(This & last week's social anxiety blog posts are available as a PDF file or a Word doc - you may need to 'save' the latter before you can open it)

"Courage is not simply one of the virtues but the form of every virtue at the testing point"     C. S. Lewis

Last week I wrote a post "Fear of blushing is more a problem of hyperawareness than of facial temperature".  Excessive, self-evaluative self-focus is a bit of a poison pill for the socially anxious - it makes us worse.  Although fascinatingly, a more "mindful", concrete attending to sensory experience rather than analytically evaluating it seems not to feed self-judgement in the same way - see "Adaptive and maladaptive self-focus: A pilot extension study with individuals high and low in fear of negative evaluation".  There are a number of research studies that show how self-focused evaluation is toxic though - for example, Zhou et al in their paper "The effect of attentional focus on social anxiety", wrote "Subjects were ... asked to engage in a 5min conversation with the first author, and were instructed to either self-focus (SFA condition) or task-focus (TFA condition). Levels of social anxiety and self-awareness were measured using visual analogue scales. Results suggest that the there was a significant condition by group interaction, with high blushing individuals showing considerably higher levels of social anxiety in the SFA condition compared to the TFA condition ...". 

So can people train themselves to become more task-focused? Certainly! Sometimes it can be done in an instant. I personally was troubled a lot by blushing as a teenager. I remember on one occasion "hiding" in the kitchen when my older brother and sister had invited a lot of friends round for a party. My mother, who was typically very loving and supportive, found me and gave me a bit of a pull-your-socks-up message, saying something like "These people are your guests too. Some of them feel shy and awkward here. It's your job as host to get out there, talk with them, and help them relax, feel welcomed and at home here." Surprised and a little tail-between-my-legs I went out into the party. Sure enough there were people dotted here and there who did look uncomfortable and isolated. I went up to one or two and started to chat to try to be a better host. After a few minutes I noticed, rather too my amazement, that I wasn't feeling shy at all anymore. Good task focus!

And this approach has been developed into a good treatment for social phobia. Bogels and colleagues reported on this in their paper "Fear of blushing: effects of task concentration training versus exposure in vivo on fear and physiology". They wrote "Patients with fear of blushing as the predominant complaint (N = 31) were randomly assigned to (1) exposure in vivo (EXP), or (2) task concentration training (TCT), in order to test the effect of redirecting attention above exposure only ... Both treatments appeared to be effective in reducing fear of blushing and realizing cognitive change. Yet, at posttest, TCT tended to produce better results with respect to fear of blushing. At 6-weeks follow-up, TCT produced significantly more cognitive change." And the method was extended to include other social anxiety symptoms in the paper "Task concentration training versus applied relaxation, in combination with cognitive therapy, for social phobia patients with fear of blushing, trembling, and sweating" where Bogels found "Social phobia patients with fear of blushing, trembling, sweating and/or freezing as main complaint (N = 65) were randomly assigned to either task concentration training (TCT) or applied relaxation (AR) both followed by cognitive therapy (CT). Measurements took place before and after wait-list, after TCT or AR (within-test), after CT (post-test), at 3-months and at 1-year follow-up. Effects were assessed on fear of showing bodily symptoms (the central outcome variable), social phobia, other psychopathology, social skills, self-consciousness, self-focused attention, and dysfunctional beliefs. No changes occurred during wait-list. Both treatments were highly effective. TCT was superior to AR in reducing fear of bodily symptoms and dysfunctional beliefs at within-test. This difference disappeared after CT, at post-test and at 3-months follow-up. However, at 1-year follow-up the combination TCT-CT was superior to AR-CT in reducing fear of bodily symptoms, and effect sizes for TCT-CT reached 3. Furthermore, at all assessment moments TCT or the combination TCT-CT was superior to AR-CT in reducing self-consciousness and self-focused attention. The superior long-term effect of TCT on fear of showing bodily symptoms is explained by lasting changes in attentional focus."

Pretty convincing stuff! It reminds me of "The bus driver metaphor" and the task-focused challenge of driving "the bus of our life" without being distracted by the unruly passengers of unhelpful thoughts & feelings.  The process can be made even more effective by incorporating implementation intentions as shown by Webb et al in their recent paper "Using implementation intentions to overcome the effects of social anxiety on attention and appraisals of performance."  For more on this see the posts "Implementation intentions & reaching our goals more effectively".  Next week I'll write about the fascinating recent finding that people who blush are, in many situations, actually judged by others as more trustworthy and generous than people who don't.