Robert F. Mullen, PhD
Director/ReChanneling

For each new subscriber, ReChanneling donates $25 for workshop scholarships.

The distinction between social anxiety and social anxiety disorder is in severity. We are not all affected by the same symptoms or relentlessness. The characteristics and traits are equivalent. These conditions originate homogeneously, their trajectories differentiated by environment, experience, and the diversity of human thought and behavior. While comorbidities dramatically benefit, the recovery methods identified are for social anxiety and social anxiety disorder, and reference to one includes the other.

Recent Posts

I recognize that I have fallen behind on my weekly posts. We have been finalizing editing of our upcoming book, A Survivor’s Common-Sense Approach to Recovery from Social Anxiety, which goes to the publisher next week. Accounting for the average four-month schedule to get to print, we hope to make this book available sometime in the spring.

Social Anxiety’s Failure to Establish, Develop, and Maintain Healthy Relationships. Part I

From C.-H. Mayer and E. Vanderheiden (eds), International Handbook of Love. Springer Nature Switzerland, 2025. 10.1007/978-3-031-76665-7_59-1

Abstract

Social anxiety disorder (SAD) is one of the most common psycho-physiological malfunctions. Affecting the emotional and mental well-being of over 15 million US adults who find themselves caught up in a densely interconnected network of fear and avoidance of social situations. These observations provide insights into the relationship deficits experienced by people with SAD. Their innate need for intimacy is just as dynamic as that of any individual. Still, their impairment disrupts the ability (means of acquisition) to establish affectionate bonds in almost any capacity. The spirit is willing, but competence is insubstantial. The means of acquisition and how SAD symptomatically disrupts them are the context of this research.

Notwithstanding overwhelming evidence of social incompatibility, there is hope for the startlingly few SAD individuals who commit to recovery. Integrating positive psychology’s optimum human functioning with CBT’s behavior modification, neuroscience’s network restructuring, and other supported and non-traditional approaches can establish a working platform for discovery, opening the bridge to procuring forms of intimacy previously inaccessible.

Keywords: Love -Social anxiety disorder -Intimacy –Philautia -Relationships

Social Anxiety Disorder

The distinction between social anxiety and social anxiety disorder is in severity. We are not all affected by the same symptoms or relentlessness. The characteristics and traits are equivalent. These conditions originate homogeneously, their trajectories differentiated by environment, experience, and the diversity of human thought and behavior. While comorbidities dramatically benefit, the recovery methods identified are for social anxiety and social anxiety disorder, and reference to one includes the other.      

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) estimates that roughly 15 million (7%) American adults currently experience its symptoms. Ritchie and Roser (2018) report 284 million SAD persons, worldwide, and the National Institute of Mental Health (NIMH, 2017) reports that 31.1% of US 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).

Studies in other Western nations (e.g., Australia, Canada, Sweden) note similar prevalence rates as in the USA. As do those in culturally westernized nations such as Israel. Even countries with strikingly different cultures (e.g., Iran) note evidence of social anxiety disorder (albeit at lower rates) among their populace. (Stein & Stein, 2008)

SAD is the most common psychiatric disorder in the United States after major depression and alcohol abuse (Heshmat, 2014). It is also arguably the most underrated and misunderstood. A “debilitating and chronic” psychophysiological affliction (Castella et al., 2014), SAD “wreaks havoc on the lives of those who suffer from it” (ADAA, 2019a).

SAD attacks all fronts, negatively affecting the entire body complex, delivering mental confusion (Mayoclinic, 2017b), emotional instability (Castella et al., 2014; Yeilding, 2017), physical dysfunction (NIMH, 2017; Richards, 2019), and spiritual malaise. Emotionally, persons experiencing SAD feel depressed and lonely (Jazaieri et al., 2015). Physically, they are subject to unwarranted sweating and trembling, hyperventilation, nausea, cramps, dizziness, and muscle spasms (ADAA, 2019a; NIMH, 2017). Mentally, thoughts are discordant and irrational (Felman, 2018; Richards, 2014). Spiritually, they define themselves as inadequate and insignificant (Beck, 2021).

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 may be hereditary, environmental, or the result of some traumatic experience.

SAD is randomly misdiagnosed (Richards, 2019), and the low commitment to recovery (Shelton, 2018) suggests a reticence by those infected to recognize and/or challenge their malfunction. Roughly 5% of SAD individuals commit to early recovery, reflective of symptoms that manifest maladaptive self-beliefs of insignificance and futility. Grant et al. (2005) speculate that “about half of adults with the disorder seek treatment,” but that is after 15–20 years of experiencing the condition (Ades & Dias, 2013).

