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

Robert F. Mullen, PhD
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AI Generated: Relationships | Social Anxiety’s Failure to Establish, Develop, and Maintain Healthy Relationships. Part II

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.

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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 II

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

Categories of Interpersonal Love

In Nicomachean Ethics, Aristotle. (1999) encapsulates love as “a sort of excess of feeling.” Utilizing the classic Greek categories of interpersonal love is vital to this study; each classification illustrates how SAD symptoms thwart the subject’s means of acquisition in seven of eight categories (except healthy philautia ).

The three primary categories, (1) philia (comradeship), (2) eros (sexual), and (3) agape (selfless and unconditional), are followed by (4) storge (family), (5) ludus (provocative), (6) pragma (practical), and the two extremes of philautia: (7) narcissistic and (8) positive self-qualities. Forms of inanimate love are excluded from this study, “including love for experiences (meraki), objects (érōs), and places (chōros)” (Lomas, 2017):

Philia

Aristotle called philia “one of the most indispensable requirements of life” (Grewal, 2016). Philia is a bonding of individuals with mutual experiences—a “warm affection in intimate friendship” (Helm, 2017). This platonic love subsists on shared experience and personal disclosure. A core symptom of a SAD person is the fear of revealing something that will make them appear “boring, stupid or incompetent” (Ades & Dias, 2013). Even the anticipation of interaction causes “significant anxiety, fear, self-consciousness, and embarrassment” (Richards, 2014) because of the fear of being scrutinized or judged by others (Mayoclinic, 2017b).

Eros

Eros is reciprocal feelings of shared arousal between people physically attracted to each other, the fulfillment declared by the sexual act. The SAD person’s self-image of undesirability and fears of intimacy (Montesi et al., 2013) and rejection (Tsitsas & Paschali, 2014) has significant consequences in terms of acquiring a sexual partner and satisfaction of the sexual act. SAD’s culture of maladaptive self-appraisal poses severe challenges to their ability to establish, develop, and maintain romantic relationships (Cuncic, 2018; Topaz, 2018). A study by Montesi et al. (2013), examining the SAD person’s symptomatic fear of intimacy and sexual communication concluded “socially anxious individuals experience less sexual satisfaction in their intimate partnerships than nonanxious individuals, a relationship that has been well documented in previous research.” The study reported a lacuna of literature, however, examining the sexual communication of SAD persons.

Agape

Through the universal mandate to love thy neighbor, the concept of agape embraces unconditional love that transcends and persists regardless of circumstance (Helm, 2017). SAD generally infects adolescents who have experienced detachment, exploitation, and or neglect (Steele, 1995). This form of love characterizes itself through unselfish giving; the SAD person’s maladaptive self-belief that she or he is the constant focus of attention is a form of self-centeredness bordering on narcissism (Mayoclinic, 2017a).

Storge

Again, the primary cause of SAD stems from childhood hereditary, environmental (Felman, 2018; NAMI, 2019), or traumatic events (Mayoclinic, 2017b). In each case, the SAD person is exploited (unconsciously or otherwise) in the formative stages of human motivational development: physiological safety, belongingness, and love (Maslow, 1943). As a result, storge or familial love and protection, vital to the healthy development of the family unit, are severely affected. The exploited adolescent (Steele, 1995) faces serious challenges recognizing or embracing familial love as an adolescent or adult.

Ludus

The SAD persons’ conflict with the provocative playfulness of ludus is evident in the fear of being judged and negatively evaluated by others (Mayoclinic, 2017b) as well as themselves (Hulme et al., 2012; Ritter et al., 2013). Persons experiencing SAD do not find social interaction pleasurable (Richards, 2019) and have limited expectations that things will work out advantageously (Mayoclinic, 2017b). Finally, SAD persons’ maladaptive self-beliefs generally result in inappropriate behavior in social situations (Kampmann et al., 2019).

Pragma

The obvious synonym for pragma is practicality—a balanced and constructive quality counterintuitive to someone whose modus operandi is discordant thought and behavior (Richards, 2014; Zimmerman et al., 2010). Pragma is mutual interests and goals securing a working and endurable partnership facilitated by rational behavior and expectation. The SAD personality sustains itself through irrationality (Felman, 2018) and maladaptive self-beliefs (Hulme et al., 2012; Ritter et al., 2013). The pragmatic individual deals with relationships sensibly and realistically, conforming to typical standards. The overriding objective of a SAD person is to “avoid situations that most people consider ‘normal’” (WebMD, 2019).

