I’ve found it helps to ask newcomers to treatment a few questions along these lines:

In group situations, do you ordinarily:

  • Find yourself worrying about the possibility that other people are judging you?
  • Wonder if others can perceive how nervous you really are?
  • Sometimes experience feelings of anxiety (rapid heartbeat, sweating, trembling)?

These are symptoms of social anxiety, an extremely common problem among the newly in recovery, and one that can have a negative impact on the recovering person’s ability to benefit from or even participate in group situations– such as therapy, but also self-help fellowships.

Most of us have experienced anxiety at the thought of looking bad, making mistakes, or being embarrassed in front of other people. That’s sometimes complicated by deficiencies in important interpersonal skills such as verbal communication, recognizing others moods, or even identifying and expressing our own feelings (sometimes called alexithymia). Repeated negative experiences of this type can create a phobia-like state where we go out of our way to avoid certain situations in the first place– even to our detriment. We may all along be conscious of how irrational our feelings are. And yet somehow we’re unable to control them.

Social anxiety can be a major barrier to successful engagement in treatment and recovery, and it’s so common that most counselors develop skills to address it. Those may include CBT techniques such as stress reduction and relaxation training, or their equivalent drawn from years of 12 Step experience. We don’t need to ‘cure’ social anxiety, only to increase the individual’s level of control over his or her emotions to the point where he/she can tolerate the group environment and presumably benefit from the support it provides.

Patients often arrive in treatment aware of their past experience with social anxiety and all it takes is a few simple questions about their history to identify it. It’s worth the effort if it contributes to better overall engagement in the therapy process.

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