Abstract. Social anxiety disorder (SAD) is one of the most common personality disorders, affecting the well-being of over 15 million U.S. adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. SAD generally infects adolescents between the middle and late teens who have experienced detachment, exploitation, and or neglect, whether the cause be hereditary, environmental, or the result of some traumatic event. This abuse, accidental or otherwise, disrupts their normal course of human motivational development affecting physiological safety and belongingness and love. This study provides insight into the symptomatic impairments that obstruct the SAD person’s ability to acquire six of the seven basic types of interpersonal love: philia, eros, agape, storge, ludus, and pragma. Corrupted by a culture of maladaptive self-belief, SAD persons suffer from a deficit of implicit and explicit self-esteem and self-inflicted social exclusion. The psychology of healthy philatia can address these concerns by reinvigorating the intrinsic positive self-qualities ―self –esteem, -compassion, -love, -regard, -respect, -value, -worth, and other wholesome attributes―guiding the SAD person to the recognition of their value and consequences, overriding the destructive culture of maladaptive self-beliefs. Cognitive-behavioral therapy has addressed SAD symptoms for 25 years through programs of thought and behavior modification and the obtainment of self-esteem, but there is a need for innovative psychological and philosophical research to address the broader implications of healthy philautia’s positive self-qualities, which could deliver the potential for self-love and societal concern to the SAD person, opening the bridge to the procurement of all forms of interpersonal love.
Social anxiety disorder (SAD) is the second most commonly diagnosed form of anxiety in the United States (MHA, 2019). The Anxiety and Depression Association of America (ADAA, 2019a) estimate nearly 15 million (7%) American adults currently experience its symptoms. Ritchie & Roser (2018) report 284 million SAD persons, worldwide, and the National Institute of Mental Health (NIMH, 2017) report 31.1% of U.S. adults experience some anxiety disorder at some time in their lives, Global statistics are subject to “differences in the classification criteria, culture, and gender” (Tsitsas & Paschali, 2014), and“in the instruments used to ascertain diagnosis” (NCCMH, 2013).
The National Institute of Mental Health estimates that 9.1% of adolescents experience social anxiety disorder, and 1.3% have severe impairment (NIMH, 2017). The onset of SAD is generally considered “to take place between the middle and late teens” (Tsitsas & Paschali, 2014). Like other pathogens, SAD can remain dormant for years before symptoms materialize. Any number of situations or events trigger the initial contact; it could be hereditary, environmental, or the result of some traumatic experience. The LGBTQ community is 1.5 to 2.5 times as susceptible to SAD “than that of their straight or gender-conforming counterparts” (Brenner, 2019). 39.5% of general anxiety sufferers pursue recovery compared to “5% of SAD persons in the first year of experiencing the malfunction” (Shelton, 2018).
Maladaptive Self-Beliefs. SAD’s culture of maladaptive self-beliefs (Ritter et al., 2013) and negative self-evaluations (Castella et al., 2014) aggravate anxiety and impede social performance (Hulme et al., 2012). “Patients with SAD often believe they lack the necessary social skills to interact normally with others” (Gaudiano & Herbert, 2003). Maladaptive self-beliefs are distorted reflections of a situation, often accepted as accurate.
Anxiety and other personality disorders are branches of the same tree. “There is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression (19%), substance-abuse disorder (17%), GAD (5%), panic disorder (6%), and PTSD (3%)” (Tsitsas & Paschali, 2014). The Anxiety and Depression Association of America (ADAA, 2019a) includes many emotional and mental disorders related to, components of, or a consequence of social anxiety disorder including avoidant personality disorder, panic disorder, generalized anxiety disorder, depression, substance abuse, eating disorders, OCD, and schizophrenia.
Cognitive behavioral therapy purposed for SAD is typically conceptualized as a short-term, skills-oriented approach aimed at exploring relationships among a person’s thoughts, feelings, and behaviors while changing the culture of maladaptive self-beliefs into productive, rational thought and behavior (Thomas, 2019).
