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Social Anxiety and Social Skill Competencies

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by Michelle Garcia Winner, CCC-SLP
Autism Asperger’s Digest
| November/December 2011

Social skills challenges don’t stand alone. Our social skills are social behaviors that impact how others think and feel. In turn, how people respond to us affects how we think and feel. Many students with higher-level social learning challenges are aware they do not learn as easily as do their peers, and that others are not as accepting of them as they would like. This awareness impacts how they feel about themselves. The research is clear that anxiety and depression often comingle in individuals with ASD and ADHD, which adds extra variables when designing a treatment program for these individuals.

In our culture certain issues, such as social anxiety and depression, are usually handled by our mental health systems and professionals such as psychiatrists and psychologists. Prescription medication and/or cognitive behavior therapy are often the main treatment choices to help lessen the symptoms. It may be time that we stop to reconsider our perceptions about social anxiety and which professionals are solely “responsible” for treatment. From my experience working with hundreds of individuals with varying levels of social learning problems, anxiety and depression may be the direct result of an individual’s social learning challenges. This expanded line of thinking means those of us who teach social skills and social thinking also need awareness of treatment concepts related to anxiety.

Two Types of Anxiety
At our Social Thinking Center in San Jose, CA, my colleagues and I have engaged in persistent clinical study of the heterogeneous nature of individuals with ASD and related social learning challenges. We have observed there are two main types of anxiety manifested by persons with different levels of social learning problems. Our clients who tend to have reasonable to high verbal intelligence, who may start with a language disorder but acquire more spontaneous verbal language but are very literal, struggle to deal with change, have poor social self-awareness, and exhibit a form of anxiety we refer to as “world-based anxiety.” Their anxiety often stems from situations that may not be happening around them in the manner they predict, based on their more rigid interpretation of their world and related events within it. For example, this type of person may have a difficult time coping with a substitute teacher or a schedule change. This type of social learner (one we refer to as our Emerging Social Communicator) does not appear to have huge amounts of social anxiety, given this group’s significant lack of self-awareness. So, while their anxiety can be significant, it is often not related to how people think and feel about them.

On the other hand, we work with students who also have solid to strong verbal intelligence and solid language skills but who have tremendous social anxiety. This type of student tends to be less literal. By upper elementary school they adapt fairly well to changes in routine or schedule but can experience massive and pervasive fear related to social interactions. Not coincidentally, individuals in this group also have strong social self-awareness and frequently a bend toward perfectionism, making them unforgiving of any social error they make, no matter how subtle.

While both types of students may have difficulty with social interaction, it is our experience that those with world-based anxiety need a very different type of anxiety treatment approach than do those with social anxiety. (For more information on our different levels of the social mind, read our free article, “The Social Thinking–Social Communication Profile” by Winner, Crooke & Madrigal, 2011, at socialthinking.com)

An Expanded Approach to Social Anxiety Treatment
If social learning problems are the catalyst for comingled social anxiety in these individuals, it behooves us to tailor our treatment strategies and lessons accordingly. We need to begin treatment by primarily working with our clients on increasing social knowledge and related social skill competencies (i.e., engaging them in learning about Social Thinking®). As their competencies evolve we then need to expand our focus to address their social anxiety as it links back to understanding social situations and the people they encounter. My colleagues and I came to this conclusion after researching traditional social anxiety treatment programs and attempting to implement these strategies—with limited success—with our students with social learning challenges (e.g., Asperger’s Syndrome, High Functioning Autism, ADHD).

More traditional social anxiety curriculums often teach the socially anxious person to recognize and embrace the idea that others welcome their participation and friendship. This is where I struggled. While I work with many clients with social learning challenges whom I personally like, the reality is their peer group is not embracing them. To ask my clients to look for signs that a peer was ready to befriend them, assuring them if they just weren’t so anxious the response would be positive, was like setting them up for further rejection and disappointment.

My response was to create a different teaching pathway. After years of teaching them improved social competencies, I began to really talk to my students about how far they had come to help them recognize the progress they were making in being more socially approachable and appropriate. It was important to review this with them on a regular basis, as treatment progress in social learning is often slow and steady. For many of my clients, it took years to make significant gains in social interpretation and related social responses. As a treatment provider I also had to keep in mind that each year my clients showed social progress their peers also intuitively advanced in their own social awareness, which kept our clients’ skill base still lagging behind that of their peers.