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The onset of SAD is a consequence of early psychophysiological disturbance (Mayoclinic, 2017a). The receptive juvenile might be the product of bullying (Felman, 2018), abuse (NAMI, 2019), or a broken home. Perhaps parental behaviors are overprotective or controlling or do not provide emotional validation (Cuncic, 2018).

Subsequently, the SAD person finds it difficult to let their guard down and express vulnerability, even with someone they love and trust (Cuncic, 2018). Alden et al. (2018) note that SAD persons “find it difficult, in their intimate relationships, to be able to self-disclose, to reciprocate the affection others show toward them.”

There is a large body of research linking love with positive mental and physical health outcomes (Rodebaugh et al., 2015). Relationships, love, and associations with others lead one to recognition of their value to society “and motivates them towards building communities, culture and work for the welfare of others” (Capon & Blakely, 2007).

Love is developed through social connectedness. Social connectedness, essential to personal development, is one of the central psychological needs “required for better psychological development and well-being” (Deci & Ryan, 2000). Social connectedness plays a significant role as mediator in the relationship between SAD and interpersonal love (Lee et al., 2008) and is strongly associated with the level of self-esteem (Fatima et al., 2018).

Philautia

The seventh and eighth categories of interpersonal love are the two extremes of philautia: narcissism and positive self-qualities. To Aristotle, healthy philautia is vigorous “in both its orientation to self and to others” due to its inherent virtue (Grewal, 2016). “By contrast, its darker variant encompasses notions such as narcissism, arrogance and egotism” (Lomas, 2017). In its positive aspect, any interactivity “has beneficial consequences, whereas in the latter case, philautia will have disastrous consequences” (Fialho, 2007):

The good man should be a lover of self (for he will both himself profit by doing noble acts, and will benefit his fellows), but the wicked man should not; for he will hurt both himself and his neighbors, following as he does evil passions. (Grewal, 2016)

Unhealthy Philautia

Unhealthy philautia is akin to borderline narcissism—a mental condition in which people function with an “inflated sense of their own importance [and a] deep need for excessive attention and admiration.” Behind this mask of extreme confidence, the Mayoclinic Report (2017a) states “lies a fragile self-esteem that’s vulnerable to the slightest criticism.” SAD persons live on the periphery of morbid self-absorption through their self-centeredness. Their obsession with excessive attention (ADAA, 2019b) mirrors that of unhealthy philautia.

In Classical Greece, persons could be accused of unhealthy philautia if they placed themselves above the greater good. Today, hubris refers to “an inflated sense of one’s status, abilities, or accomplishments, especially when accompanied by haughtiness or arrogance” (Burton, 2016). The self-centeredness and self-absorption of a SAD person often present themselves as arrogance; in fact, the words are synonymous. The critical difference is that SAD persons do not possess an inflated sense of their own importance but one of insignificance.

Healthy Philautia

Aquinas’ (1981) response to demons and disorder states “Evil cannot exist without good.” The Greeks believed that the narcissism of unhealthy philautia would not exist without its complementary opposition to healthy philautia, commonly interpreted as the self-esteeming virtue—an unfortunate and wholly incomplete definition. Rather than only focusing on self-esteem, philautia incorporates the broader spectrum of all positive self-qualities:

Rather, we are concerned here with various positive qualities prefixed by the term self, including -esteem, -efficacy, -reliance, -compassion, and -resliance. Aristotle argued in Nichomachean Ethics that self-love is a precondition for all other forms of love. (Lomas, 2017)

Positive self-qualities determine one’s relation to self, others, and the world. They recognize that one is of value, consequential, and worthy of love. “Philautia is important in every sphere of life and can be considered a basic human need” (Sharma, 2014). To the Greeks, philautia “is the root of the heart of all the other loves” (Jericho, 2015). Gadamer (2009) writes of philautia: “Thus it is; in self-love one becomes aware of the true ground and the condition for all possible bonds with others and commitment to oneself.” Healthy philautia is the love that is within oneself. It is not, explains Jericho (2015), “the desire for self and the root of selfishness.” Ethicist John Deigh (2001) writes:

Accordingly, when Aristotle remarks that a man’s friendly relations with others come from his relations with himself … he is making the point that self-love (philautia ), as the best exemplar of love … is the standard by which to judge the friendliness of the man’s relations with others.