Resistance to new ideas and concepts transcends those of other emotional malfunctions and is justified by:

• General public cynicism

• Self-contempt by the afflicted, generated by maladaptive self-appraisal

• Ignorance or ineptitude of mental health professionals

• Real or perceived social stigma

• The natural physiological aversion to change

Many motivated toward recovery are unable to afford treatment due to SAD-induced “impairments in financial and employment stability” (Gregory et al., 2018). The high percentage of jobless people experiencing social anxiety disorder in the United States is related to “job inefficiency and instability” (Felman, 2018), greater absenteeism, job dissatisfaction, and/or frequent job changes. “More than 70% of social anxiety disorder patients are in the lowest economic group” (Nardi, 2003).

Dr. Mullen is doing impressive work helping the world. He is the
pioneer of proactive neuroplasticity, utilizing DRNI – deliberate,
repetitive, neural information. – WeVoice (Madrid, Málaga)  

According to leading experts, the high percentage of SAD misdiagnoses is due to “substantial discrepancies and variation in definition, epidemiology, assessment, and treatment” (Nagata et al., 2015). The Social Anxiety Institute (Richards, 2019) reports that among patients with generalized anxiety, an estimated 8.2% had the condition, but just 0.5% were correctly diagnosed.

Social anxiety disorder is a pathological form of everyday anxiety. The clinical term “disorder” identifies extreme or excessive impairment that negatively affects functionality. Feeling anxious or apprehensive in certain situations is normal. Most individuals are nervous speaking in front of a group and anxious when pulled over on the freeway. The typical individual recognizes the ordinariness of a situation and accords it appropriate attention. The SAD person anticipates it, takes it personally, dramatizes it, and obsesses on its negative implications (Richards, 2014).

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 condition or situation, often accepted as accurate.

Maladaptive means we do not adapt to certain fears, thus amplifying our distress. The co-founder of cognitive-behavioral therapy (CBT), Aaron Beck, provides three types of maladaptive self-beliefs responsible for persistent social anxiety. Core beliefs are enduring fundamental understandings, often formed in childhood and solidified over time. Because SAD persons “tend to store information consistent with negative beliefs but ignore evidence that contradicts them, [their] core beliefs tend to be rigid and pervasive” (Beck, 2011).

Core beliefs influence the development of intermediate beliefs—attitudes, rules, and assumptions that affect the overall perspective, which, in turn, influences our automatic negative thoughts (ANTs).

Automatic negative thoughts are immediate, involuntary, anxiety-provoking thoughts, emotions, and images that occur in anticipation of or reaction to a feared situation. They are the unpleasant, self-defeating expressions of our negative self-appraisal that define who we think we are, who we think others think we are, and how we express our fears and anxieties. They are borne of our negative and intermediate core beliefs and the onset of our disorder:

Negative self-images reported by patients with social anxiety disorder reflect a working self that is retrieved in response to social threat and which is characterised by low self-esteem, uncertainty about the self, and fear of negative evaluation by others. (Hulme et al., 2012)

Halloran and Kashima (2006) define culture as “an interrelated set of values, tools, and practices that is shared among a group of people who possess a common social identity.” As the third largest mental healthcare problem in the world (Richards, 2019), social anxiety disorder is culturally identifiable by the victims’ “marked and persistent fear of social and performance situations in which embarrassment may occur” and the anticipation that “others will judge [them] to be anxious, weak, crazy, or stupid” (APA, 2017).

Although studies evidence “culture-specific expression of social anxiety” (Hoffman et al., 2010), SAD “is a pervasive disorder and causes anxiety and fear in almost all areas of a person’s life” (Richards, 2019). SAD affects the “perceptual, cognitive, personality, and social processes” of the afflicted, who find themselves caught up in “a densely interconnected network of fear and avoidance of social situations” (Heeren & McNally, 2018).

Space is Limited
For Information

It is one of the best investments I have made in myself, and I will
continue to improve and benefit from it for the rest of my life. – Nick P.   

The superficial overview of SAD is intense apprehension—the fear of being judged, negatively evaluated, and ridiculed (Bosche, 2019). There is persistent anxiety or fear of social situations such as dating, interviewing for a position, answering a question in class, or dealing with authority (ADAA, 2019a; Castella et al., 2014).

Often, mere functionality in perfunctory situations—eating in front of others, riding a bus, and using a public restroom—can be unduly stressful (ADAA, 2019a; Mayoclinic, 2017b). This overriding fear of being found wanting manifests in perspectives of incompetence and worthlessness (Richards, 2019).

SAD individuals are unduly concerned that they will say something that will reveal their ignorance, whether perceptual or otherwise (Ades & Dias, 2013). They walk on eggshells, supremely conscious of their awkwardness, surrendering to the gaze—the anxious state of mind that comes with the maladaptive self-belief they are the center of attention (Felman, 2018; Lacan, 1978). Their movements can appear hesitant and awkward, small talk clumsy, attempts at humor embarrassing, and every situation reactive to negative self-evaluation (ADAA, 2019a; Bosche, 2019).