While this strategy was slow and methodical, most of our students showed progress. As our clients became able to state and demonstrate their improved competencies, we then were able to use that information to help them make realistic decisions about which people to pursue for social activities and/or friendships. “Choosing an appropriate social partner who is friendly toward you” became an important discussion topic, as some of our clients have unrealistic social expectations about who they want as friends. An unspoken but readily observable fact of the school yard or even an office work group is that different people in the same community have different levels of social status. If a client pursues friendships with a person or a group of people who are thought to have higher social status, our client stands the risk of being made fun of or even bullied. Of course, we do not condone the negative reactions of the “higher-status” peers, but this is a reality of our social world we need to openly explore with our students. In fact, our own students, when they perceive they are of higher social status than another student, may even bully that student! Ultimately we discuss that not just any peer is a potential, suitable friend and even friends of similar status may not choose to be friends with another person for a whole host of reasons.

The more our students understand the complexities of social relationships and peer groups, the less random the social world appears, and the more confident our students can be in deciphering social information. It is this growing confidence in skills and abilities that will lead to a less anxious social response. Once we reach this point with our clients, we then discuss the wall of social anxiety that may be further preventing them from using their more evolved social thinking and social relatedness skills. Had we tried to do this earlier in the therapeutic process, our students could not have appreciated the extent to which their social anxiety and their social competencies were entwined. In our clinic we would often observe that our clients were far more socially competent when relaxed and comfortable, yet when faced with anxiety their social competencies plummeted. It was a vicious cycle, with anxiety feeding social failure, which in turn further exacerbated their anxiety.

The Spirals of Social Success and Failure
My goal was to find a way to help our clients decrease anxiety while increasing their social competencies. The result was a treatment strategy called the Spirals of Social Success and Social Failure. I developed this approach for high-level teens and young adults who had first developed social competencies and were now ready to explore social anxiety. We discovered this teaching strategy helped motivate them to challenge their anxiety by giving them alternative strategies to use when stressed by specific social situations. An overview of the social concepts we shared with clients, as well as the description of the spirals, follows.

Social anxiety has deep tentacles; once it disrupts our functioning it likes to keep that power in place! Once it inhabits a person, anxiety will not go away without a fight. This means as our students recognize they have increased social competencies, they have to actively work at reducing their anxiety. This involves learned strategies, as well as their own shift in perception in making a choice in the moment: are you going to default to anxiety or use your strategies? Some of the key social learning–social anxiety reduction strategies we teach our clients include:

  1. Take ownership; be personally accountable for what you need to learn. After many years of working with adolescents, I realized that while I understood they had social learning differences, as long as I prompted them to use their strategies, I was the one taking ownership of their problems. Now I realize that as I teach them these strategies, they have to work at using them, which first means they have to realize these strategies are theirs and not ours (the teachers and parents).
  2. Accept that your job is to become more comfortable with social discomfort. The neurotypical teen and adult world is filled with social discomfort. Using strategies does not mean our clients won’t feel discomfort. Their job is to work at learning how to be comfortable with the fact they will be uncomfortable socially at times! The mentor’s job is to encourage the client to use the treatment strategies even when experiencing discomfort.
  3. Recognize and celebrate the small steps of progress being made. We need to help our students feel intrinsically proud of themselves for their progress. Avoid using token rewards for progress as these provide extrinsic but not intrinsic motivation.
  4. Use your inner coach, rather than your self-defeater voice, inside your head. You and I use an “inner coach” or “private voice” in our heads to encourage and motivate ourselves through difficulties. Our inner coach may say to us: “You can do this!” “Just do it and get it over with!” “Remember last time this wasn’t as bad as you thought it was going to be, so just go do it!” Unfortunately, many of our students have a “self-defeater” voice in their heads. This voice discourages rather than encourages: “You’re bad at this.” “You’ve never been able to do this, so you won’t be able to do it now.” Individuals who have a loud self-defeater voice in their heads will default to avoiding the uncomfortable task at hand; those with an inner coach have a far better chance of pushing themselves through the uncomfortable task. We need to help our students be realistic about their strengths and challenges while reinforcing their choice to use their inner coach as much as possible.
  5. Stop making excuses for avoiding social encounters. Those with strong self-defeater voices tend to find a lot of benign excuses for avoiding the task at hand. Many of our students don’t recognize that what they are saying is, in fact, an excuse for not pushing themselves through an uncomfortable moment. Instead, they automatically default to their excuses. Our strategy is to explore the personal excuses they make as we assign them tasks that provide opportunities to practice social competencies and use their anxiety-reducing strategies. Once students begin to notice and then take ownership of the fact they are making excuses, they further progress.
  6. Your brain always learns; whether it learns positive or negative ways to cope, it is always learning!
    We discuss how our brains are always learning, all the time, that anytime we are awake we are learning from our experiences. If we “default” to what we are accustomed to doing, we constantly teach our brains we can only do it the way we have done it before. If students want to teach their brain a new set of skills, they have to try to do things differently. This idea may seem elementary, but it can be difficult for our concrete-thinking, rule-bound students to change the way they do things, especially their thinking patterns. I often ask them a direct question: “Do you want to teach your brain you can’t do something, or do you want to teach your brain you can do something?” Hopefully their answer is a “can-do” response, and we circle back to our other strategies to help them retrain their brain.

