already have this core belief, you are more likely to fear that others will judge you.”

Those with social anxiety harbor a deep-rooted”core” belief that they are socially inept — a feeling which causes them to wonder whether others will pick up on their discomfort and subsequently think they are “wacky” or “crazy”, said Cohen.

In reality, however, others rarely notice the discomfort and nervousness which a socially anxious person experiences, he said.

“At worst, they come off as sort of shy,” Cohen said. “Meanwhile, they are wondering, ‘Will I be interesting enough, witty enough, attractive enough? Will I embarrass or humiliate myself?'”

When treating his socially anxious clients,Cohen, like most mental health professionals, uses a combination of cognitive and behavioral therapy.

The first step, he said, is to identify the core beliefs that lead to their negative thoughts and reclusive behavior. The cognitive component, therefore, works to change the client’s thought pattern, while the behavioral approach helps alter the way a client reacts to his or her feelings.

“It’s not the power of positive thinking,” Cohen said. “But the power of realistic thinking.”

Group therapy is often the most effective, said Regina Ottaviani, a Maryland clinical psychologist who specializes in the treatment of social anxiety.

“People feel like they’re isolated and that they’e the only ones who experience this,” she said. “So groups provide a great opportunity to expose them to the very thing they are afraid of. We assume we know what others are thinking about us, when it’s really about what we are thinking about ourselves. Those are the thought distortions that group therapy looks at.

Ottaviani also incorporates “shaming exercises” into her group treatment.

“I tell them to go into a store and yell out the time, or to black out their teeth and go buy something,” she said. “It’s effective, because even though this kind of behavior is bizarre, usually no one pays any attention. People usually report that it is very freeing.”

Anti-depressant and anti-anxiety drugs can also be incorporated into one’s treatment, said 0ttaviani.

“Medication can help reduce some of the physical symptoms,” she said. “The important thing for people to know is that this is a treatable problem.”


Thinking “accurately” rather than “positively” is the first step in overcoming social anxiety, said Gay social worker Larry Cohen. Quashing negative thinking, therefore, is crucial.

“Negativity creeps in,” Cohen said. “We think others are going to judge us negatively, so we either run away or freeze up. So the thing to do is to try to change your thinking.”

One way to do this, said Cohen, is to stop the “automatic thoughts” that cause socially anxious people to think they will be rejected.

“Begin with changing your thoughts,” he said. “Changes in your hehavior will follow.”

For example, when a person is attending a function where he or she knows few people, Cohen suggests that the person begin mingling instead of automatically thinking that he or she has nothing interesting to say.

“Sometimes, we assume we know what everyone is thinking about us when really all we know is what we’re thinking about us,” said Cohen, who employs “accurate thinking” to counter his own anxiety. “At parties, I still have to remind myself to interact with people because I might naturally drift off and withdraw.”

– Wendy Johnson

Reproduced with permission from The Washington Blade, August 30, 1996.


If you have any questions or comments, please email Larry Cohen, LICSW, with offices in Washington, DC.

Social Anxiety Help is a founding regional clinic of the National Social Anxiety Center (NSAC):