Social Anxiety Help
Larry Cohen, LICSW
Social Anxiety Does Not Equal Introversion
Many people mistake social anxiety with introversion. Introversion is a perfectly normal personality trait. More precisely, there is a continuum from extroversion to introversion that describes one dimension of personality. Those who are relatively extroverted have an innate disposition to interact with many different people, often in groups. Those who are relatively introverted are more disposed to solitude and interactions with fewer persons, often one at a time.
Extroversion and introversion simply describe one element of our basic temperament: what feels natural to us, rather than what feels like work. There is evidence suggesting that there is a genetic basis for introverted and extroverted temperaments. But that doesn’t mean we can’t behave in a way that doesn’t come naturally when a situation calls for it. Healthy people are capable of, and often engage in, both extroverted and introverted activities since each has its advantages. For example, it is easier to meet people and develop support networks through extroverted behaviors. It is easier to get close to people and develop intimate relationships through introverted behaviors.
Social anxiety, remember, is based on a tendency to be overly concerned about social danger: judgment, rejection and embarrassment. Extroverts and introverts alike may suffer from social anxiety. Nor are all introverts socially anxious.
Socially anxious extroverts may be fearful of being assertive, speaking in front of groups or talking to attractive strangers…just like socially anxious introverts. When they are feeling socially anxious, extroverts often behave in an avoidant or withdrawn manner which many people misinterpret as meaning they are introverts.
Compounding this confusion, “mainstream” culture in the United States is decidedly extroverted. Introversion is viewed with derision or pity. This is not true of all subcultures in the United States. Nor is it true of all other societies. American-style extroverted behavior is considered rude, arrogant and domineering by many cultures.
But within “mainstream” U.S. culture, introverted children and adolescents often have a hard time adapting to extroverted activities, and often are teased or harassed by more outgoing peers in the process. These experiences could easily foster the development of core beliefs among American introverted young people that they are fundamentally different and/or deficient, and do not fit in. (This process is even more intensified among lesbian, gay, bi and trans [LGBT] young people who grow up in a culture that condemns them as sick and sinful.) As a result, this may lead to a higher incidence of social anxiety among introverts in the United States.
Sadly, some clinicians do not seem to not understand the difference between social anxiety and introversion and seek to treat introversion as though it were a mental illness. A glaring example of such ignorance is psychiatrist Peter D. Kramer, whose 1993 best selling Listening to Prozac devotes a chapter to advocating using this medication to help “cure” people of their introversion. In reality, Prozac and other SSRIs (including Luvox, Paxil, Zoloft, Celexa and Lexapro) may help many people to overcome their social anxiety. But there is no evidence that any medication converts introverts into extroverts. Nor is introversion considered a psychiatric disorder or even a psychiatric symptom by the American Psychiatric Society.
I believe that the basic goal in therapy for social anxiety–whether using cognitive-behavioral therapy and/or medication–is to help extroverts and introverts alike feel more self-confident and interact more assertively. I believe it is both ineffective and unethical to try to change those who are temperamentally introverts into extroverts…or vice versa. Such efforts are not only bound to fail, but they tend to reinforce the distorted core beliefs about personal deficiency that generates social anxiety in the first place.
For more information, please read:
Social Anxiety and U.S. Bias for Extroversion (Advances in Cognitive Therapy Newsletter; see “President’s Message” on pp. 1 & 9).
Perception is the Starting Point
Social Anxiety Does Not Equal Introversion
Biology, Social Anxiety and Medication
Cognitive-Behavioral Therapy for Social Anxiety
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): nationalsocialanxietycenter.com