Positive self-qualities are obscured by SAD’s culture of maladaptive self-beliefs and the interruption of the normal course of natural motivational development. Positive psychology embraces “a variety of beliefs about yourself, such as the appraisal of your own appearance, beliefs, emotions, and behaviors” (Cherry, 2019). It measures “how much a person values, approves of, appreciates, prizes, or likes him or herself” (Blascovich & Tomaka, 1991). Ritter et al. (2013) conducted a study on the relationship of SAD and self-esteem. The research concluded that SAD persons have significantly lower implicit and explicit self-esteem relative to healthy controls, which manifest in maladaptive self-beliefs of incompetence, unattractiveness, unworthiness, and other irrational self-evaluations.

Healthy philautia is essential for any relationship; it is easy to recognize how the continuous infusion of healthy philautia into a SAD person supports self-positivity and interconnectedness with all aspects of interpersonal love. “One sees in self-love the defining marks of friendship, which one then extends to a man’s friendships with others” (Deigh, 2001).

Self-worth and self-respect improve self-confidence, which allows the individual to overcome fears of criticism and rejection. Risk becomes less potentially consequential, and the playful aspects of ludus are less threatening. Self-assuredness opens the door to traits commonly associated with successful interpersonal connectivity—persistence and persuasiveness, optimism of engagement, and willingness to vulnerability.

A SAD person’s recognition of their inherent value generates the realization that they “are a good person who deserves to be treated with respect” (Ackerman, 2019). The philautia described by Aristotle “is a necessary condition to achieve happiness” (Arreguín, 2009), which, as we continue down the classical Greek path, is eudemonic. “To feel joy and fulfillment at being you is the experience of philautia” (Jericho, 2015). In the words of positive psychologist Stephen (2019), eudaimonia:

describes the notion that living in accordance with one’s daimon, which we take to mean ‘character and virtue,’ leads to the renewed awareness of one’s ‘meaning and purpose in life.’

Aristotle touted the striving for excellence as humanity’s inherent aspiration (Kraut, 2018). He described eudaimonia as “activity in accordance with virtue” (Shields, 2015). Eudaimonia reflects the best activities of which man is capable. The word eudaimonia reflects personal and societal well-being as the chief good for man. “The eudaimonic approach … focuses on meaning and self-realization and defines well-being in terms of the degree to which a person is fully functioning” (Ryan & Deci, 2001). It is through recognition of one’s positive self-qualities and their potential productive contribution to the general welfare that one rediscovers the intrinsic capacity for love.

Let us view this through the symbolism of Socrates’ tale of the Cave (Plato, 1992). In it, we discover SAD persons chained to the wall. Their perspectives are generated from the shadows projected by the unapproachable light outside the cave. They name these maladaptive self-beliefs as useless, incompetent, timid, ineffectual, ugly, insignificant, and stupid.

The prisoners have formed a subordinate dependency on their surroundings and resist any other reality until, one day, they find themselves loosed from their bondage and emerge into the light. Like the cave dwellers, the SAD person breaks away from maladaptive self-beliefs into healthy philautia ’s positive self-qualities, which encourage and support connectivity to all forms of interpersonal love.

A study published in Cognitive Behaviour Therapy (Hulme et al., 2012) looked at the effect of positive self-images on self-esteem in the SAD person. Eighty-eight students were screened with the Social Interaction Anxiety Scale (SIAS) and divided between the low self-esteem group and the high self-esteem group. The study had two visions. The first was to study the effect of positive and negative self-appraisal on implicit and explicit self-esteem. The second was to investigate how positive self-beliefs would affect the negative impact of social exclusion on explicit self-esteem and whether high socially anxious participants would benefit as much as low socially anxious participants.