Persons experiencing SAD are apprehensive of potential “negative evaluation by others” (Hulme et al., 2012), concerned about “the visibility of anxiety, and preoccupation with performance or arousal” (Tsitsas & Paschali, 2014). SAD persons frequently generate images of themselves performing poorly in feared social situations (Hirsch & Clark, 2004; Hulme et al., 2012), and their anticipation of repudiation motivates them to dismiss overtures to offset any possibility of rejection (Tsitsas & Paschali, 2014).

SAD is repressive and intractable, imposing irrational thought and behavior (Richards, 2014; Zimmerman et al., 2010). It establishes its authority through its subjects’ defeatist measures produced by distorted and unsound interpretations of actuality that govern perspectives of personal attractiveness, intelligence, competence, and other errant beliefs (Ades & Dias, 2013). SAD individuals:

crave the company of others but shun social situations for fear of being found out as unlikeable, stupid, or annoying. Accordingly, they avoid speaking in public, expressing opinions, or even fraternizing with peers … People with social anxiety disorder are typified by low self-esteem and high self-criticism. (Stein & Stein, 2008)

Anxiety and related 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 [generalized anxiety disorder] (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, obsessive-compulsive disorder (OCD), and schizophrenia.

While there is less evidence of strong comorbidity with most personality disorders, there are symptomatic similarities. Personality disorders involve long-term patterns of thoughts and behaviors that are unhealthy and inflexible. “The behaviors cause serious problems with relationships and work. People with personality disorders have trouble dealing with everyday stresses and problems” (UNLM, 2018).

Personality reflects deep-seated patterns of behavior affecting how individuals “perceive, relate to, and think about themselves and their world” (HPD, 2019). A personality disorder denotes a “rigid and unhealthy pattern[s] of thinking, functioning and behaving,” which potentially leads to “significant problems and limitations in relationships, social activities, work and school” (Castella et al., 2014).

A recent article in Scientific American speculates that “mental illnesses are so common that almost everyone will develop at least one diagnosable mental disorder at some point in their life” (Reuben & Schaefer, 2017).

SAD and Interpersonal Love

In unambiguous terms, the desire for love is at the heart of social anxiety disorder (Alden et al., 2018). Interpersonal love relates to communications or relationships of love between or among people. The diagnostic criteria for SAD, outlined in the DSM-V (APA, 2017), include “Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.”

SAD persons find it difficult to establish close, productive relationships (Castella et al., 2014; Fatima et al., 2018). Their avoidance of social activities limits the potential for comradeship (Desnoyers et al., 2017; Tsitsas & Paschali, 2014), and their inability to interact rationally and productively (Richards, 2014; Zimmerman et al., 2010) makes long-term, healthy relationships unlikely. SAD persons frequently demonstrate significant impairments in friendships and intimate relationships (Castella et al., 2014). According to Whitbourne (2018), SAD persons’:

avoidance of other people puts them at risk of feeling lonely, having fewer friendships, and being unable to take advantage of the enjoyment of being with people who share their hobbies and interests.

There is a death of research directly investigating the relationship between SAD and interpersonal love (Montesi et al., 2013; Read et al., 2018). A study on friendship quality and social anxiety by Rodebaugh et al. (2015) notes the lack of relative quality studies, and Alden et al. (2018) report on the lack of attention paid to the SAD person’s inability or refusal to function in close relationships. The few existing studies report that the SAD person exhibits inhibited social behavior, shyness, lack of assertion in group conversations, and feelings of inadequacy while in social situations (Darcy et al., 2005).

This dominant culture of maladaptive self-beliefs results in the tendency to avoid new people and experiences, making the development of “adequate and close relationships (e.g., family, friends, and romantic relationships)” extremely challenging (Cuming & Rapee, 2010). Experiencing social anxiety disorder translates to less trust and perceived support from close interpersonal relationships (Topaz, 2018).

Although intimately related, the desire for love and the means of acquisition are binary operations. Most forms of interpersonal love require the successful collaboration of wanting and obtaining. The desire for love is the non-consummatory component of Freud’s eros life instinct (Abel-Hirsch,2010). The means of acquisition are the methods and skills required to complete the transaction. Techniques that vary depending upon the type of love.

Let us visualize love as a bridge, with desire (thought) at one end and acquisition at the other. The span is the means of acquisition (behavior). The SAD person cannot get from one side to the other because the means of acquisition are structurally deficient (Desnoyers et al., 2017; Tsitsas & Paschali, 2014). They grasp the fundamental concepts of interpersonal love and are presented with opportunities. But lack the skills to close the deal. Painfully aware of the tools of acquisition, they cannot seem to operate them.

