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Whenever she met friends or acquaintances socially, Hilda faced an agonizing dilemma--to hug or not to hug. She couldn’t think of any clear rule of etiquette governing hugging, and was afraid that people might disapprove of her if she were to hug or not hug when the opposite was judged more appropriate.

Hilda would even worry about this "difficult" decision ahead of time. "I can’t very well hug Joanna, but wouldn’t I insult her if I hugged Leslie and not her? I didn’t hug Felicity the last couple of times--she didn’t seem to want to--so wouldn’t she think it strange if I were to hug her tonight? Do I know Rosemary well enough to hug her--or should I perhaps give her the opportunity to initiate the hugging?"

Hilda’s hugging horror was just one of several predicaments she had created for herself. It’s quite typical of a very widespread problem--anxiety about social interaction.

When Hilda first came to see me, she radiated nervousness and painful shyness. She positioned herself uncomfortably at the edge of my office’s honey-yellow chair. She blurted out short, disjointed sentences, each somewhat disconnected from what preceded or followed. She punctuated her thoughts with a nervous giggle and a brief glance at me with restless eyes. Yet it wasn’t difficult to see beyond this demeanor to a woman alive with energy and intelligence.

Hilda’s wavy blonde hair and strong jaw betokened her Pennsylvania Dutch background. Just 21 years old, she was a college sophomore, determined to pursue a career in mathematics or physics. She aptly labeled herself "a bundle of nervous energy."

Hilda had already diagnosed her problem as "low self-esteem--withdrawing in social situations." Detailing a variety of her fears, she described a life of walking on thin ice, about to fall into the abyss below.

Anxiety And Groups

Insecurity, awkwardness, and feeling out of place in social groups were a few of Hilda’s numerous shyness-related symptoms. "My heart races--I feel faint, as if I’m going to black out. I’m afraid to say anything--I’m scared I will become the center of attention and then look like a fool," she gasped.

Recently, a college friend invited her and some mutual acquaintances to a dinner party. She was nervous beforehand, and once there Hilda was painfully aware of clamming up, feeling rigid, and remaining silent. She became self-conscious about this and forced herself to say one or two things. She was nervous that the others would talk much more than she would. She kept a running count of how many times everyone spoke and felt intense embarrassment that she uttered the fewest words.

"Suppose, Hilda," I asked, "that you actually did say less than everyone else, as you maintain. What’s the worst aspect of this?"

"I dunno." She fluttered nervously.

"Project yourself back into that situation. Assume everyone’s thinking about how quiet you are, which they’re usually not--they’re probably worried about how they’re coming across. But anyway, let’s grant you the worst-case scenario, that they’re all thinking about you, you, you. So?"

"Well, who would want to be with someone who never talks?"

"Since you do have friends, apparently there are people who value your company. But the main issue is that you’re demanding that you talk. You have yourself convinced that if you don’t it would be the end of the universe, and that you’d turn into a worm. And then when you put that kind of pressure on yourself, you clam up and talk even less!"

"Yes--I see what you’re saying."

The next step was to help Hilda identify and then dispute the "musts" that were creating all this mischief. We came up with the following:

• I MUST be liked by others or else I’m unlikable

• I MUST prove I’m competent socially or else I’m no good

• I MUST show how bright I am or else I’m a dummy

• I MUST not appear different or else I’m a pariah

• I MUST not act stupid or else I’m an idiot

• I MUST avoid being the center of attention and it’s awful if I stand out

I recommended that Hilda use a technique employing flashcards. First I asked her to write each of these "musts" on one side of an index card. We then devised some rational alternatives to each statement and put it on the other side. We tried to write at least four or five statements on the reverse side in response to each irrational belief. For example in response to "I MUST be liked by others or else I’m unlikable," some of the rational alternatives consisted of:

1. Although I prefer to be liked by others, I don’t absolutely HAVE TO be!

2. The dislike of others is unpleasant but never horrible, terrible, or awful!

3. Some people disliking me does not prove that other people won’t like me!

4. Even if no one ever liked me (which could hardly happen if I continue to put myself out and meet people) I could still fully accept myself!