The researchers used a variety of measures and instruments. The Social Interaction Anxiety Scale is standard in SAD therapy and CBT workshops; the Implicit Association Test reveals the strength of the association between two different concepts. The Rosenberg Self-Esteem Scale is a ten-item self-report measure of explicit self-esteem, the State-Trait Anxiety Inventory-Trait (STAI-T) is a 20-item scale that measures trait anxiety, and the Depression Anxiety Stress Scale-21 (DASS-21) is a self-report scale measuring depression, anxiety, and general distress:

Social exclusion is inherently aversive and reduces explicit self-esteem in healthy individuals … the effect of exclusion has been measured in terms of its impact on positive affect and on four fundamental need scores (self-esteem, control, belonging, and meaningful existence) which contribute to psychological well-being. (Hulme et al., 2012)

The study’s results were consistent with evidence that was based on implicit self-esteem in other disorders; it found that negative self-imagery reduces positive implicit self-esteem in both high and low socially anxious participants. It provided supporting evidence of the effectiveness of promoting positive self-beliefs over negative ones, “because these techniques help patients to access a more positive working self” (Hulme et al., 2012). It also demonstrated that positive self-imagery maintained explicit self-esteem even in the face of social exclusion.

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Conclusion

For 25 years, since the appearance of SAD in DSM-IV, the cognitive-behavioral approach has reportedly been effective in addressing social anxiety disorder. It is structurally sound and would conceivably remain the foundation for future programs. However, it is not the therapeutic panacea it claims to be. Productive cognitive-behavioral approaches emphasize replacing SAD’s automatic negative thoughts and behaviors (ANTs) with automatic rational ones (ARTs). As defined by UCLA psychologists Hazlett-Stevens and Craske (2002), CBT:

approaches treatment with the assumption that a specific central or core feature is responsible for the observed symptoms and behavior patterns experienced (i.e., lawful relationships exist between this core feature and the maladaptive symptoms that result). Therefore, once the central feature is identified, targeted in treatment, and changed, the resulting maladaptive thoughts, symptoms, and behaviors will also change.

Clinicians and researchers have reported the lack of a precise, diagnostic definition for social anxiety disorder; features overlap and are comorbid with other mental health problems (ADAA, 2019a; Tsitsas & Paschali, 2014). Experts cite substantial discrepancies and disparities in the definition, epidemiology, assessment, and treatment of SAD (Nagata et al., 2015). More specifically, according to a study published in the Journal of Consulting and Clinical Psychology (Alden et al., 2018), “there is not enough attention paid in the literature to the ability to function in the close relationships” required for interpersonal love.

Standard CBT also lacks methodological clarity. Johnsen and Friborg (2015) cite the various forms of CBT used in studies 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 that neither faction should be ignored if we are to effectively address the complexities of positive self-qualities and their importance to the individual’s psychological well-being.

The deficit of positive self-qualities in individuals impaired by SAD’s symptomatic culture of maladaptive self-appraisal and the interruption of the natural course of human motivational development is a new psychological concept in our evolving conscious complexity. Cognitive-behavioral therapies focus on resolving negative self-imaging through programs of thought and behavior modification.

Positive self-quality in healthy philautia is not a new concept; it was discussed in symposia almost two-and-a-half centuries ago. However, the psychological ramifications and methods to address it are in their formative stages. 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 procuring all forms of interpersonal love.

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.

Training in prosocial behavior and emotional literacy are valuable supplements to typical interventions. Behavioral exercises can be used to practice the execution of considerate and generous social skills. Positive affirmations have enormous subjective value as well. Data provide evidence for mindfulness and acceptance-based interventions, where the goal is not only to respond to the negativity of maladaptive self-beliefs but to pursue positive self-qualities despite unwanted negative thoughts, feelings, images, or memories. Castella et al. (2014) suggest motivational enhancement strategies to help clients overcome their resistance to new ideas and concepts.

Ritter et al. (2013) tout the benefits of positive autobiography to counter SAD’s association with negative experiences, and self-monitoring helps SAD persons recognize and anticipate their maladaptive self-beliefs (Tsitsas & Paschali, 2014). Finally, the importance of considering the “nuanced and unique dynamics inherent in the relationships among emotional expression, intimacy, and overall relationship satisfaction for socially anxious individuals” should be thoroughly considered (Montesi et al., 2013). As positive psychology focuses on 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.

Competing Interest Declaration

The author(s) has no competing interests to declare that are relevant to the content of this manuscript.