Visualizing the Spirals of Social Success and Failure
Visual representations are strong—and welcomed—tools in helping our students understand the interrelationships that exist in social thinking and social processing. To help our students understand the concepts outlined in this article, I developed two graphic representations of the thought processes used in working through social situations. The Spiral of Social Success summarizes these concepts:

  • You will encounter some stress approaching this situation. In the past your anxiety would prompt you to bail out of this situation. Instead of starting by doubting yourself, explore what strategies you can use to help yourself deal with the uncomfortable social situation.
  • Use your inner coach to remind yourself how much better you will feel once you use your strategies—that you are capable of using these strategies as well as choosing specific strategies to use.
  • You feel better about yourself when you are demonstrating your abilities or social competencies.
  • This encourages you to use the strategies.
  • In doing so, you are training your brain that “you can do it” better than you have done it before!

Conversely, the Spiral of Social Failure illustrates what happens when our clients fail to embrace their social-learning–social-anxiety reducing strategies:

  • You encounter the same stressful situation, one you previously avoided.
  • Your anxiety prompts you to think of excuses for why you won’t engage in this situation today.
  • Your self-defeater voice assures you that you can’t do it and that you have never been able to do it.
  • You have negative emotions about your inability to get through this situation.
  • You avoid putting yourself in the situation.
  • You teach your brain one more time that you cannot do it! Your memory now reflects your inability and your self-defeater voice grows stronger.

The purpose of the Spirals of Social Success and Social Failure was to help our students understand how best to place the strategies they were learning in the context of their own functioning. Our students helped us adjust the spirals so the wording more clearly matched their own experiences and emphasized how they related to the content of each spiral. This visual presentation paired with lessons that taught them the key concepts outlined in the graphics—increased accountability, self-learning, letting go of excuses, and embracing change—led to some very positive results. They discovered they could choose positive behavioral responses to anxiety-laden situations and retrain their brains to learn new ways of acting and reacting. While the situations still caused anxiety, our clients gained confidence in attempting to push through their anxiety, further reinforced by the success they could achieve within the interaction. However, this learning process takes time. It may take years to help our students, through active learning of these strategies, to get them onto the Spiral of Social Success.

Some level of anxiety is inherent in every social situation we encounter. This set of strategies does not offer a cure for the anxiety experienced by individuals with social learning challenges. However, it can help minimize some of the anxiety by helping our students better appreciate how anxiety affects us and giving our students a toolbox of options to use when anxiety arises. Such coping strategies are beneficial—not just for individuals with social learning challenges, but for us all!

Michelle Garcia Winner is the founder of Social Thinking®. She works in her clinic in San Jose, CA, has written numerous books, and speaks internationally. Visit her website, socialthinking.com, for more information.

Copyright © Autism Asperger’s Digest. 2012. All Rights Reserved. Distribution via print is prohibited without written permission of publisher.

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