5. Although friendships consists of one way to enjoy life, without them there are still practically an infinite number of other ways to enjoy life, including work, hobbies, long-term projects, and momentary pleasures!

6. Rejection by others in no way proves I’m a worthless person, but rather is just an indication of their taste!

7. It’s not the rejection by others that gives me low self-esteem, but rather its my own self-condemnation about this rejection that does this!

She would carry the index cards with her and look at a few of them whenever she had a few seconds: waiting on line at the store, waiting for the bus, while eating, while on hold, and during commercials while watching TV. This was a convenient and time-saving way for her to practice rational thinking.

I suggested to her that she always write out a Three Minute Exercise immediately before meeting friends.

Hilda’s Three Minute Exercise

We targeted her belief, "I MUST appear to do the right thing in the right way when greeting." Here is one of the many Three Minute Exercises Hilda did to help her with this worry:

1. (Activating event): What if other people think I am hugging the wrong people, or not hugging the right people, or showing my awkwardness by being indecisive about hugging someone?

2. (irrational Belief): I MUST appear poised, savvy, and appropriate regarding who, how, and when I hug?

3. (emotional Consequences): Anxiety.

4. (Disputing): What is the evidence I MUST appear poised, savvy, and appropriate regarding who, how, and when I hug?

5. (Effective new thinking): No such evidence exists. Since I’m an imperfect human, I will not always appear poised and suave. If my friends think badly of me, that’s sad, not the end of the universe. I can stand their disapproval. I’ve greeted people imperfectly in the past and it wasn’t awful. I will in the future and I’ll survive.

   The more I push myself to hug, the more comfortable I’ll tend to get at it, although I may never feel perfectly comfortable about it. Some of my friends probably feel a bit awkward about this also but they survive, and usually don’t appear terribly uncomfortable.

   It’s not the awkwardness or anything else about my greeting or their reaction to it that makes me anxious, but rather it’s my self-created demand that it go well that’s the fundamental cause of my anxiety. I can change how I view it and thereby make myself considerably less anxious even if my interactions don’t improve. The logical extension of my fear is that the whole world boycotts me because they don’t like the way I hug, but that prospect just seems very humorous!

6. (new Feeling): Concern, rather than anxiety, about other people’s possible disapproval of me.

Paradoxical Intention

Hilda had another social fear that was more unusual. It arose when she was in a quiet setting, such as a movie during hushed scenes, the soft passages in a classical music concert, or when in bed with her boyfriend. She worried that she might swallow loudly and others might hear this each time she swallowed. She feared that they would think her weird, recognize she was anxious, self-conscious, or uncomfortable and thus find her annoying or be disdainful of her.

For Hilda I proposed a technique called Paradoxical Intention, formulated by the Viennese psychiatrist Viktor Frankl. Frankl related the true story of a man afflicted by a severe case of stuttering. This man couldn’t remember an occasion when he had ever been able to speak without stuttering--except just once, when he was 12 years old. He had hooked a ride on a streetcar, and was caught by the conductor. The 12-year-old decided to play for sympathy by deliberately stuttering in order to depict himself as a poor, inadequate boy who was not worth prosecuting. But at that very moment, when he was deliberately trying to stutter, he found that he spoke normally and didn’t stutter. Frankl developed this idea as a therapeutic technique: When his clients had some behavior from which they wished to refrain, Frankl would ask them to deliberately strive to engage in just that behavior.

I recommended to Hilda, when she started to worry about swallowing loud, that she say to herself: "I’ll try to show my date what a noisy swallower I am. I will try to swallow as loudly as I possibly can, louder than anyone has ever swallowed!"

This technique required the kind of sense of humor that allows one to laugh at one’s flaws. At times Hilda possessed perspective and she found the paradoxical intention helpful. She discovered that when she tried really hard to swallow noisily, she was unable to make much noise by swallowing and lost her self-consciousness. She reported that, as a result of practicing paradoxical intention, she developed an entirely new perspective on noisy swallowing: "It’s not awful or horrible if I do this, in fact it’s kind of humorous!"