Almost 90 percent of the approaches empirically supported by the “American Psychological Association’s Division 12 Task Force on Psychological Interventions” involve cognitive-behavioral treatments, according to Lyford (2017). “Individuals who undergo CBT show changes in brain activity, suggesting that this therapy improves your brain functioning as well” (NAMI, 2019).
Studies of CBT have shown it to be an effective treatment for a wide variety of mental illnesses including depression, SAD, generalized anxiety disorders, bipolar disorder, eating disorders, PTSD, OCD, panic disorder, and schizophrenia (NAMI, 2019; Kaczkurkin & Foa, 2015). However, David et al. (2018) suggest if the gold standard of psychotherapy defines itself as the best in the field, then CBT is not the gold standard. There is clearly room for further improvement, “both in terms of CBT’s efficacy/effectiveness and its underlying theories/mechanisms of change.”
Lyford (2017) provides two examples of criticism. A 2013 meta-analysis published in Clinical Psychology Review comparing CBT to other therapies, failed to “provide corroborative evidence for the conjecture that CBT is superior to bona fide non-CBT treatments.” An 8-week clinical study by Sweden’s Lund University in 2013, concluded that “CBT was no more effective than mindfulness-based therapy for those suffering from depression and anxiety.”
Another meta-analysis conducted by psychologists Johnsen & Friborg (2015) tracked 70 CBT outcome studies conducted between 1977 and 2014 and concluded that “the effects of CBT have declined linearly and steadily since its introduction, as measured by patients’ self-reports, clinicians’ ratings, and rates of remission.” According to Johnsen, “Just seeing a decrease in symptoms,” he says, “doesn’t translate into greater well-being.”
While this study recognizes CBT as the best foundation for addressing the SAD culture of maladaptive self-beliefs, it makes the point standard CBT is not necessarily the most productive course of treatment. New and innovative methodologies supported by a collaboration of theoretical construct and integrated scientific psychotherapy are needed to address mental illness as represented in this era of advanced complexity. A SAD person subsisting on paranoia sustained by negative self-evaluation is better served by non-traditional and supported approaches, including those defined as new (third) wave (generation) therapies, developed through client trust, cultural assimilation, and therapeutic innovation with CBT serving as the foundational platform for integration.
Standard CBT also lacks methodological clarity. Johnsen and Friborg (2018) cite the varying forms of CBT used in study and therapy over the years. Experts point to two predominant types of CBT: “the unadulterated CBT created by Beck and Ellis, which reflects “the protocol-driven, highly goal-oriented, more standardized approach they first popularized,” and the more integrative and collaborative approaches of “modern” CBT (Wong et al., 2013). This study maintains neither faction should be ignored if we are to effectively challenge address the evolving complexities of positive self-qualities and their importance to the individual’s psychological well-being.
Kashdan et al. (2011) cite the “evidence that social anxiety is associated with diminished positive experiences, infrequent positive events, an absence of positive inferential biases in social situations, fear responses to overtly positive events, and poor quality of life.” Models of CBT that attempt only to reduce the individual’s avoidance behaviors would benefit from addressing more specifically the relational deficits that such people experience, as well as positive psychological measures to counter SAD’s culture of maladaptive self-beliefs. Non-traditional and supported approaches, including those defined as new (third) wave (generation) therapies, with CBT serving as the foundational platform for integration, would widen the scope and perspective in comprehending SAD’s evolving intricacies.
One such step is the integration of positive psychology within the cognitive behavioral therapy model which, “despite recent scientific attention to the positive spectrum of psychological functioning and social anxiety/SAD … has yet to be integrated into mainstream accounts of assessment, theory, phenomenology, course, and treatment” (Kashdan et al., 2011). CBT would continue to modify automatic maladaptive self-beliefs, thoughts, and behaviors, and positive psychology would replace them with positive self-qualities.
As positive psychology turns its attention to the broader spectrum of philautia’s positive self-qualities, integration with CBT’s behavior modification, neuroscience’s network restructuring, and other non-traditional and supported approaches would establish a working platform for discovery.