Cognitive-Behavioral Therapy

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 (Richards, 2019). CBT focuses on “developing more helpful and balanced perspectives of oneself and social interactions while learning and practicing approaching one’s feared and avoided social situations over time” (Yeilding, 2017).

Almost 90% 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).

Recent meta-analytic evidence suggests that CBT as an effective treatment for SAD compares favorably with other psychological and pharmacological treatment programs (Cuijpers et al.,2016). However, there is no guarantee of success, and standard CBT is imperfect (David et al., 2018). The best outcome someone experiencing SAD can hope for is the dramatic mitigation of symptoms through thought and behavior modification. And the simultaneous restructuring of the neural network, along with other supported and non-traditional treatments:

‘[M]any patients, although being under drug therapy, remain symptomatic and have a recurrence of symptoms,’ according to the Brazilian Journal of Psychiatry. ‘40–50% are better, but still symptomatic, and 20–30% remain the same or worse.’ (Manfro et al., 2008)

Behavioral and cognitive treatments are globally proven methodologies. Multiple associations worldwide are “devoted to research, education, and training in cognitive and behavioral therapies” (McGinn, 2019). CBT Conferences (2019) are offered across the globe, “where knowledge transfer takes place through debates, round table discussions, poster presentations, workshops, symposia, and exhibitions.” David et al. (2018) credit CBT as the best standard currently available for the following reasons:

(1) CBT is the most researched form of psychotherapy. (2) No other form of psychotherapy is systematically superior to CBT in the treatment of anxiety, depression, and other disorders. If there are systematic differences between psychotherapies, they typically favor CBT. (3) Moreover, the CBT theoretical models/mechanisms of change have been the most researched and are in line with the current mainstream paradigms of the human mind and behavior (e.g., information processing).

The Association for Behavioral and Cognitive Therapies (ABCT) is “a worldwide humanitarian organization” fostering the “dissemination of evidence-based prevention and treatments through collaborations with the World Health Organization (WHO) and the United Nations Educational, Scientific and Cultural Organization (UNESCO)” (McGinn, 2019). The World Confederation of Cognitive and Behavioural Therapies (WCCBT) is a global multidisciplinary organization promoting health and well-being through the scientific development and implementation of “evidence-based cognitive-behavioral strategies designed to evaluate, prevent, and treat mental conditions and illnesses” (ACBT, 2019).

Cognitive-behavioral therapy is arguably the gold standard of the psychotherapy field. David et al.(2018) maintain “There are no other psychological treatments with more research support to validate.” 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 (Kaczkurkin & Foa, 2015; NAMI, 2019). 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.”

The fault, however, does not lie with the methodology but with the abundance of therapists who believe that CBT is the golden panacea for all recovery. When the diversity of human thought and experience demands a collaboration of science, philosophy, and psychology. And philosophy, existentially defined, welcomes religious and spiritual insight.

A coalescence of science and east-west psychologies is essential to capture the diversity of human thought and experience. Science gives us proactive and active neuroplasticity, cognitive-behavioral self-modification, and positive psychology’s three waves of optimal functioning, which are Western-oriented. Eastern practices provide the therapeutic benefits of Abhidharma psychology and the overarching truths of ethical behavior. Individual targeted approaches and scales that focus on regenerating our self-esteem are crucial to recovery.

In her therapeutic sessions, CBT specialist Judith Beck (2021) incorporates techniques from acceptance and commitment therapy, compassion-focused psychotherapy, behavior therapy, Gestalt therapy, interpersonal psychotherapy, mindfulness-based cognitive therapy, person-centered psychotherapy, scheme therapy, psychodynamic therapy, schema therapy, and solution-based therapy, among others.

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 and Friborg (2015), tracked 70 CBT outcome studies conducted between 1977 and 2014. It 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 the authors, “Just seeing a decrease in symptoms,” he says, “doesn’t translate into greater well-being.” This is reflective of most one-size-fits-all approaches.

While this study recognizes CBT as the best foundation for addressing the SAD culture of maladaptive self-appraisal, it makes the point standard CBT alone 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 multiple 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 and positive psychology serving as the foundational platform for integration.

Part II: 11/26/2025

Proactive Neuroplasticity YouTube Series

INDIVIDUAL RECOVERY. The symptoms of social anxiety make it challenging for some to participate in a collective workshop. Dr. Mullen works one-on-one with a select group of individuals uneasy in a group setting. ReChanneling offers scholarships to accommodate the costs. What is absent in group activities is provided in our monthly Graduate Recovery Group. In this supportive community, graduates interact with others who have completed the program.  Contact ‘rmullenphd@gmail.com’.

Committing to recovery is one of the hardest things you will ever do.
It takes enormous courage and the realization that you are of value, 
consequential, and deserving of happiness.