Hilda continued to work conscientiously at the paradoxical intention, the Three Minute Therapy written exercises, and the index cards. Her strong commitment to practice these strategies daily never flagged. Predictably, her hard work resulted in diminishing social anxiety. By her third session, she would commence by excitedly relating the past week’s progress.

The Happy Hugger

As well as her Emotional Problem of social anxiety, Hilda did have a Practical Problem--in certain social situations she was unsure of the "correct" way to behave. I encouraged her to do research in this area. For instance, in the case of hugging, she wrote to an advice column enquiring about the etiquette of hugging. She also began to keep a notebook recording other people’s hugging behavior and drew some conclusions about the "right," or at least the most popular, occasions to hug.

However, I also recommended to Hilda that she immediately begin to follow the guideline: "When in doubt, hug." An excellent rule of thumb in dealing with social anxiety is to do whatever’s more out of character for you. Acting according to this principle enables a person to prove in practice that the feared course of action doesn’t lead to the end of the world. Furthermore, people generally respond favorably to friendly behavior. If someone hugs more than is customary, people rarely think badly of that person for hugging. Instead, they instinctively like that person who seems to show by her hugging that she cares about them and thinks them important.

During Hilda’s ninth session, it became obvious to me that I was about to lose a client. I congratulated Hilda on this fact.

He’s So Shy

Bob was 51. He spoke in a low, barely audible whisper, looking up not more than twice during our entire forty-five-minute session.

With much feeling he told me about his background: "I had a dysfunctional childhood and I’ve had fears all my life. My father left when I was five years old so I was raised by my mother along with two brothers and two sisters. My mother scolded me piercingly when I was growing up. She put in overtime criticizing me; she was always cold, never showing love and affection. I was petrified of her criticism so I played the role of the good, ever-obedient child. I tried so hard to guess what she was thinking so that I wouldn’t displease her."

"My fears and shyness have something to do with the pain in my childhood. That’s why I’m so afraid of criticism and lack self-esteem. I need approval. I don’t have any good friends because I’m afraid to open up and expose myself. And I don’t say much at the office."

Not A Victim

I commiserated with Bob over his painful childhood and neurotic mother but quickly emphasized that he was mistaken about the causes of his current problems. Although his mother was responsible for her ill treatment of him, it was Bob himself who was now responsible for his fears. He perpetuated them and kept them alive.

Bob somewhat reluctantly admitted that the notion that he was not a helpless victim of his upbringing was appealing to him. It was clear, however, that he was unwilling to immediately abandon his pop-Freudian mythology lock, stock, and barrel.

"It’s hard to argue with your clear, logical perspective. The idea that, in short order, I can eliminate hurts, troubles, and damage that I’ve harbored for my entire life leaves me with a mix of hope and skepticism. I guess I should try it before I decide it’s too good to be true."

Understanding Shyness

Social anxiety is often described as "shyness," but many people who don’t consider themselves shy experience interactions with other people as uncomfortable or awkward. Around 40 percent of the American population describe themselves as "shy," while a vast majority admit to having been shy at some time in their lives. Some people go through an extremely shy phase in childhood or adolescence and later emerge from this. One client of mine, a person of extremely self-confident demeanor, related the story of his first early love interest at the age of eleven. Both he and the girl were so acutely shy that, whenever they were alone together, neither one would say a word to the other. So although they were going together for several months, they never spoke to each other except when other people were present!

We readily use the term "shy" for those people who shrink from social interaction and whose manner is timid, yet it is well-known that many forceful, even flamboyant figures are "shy underneath," and some even claim that their shyness drives them to their attention-catching behavior. Among celebrities who have confessed to being shy are Barbara Walters, Johnny Mathis, Carol Burnett, Bob Dole, John Cleese, opera star Joan Sutherland, David Niven, Rush Limbaugh, Conan O’Brien, and Kim Bassinger. Some celebrities, like Garrison Keillor and the notoriously flamboyant trial lawyer Melvin Belli, have stated that they entered upon their careers precisely because of their shyness.

