Social Anxiety in the Digital Age - By Betty Vine

The Internet has changed our social landscape—especially how we communicate—in both subtle and seismic ways. We text instead of call. We like, share, tweet, post, snap, pin, and swipe. Even when we’re physically together, our eyes remain affixed to our screens.

It only makes sense, then, that social anxiety

may also manifest differently in a digital world. Such a change doesn’t necessitate an entirely new diagnostic category. Rather, the same symptoms might find different avenues for expression and different catalysts for their continued existence.

The DSM-5 defines social anxiety disorder as a “persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.” This anxiety interferes with normal functioning and generally persists for six months or more. It’s also one of the more common anxiety disorders: Estimates suggest about 7 percent of American adults will be affected in a given year, and about 12 percent over a lifetime.

Some degree of social anxiety is adaptive: It “serves a very important survival function for humans,” explains Stefan G. Hofmann, director of the Psychotherapy and Emotion Research Laboratory at Boston University’s Center for Anxiety and Related Disorders. “In fact, in the normal progression of children, the natural stages include separation anxiety, stranger anxiety—all forms of social anxiety. These are very important features. If they're missing, something is seriously wrong with the child.”

But there’s a threshold at which social anxiety exceeds its evolutionary function and becomes maladaptive, even debilitating. The same is essentially true of our social media use. Social networking is ubiquitous because we all share the need to belong, says Hofmann. Social networks enable this connection and facilitate our ability to meet social needs. “The problem arises,” Hofmann continues, “when people aren’t actually living their real life because they spend so much time on social media.”

Might sufferers of social anxiety—many of whom find online communication less threatening than in-person interaction—spend so much time on social media that they aren’t actually living and thriving “IRL”?

Digital technology is a double-edged sword, perhaps especially as it interacts with socially phobic behaviors. “It's hard to speak in generalities about this,” as though it were universally good or bad, explains Franklin Schneier, co-director of Columbia University’s Anxiety Disorders Clinic. Yes, Internet use can be a maladaptive avoidance behavior for people with social anxiety. On the other hand, he says, “You may have someone who was so shy that they really would have had very little opportunity to socially interact. And for them, being able to be online is not avoidance, but actually improving their opportunity for interaction.”

Some research supports the idea that many individuals with social anxiety prefer communicating online. A 2016 meta-analysis in the journal Computers in Human Behavior showed a correlation “between social anxiety and feelings of comfort online.” Computer mediated communication offers a few key features that may appeal to socially anxious individuals: “text-based communication with reduced audio and visual cues,” “anonymity,” and asynchronicity (i.e., there is no immediate need to respond). In other words, some of the social cues required of face-to-face communication are absent. These cues often present a source of worry and discomfort for the highly socially anxious. “Gestures, facial expressions, eye contact … these are the subtle features of social interactions that people with social anxiety disorder will often have a problem with,” says Hofmann. It makes sense, then, that they might feel more comfortable in a digital environment.

But this preference for online communication does not necessarily confer any mental health benefits. The aforementioned meta-analysis actually found a modest correlation between social anxiety and pathological Internet use (PIU). (In this context, “problematic” refers to impaired impulse control and withdrawal symptoms with regard to internet use.)

“Arguably,” the study authors write, “socially anxious individuals ... feel more comfortable online. Consequently, they may begin to rely on [computer-mediated communication] while increasingly avoiding [face-to-face] interactions.” A study in Personality and Individual Differences found that “individuals higher in social anxiety who frequently engage in online communication report lower levels of self-esteem satisfaction and higher levels of depression, suggesting that their attempts to compensate for offline social inadequacies may fail to improve wellbeing.”

Of course, digital technology also offers new therapeutic avenues. For instance, cognitive behavioral therapy can be delivered via the Internet. As Schneier points out, “Given that most people with social anxiety and other psychiatric conditions actually don’t get treatment at all, if you could make this kind of treatment more widely accessible with a low bar of cost and a low risk of stigma, that could have a positive effect.” Furthermore, he says, researchers have developed “computer-based tasks that might help different aspects of anxiety, like helping people to train their attention away from negative stimuli,” as well as virtual reality exposure therapy that can simulate “public speaking environments and social gathering environments.” And while “most of these things can be done without virtual reality,” it can serve as a kind of “stepping stone to the more critical real-life exposures.”

“Real-life” (in vivo) exposures are still the gold standard for treating social anxiety, because “real life” interactions—not VR simulations—are ultimately the source of one’s fear. As a therapeutic tool, it forces patients to directly confront and engage with reality, to gather evidence that the catastrophic outcomes they imagine are unlikely, and to build trust in their own ability to cope.

Beyond its use in treatment, though, face-to-face communication more generally is our natural preference, despite the ease of online interaction. Why else do people travel thousands of miles for conferences when they could just have a webinar, asks Hofmann. Why do we show up to weddings and births when we could just Skype in?

In part, it’s because “we're evolutionarily programmed to be with somebody in real life,” Hofmann argues. “Physical proximity is directly related to connectedness, to how you actually feel with somebody. A person's smell, eye contact, little facial cues that suggest emotionality, a person’s oddities, all of that. You can never recreate it in an electronic form.”

Like a diet deficient in key vitamins, unfit to meet our evolved needs, an online-only social diet lacks essential nutrients, allowing us to keep sucking air but not to flourish. This idea may hold true for all of us, but it’s perhaps especially concerning for socially anxious people who rely on the Internet to meet their social needs because of the synchronicity and anonymity it affords.

Betty Vine is a former PT Editorial Intern.