Shy people will often inconvenience themselves to an extreme degree to avoid human encounters. ATMs (cash dispensers) have saved some shy people from the dreaded prospect of having to talk to a human bank teller, though the extremely shy person will probably wait until no one else is near the ATM until he uses it, fearful that spectators would form derogatory judgments about his ineptitude with the machine.

Shy people will often fail to assert themselves or even to ask simple questions when it would be to their advantage. They may spend hours driving around lost because they are too intimidated to stop and ask someone for directions. When they do engage in conversation, they will sometimes lose valuable opportunities because their panicky feelings deflect them from seeking answers which would help them. Often, a shy person’s anxious behavior may be interpreted by other people as unfriendliness.

Another disadvantage of shyness is often overlooked. Shy people may be overinclined to agree with anyone to whom they are talking because they dread that person’s disapproval. They will sometimes agree to things they would prefer not to agree to, because they are afraid other people will think badly of them if they resist their suggestions. Sometimes socially anxious people feel able to break from this pattern of compliance only by becoming angry. People in this predicament can reduce both their shyness and their anger by daily Three Minute Exercises. And they can address their Practical Problem (lack of skill in social encounters, and a habit of agreeing too easily) by observing other people and experimenting with various behaviors.

Manipulative individuals such as con-men and cult leaders are often expert at using the fears of the shy and socially anxious to create converts. The manipulator is able to convey to the dupe that she need have no fear of social awkwardness as long as she goes along with the manipulator’s schemes. Freedom from uncomfortable social interaction seems to lie in eagerly embracing the outlook and objectives of the manipulator. Women who have fears about their social skills are often pressured into relationships by such techniques, and sometimes even find themselves married to a particular individual for no better reason than that he was able, whether consciously or by instinct, to play upon the woman’s social anxiety. A series of encounters in which the woman did not summon up the courage to say "No" may lead to a major legal and domestic entanglement.

Some therapists say that shyness can be a good thing. But this confuses emotion with behavior. It can certainly be useful to adopt a somewhat reserved, quiet manner, and this will make you a more attractive person than the crude loudmouth. But it is possible to act quiet and reserved as a matter of choice, without the emotional pains of shyness and without wasting one’s brainpower on endless preoccupation with one’s own social shortcomings.

Another associated problem is that social anxiety often prompts individuals to overuse drugs like alcohol, which are consumed to excess in an attempt to reduce the agony of awkward social interaction or to improve performance in social situations.

There is accumulating evidence that shyness is partly genetic in origin. This doesn’t mean that nothing can be done about the problems caused by shyness. It is genetically determined that when you jump into a swimming pool there is an immediate chilling sensation, which it is natural to avoid as a highly unpleasant shock. But someone who wants to swim regularly soon overcomes this problem and learns to put up with the immediate chill for the sake of the subsequent enjoyment. In time the enthusiastic swimmer may come to reinterpret the chill itself as a bracing experience to be welcomed.

Similarly with shyness. One can train oneself to "break the ice" and become engaged in relaxed conversations, even if one is naturally shy.

Three Minute Relaxation

Due to his apprehension generated by his deeply ingrained "musts," Bob felt tense and nervous almost all of the time. Consequently, in addition to teaching him many of the exercises discussed in earlier chapters, I taught him a general progressive relaxation strategy.

I taught Bob Three Minute Relaxation in my office and then recommended that he practice it at home. It eventually became a useful adjunctive technique for him. He used it to fall asleep and to treat his anxious symptoms when he was feeling stressed out at work.

It might seem that a relaxation technique is contrary to the theme of this book, since it does not directly address the sufferer’s thinking. However, relaxation is a partial solution to the practical problem of tension and awkwardness associated with shyness. It directly attacks the physical and emotional effects of the sufferer’s "musty" thinking and is thus able to provide some relief from distress, pending the complete removal of the problem. Relaxation exercises have the additional benefit that they serve as a distraction from the problem by giving the sufferer something else to think about; they therefore help to reduce secondary anxiety (see chapter 13).

Bob brought an audio cassette into the office and slid it into my tape recorder. I then instructed him to find a comfortable position in his chair and then close his eyes. I engaged the tape recorder, and repeated these instructions:

"Now, Bob, focus on your feet and ankles (Pause). Notice any tightness or any tension anywhere in your feet and ankles (Pause). Now feel all that tightness and all that tension flow right out (Pause). Your feet and ankles are getting heavier and heavier, more and more relaxed (Pause). Relax (Pause). Relax (Pause). Relax (Pause).

I continued, naming each of the following muscle groups in order, while repeating the same instructions:

1. Lower legs and calves,

2. Upper legs and thighs,

3. Buttocks and hips,

4. Abdomen and pelvis,

5. Low back,

6. Upper back,

7. Chest and shoulders,

8. Arms and hands,

9. Neck and throat,

10. Jaw, face, and forehead,

11. Back and top of your head.

I concluded by having Bob repeat the same procedure used for individual muscle groups, but now focussed on his entire body:

"Now focus on your entire body (Pause). Notice any tightness or any tension anywhere in your entire body (Pause). Now feel all that tightness and all that tension flow right out (Pause). Your entire body is getting heavier and heavier, more and more relaxed (Pause). Relax (Pause). Relax (Pause). Relax.

For the first three weeks, practicing once every day, it took Bob about twenty minutes to get results. Once he had mastered it, though, he was able to relax in about three minutes, concentrating primarily on the final step involving his entire body.

At the end of treatment Bob told me: "I had no idea this was really possible. Having had this problem for a lifetime with nothing to help it, I decided I had to learn to live with it." Then he added an intriguing remark: "You know, even though I didn’t think this was possible, I always dreamed of this day when I would be free of the demons!"

Public Speaking Phobia

Orren did not seem outwardly shy and did not admit to being inwardly shy. His bright smile, his colorful, casual dress, and his nonchalant posture all helped to place him in the least shy ten percent of the population. Yet, like so many people, shy and nonshy alike, Orren suffered from a terror of one particular kind of social intercourse--speaking in front of groups of people. The larger the group, the greater the terror for Orren, but even an audience of six was enough to make the speech an ordeal for him.

In his job as a financial advisor, Orren saw opportunities where he could get more clients and advance his career by making presentations to groups large and small. And he really loved talking, explaining his ideas on investments to clients or anyone interested. But the very thought of the horrors of addressing a group made his stomach churn with anxiety.

"I remember having a terrible fear of public speaking in the ninth grade. In my junior high school English class the teacher had each student in turn stand and read from Macbeth. As my turn approached, I could feel my heart pounding, and I felt I was about to throw up. Then the class was ended early because of a fire drill, just before it was my turn to read aloud. Maybe there was a God after all!

"That was Friday, so I was off the hook until Monday. All weekend my anxiety heightened. All I could think of was making a fool of myself while all eyes were fixed on me. Sunday night I hardly slept and Monday morning I was sick to my stomach. I lacked the faith to trust to another miracle, so I stayed home from school. When I went in on Tuesday, the class had finished reading from Macbeth.

"In college I put off taking the required speech class until my last term of my senior year. Each morning, before making a presentation, I felt as if I were on death row the morning I would be walked into the gas chamber. Once the talk was over, I would always experience enormous relief, as if I had been reprieved from execution.

"I worked out many ways of escaping from being called on to speak in class. Most of the time, though, sitting all the way in the back of the room and avoiding the teacher's eye seemed to work OK."

Orren's Three Minute Exercise

Orren and I first tackled his pubic speaking phobia with a Three Minute Exercise:

1. (Activating Event): I get up to speak in front of a group. I feel panicky, and I believe my nervousness is observable. Suppose that because of my anxiety I stutter, stammer, become incoherent, my mind goes blank so that I can't think of anything to say. People would then have a low opinion of me.

2. (irrational Belief): I MUST not be thought badly of by the audience.

3. (emotional Consequences): I'm terrified.

4. (Disputing): What's the evidence that I MUST not be thought badly of by the audience?

5. (Effective new thinking): There’s just no evidence for the "must"--I will not magically turn into a worthless person if the audience should disapprove of me for one poor performance. What’s the worst that could happen? A few people would have a lower opinion of me, and I might find it more difficult to get invited for future talks. That would be unfortunate, but not horrible or awful.

   If they disdain me because of my behavior in the talk, this disdain does not change me; I’ll be the same person as before, with or without their disdain. Their thoughts are just in their heads and can’t reach out to grab me. Other people’s condemnatory thoughts have the same effect on me as do the winds on Mars, blowing the Martian sand over the Martian rocks--absolutely none.

   Experiencing anxiety and not always pleasing other people are inevitable and universal features of all human life. I will experience anxiety and arouse disapproval in other people’s heads many times in my life--this is to be expected because we’re all human. If I stammer and become incoherent on one occasion, this is unfortunate, but not a sentence of death.

   If I work at it, I can learn to accept myself fully and get considerable enjoyment out of life, despite the unpleasant reality of occasional anxiety and disapproval, just as I can survive and prosper despite the unpleasant reality of occasionally catching a cold.

6. (new Feeling): Keen concern rather than terror.

Three Minute Imagery

Three Minute Imagery, which we looked at in chapter 8, is a particularly good technique for problems like public speaking anxiety, which arise in situations faced infrequently. Three Minute Imagery can create a "virtual" public speaking situation within which to practice. Here is the Three Minute Imagery Orren did with my help:

Step 1

Vividly picture the worst possible thing you can imagine happening--in this case you get up to speak and appear very anxious. As a result of your anxiety, you stutter and stammer and your mind goes blank. And the audience condemns you for this.

Step 2

As you distinctly imagine this, allow yourself--right now in your gut--to get in touch with some feelings of terror about it.

Step 3

Still picturing the scene described in Step 1, make yourself feel only concerned and regretful, but not terrified. Since you create and control your own feelings, with persistence you can modify them. How do you make yourself feel concerned and regretful rather than terrified? Show yourself that you don’t turn into a worm if the audience disapproves of you for poor performance. Remind yourself that at the very worst, there will be disadvantages, such as not being invited back to give future talks. Convince yourself by reasoned persuasion that although it can be highly pleasurable to receive other people’s acceptance and appreciation, just as it can be pleasurable to win a lottery, no one’s approval is a dire necessity. (At this point Orren added several other "rational" statements about disapproval and anxiety.)

As homework, Orren did this Three Minute Imagery for three minutes twice a day. He began with Steps 1 and 2, and once "in touch" with the emotions in Step 2 he imediately moved to Step 3. Orren’s Three Minute Imagery overlapped with his Three Minute Exercise and reinforced it. If you find it difficult to devise a Three Minute Imagery that fits your case, begin with a Three Minute Exercise, and then base the imagery on the same A, B, and C.

Using his Three Minute Exercise and Three Minute Imagery, Orren was able to reduce his public speaking anxiety. Having done this, he found the motivation to join Toastmasters, a nationwide practice and self-help group for people who make speeches and other public presentations. This enabled him to tackle his practical problem of poorly developed public speaking skills. By attacking public speaking on both fronts, emotional and practical, Orren became an accomplished public speaker who experienced very little anxiety and soon grew to love speaking in public as much as he enjoyed speaking to a couple of friends in a bar. Within eighteen months, his attitude to public speaking had changed so much that he always looked forward eagerly to his next public speaking engagement. His public presentations gave him a threefold reward: they expanded his business, gave him an opportunity to indulge his usually sociable and talkative proclivities, and provided him satisfaction from knowing the progress he was making in overcoming an emotional problem he had once believed all-powerful and eternal.