Strong, Highly Skewed, Irrationally Incorrect Beliefs
Thomas A. Richards, Ph.D.

When someone’s beliefs about themselves (usually a component of their personality) is very irrational and extremely skewed, we say they have a dysmorphia. These “dysmorphias” are typical symptoms of social anxiety that people believe more irrationally and strongly than others.

This word is used in different ways, but in the context of social anxiety disorder, a “dysmorphia” is a strongly held belief about oneself that is not rational and completely unfounded, although the person believes them to be true.

For example, when I was in my 20s, I truly believed I was an ugly person, repugnant to look at, and completely undesirable. This is something I strongly believed. I did not know at the time that it was irrational. I thought it was the truth.
Other words I used to describe myself at the time were sickening, revolting, nauseating, and awful. One of the reasons I could not make friends, I thought, was because I was so very ugly.

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Strong, Highly Skewed, Irrationally Incorrect Beliefs

When someone’s beliefs about themselves (usually a component of their personality) is very irrational and extremely skewed, we say they have a dysmorphia. These “dysmorphias” are typical symptoms of social anxiety that people believe more irrationally and strongly than others.
This word is used in different ways, but in the context of social anxiety disorder, a “dysmorphia” is a strongly held belief about oneself that is not rational and completely unfounded, although the person believes them to be true.

For example, when I was in my 20s, I truly believed I was an ugly person, repugnant to look at, and completely undesirable. This is something I strongly believed. I did not know at the time that it was irrational. I thought it was the truth.

Other words I used to describe myself at the time were sickening, revolting, nauseating, and awful. One of the reasons I could not make friends, I thought, was because I was so very ugly.

Now, this was not an accurate or rational belief on my part. But, I strongly believed it nevertheless. Many people told me I was wrong, but I completely pushed aside, or discounted, their appraisal. I was positive that my physical appearance was horrendous and that I was beyond disgusting. No one else’s opinion was considered.

Looking back on this period of my life, I can clearly see that my thinking was not correct, I was not being rational, and what I believed about myself was, in fact, quite funny.

However, at the time, the strong belief that I was horribly undesirable fed and fueled my social anxiety and made everything in my life worse for me.

Note: This condition is not “body dysmorphic disorder” because it is better explained in context of my social anxiety. If I had not had all the other symptoms of social anxiety, then body dysmorphic disorder might be an accurate diagnosis.

Other dysmorphias we have encountered in people with social anxiety disorder:

Intelligence/lack of intelligence:

One of the brightest young men who ever went through therapy at SAI was thoroughly and completely convinced he was stupid. Nothing I could say or do (and nothing anyone else could tell him) changed this strong belief he had about himself.

This person took several independent, individual intelligence tests and scored an average of 125-130, which is in the “superior” range of intellect.

Yet, he always found a way to “discount” or negate any independent assessment of his intelligence. As a result, he saw almost everyone else in the world as being more “intelligent” or “brighter” than he was. This, in turn, fed and fueled his social anxiety and its related symptoms (e.g., lack of self-esteem, feelings of inferiority).

Eye Contact:

In this severe form of an eye contact problem, people believe they are causing others to be uncomfortable and anxious because they cannot establish direct eye contact. Sometimes, the person is convinced they have an “evil eye” or a “bad look” about them that makes it too difficult for other people to look at them or talk to them.

“I know I am sending out weird and psychopathic signals of some kind”, even though “I don’t know exactly what I’m doing”, a person said. This goes well beyond typical “eye contact problems” that many people with social anxiety have.

There is a solution to even these more stubborn and irrational social anxiety dysmorphias. The solution always lies in helping people to see themselves and the world around them more rationally.

This is an easier-said-than-done process, and it is a difficult process, but it needs to be done through what we call “Turning The Tables on ANTs”. Another way to state this is that people with social anxiety, who also have dysmorphias, must be taught (and be willing) to go “neutral” with their thinking, thinking habits, beliefs, and belief systems. They must be willing to at least consider the fact that maybe, just possibly, they may be slightly wrong.

The use of all those conditional words in the previous sentence was intentional. Why?

Someone with social anxiety who is also dealing with dysmorphias must be taught to be a “truth seeker” or a “rationality finder”. They must take a step back, be willing to say it is possible they could be slightly wrong, and then encouraged to rationally test things out.

This is a process, it does take time and patience, and nothing occurs over a short time frame. However, the more a person at least considers that they may have inaccurate beliefs about themselves, the more the brain will have a chance to become more rational.

Social Anxiety, Chemical Imbalances in the Brain and Brain Neural Pathways and Associations:

What Does It All Mean?

Most people seem to misunderstand the meaning of “chemical imbalances” in the brain. This phrase has become the buzzword to use today to explain mental health problems, including social anxiety.

We receive several letters a day concerning this subject, and the comprehensive audio therapy series “Overcoming Social Anxiety: Step by Step” explains more thoroughly than an article can what is happening in the brain as people with social anxiety learn to progress and conquer social anxiety.

Understanding completely how this works is important to progress and recovery, so this is discussed thoroughly on the audio series relative to recovery from social anxiety disorder.

What follows is a simplified version of these mechanisms, because brain processes and mechanisms are not fully understood and the explanations that we do have would fill several large textbooks.

We can say that no one is “born” with social anxiety. You may remember circumstances and events from very early in life, but there is no “gene” that codes for social anxiety, and there is not an immutable set of genes that cause social anxiety to occur.

At best, we can say that some people have a predisposition toward anxiety in general. From what we know, this is not a predisposition to social anxiety per se, it is a predisposition to be anxious in general.

Why you develop social anxiety has more to do with environment than it has to do with genetics. However, there may be combinations occurring.

People do not generally understand that even if something is genetically influenced, this does not mean it is genetically caused. Social anxiety can not occur unless events, situations, and circumstances in the persons’ environment “push” or “lead” the person to develop it.

Because we develop social anxiety over time (although some people feel it hits them all at once), the brain is learning all the time — this is cognitive structuring — how to be socially anxious. The brain is learning how and what to be afraid of.

The brain is literally creating new neural pathways and associations that feed and fuel our fears and anxieties in social situations.

This is quite normal because everything we learn becomes part of our neural associations or pathways.

When you learn things about your family, it becomes a part of your brain’s neural pathways and associations. Remembering your mother brings back many memories because they are all tied together or bundled together by these neural pathways or associations in the brain.

Anything you learn, regardless of what it is, becomes a part of the vast neuronal associations in the brain, which contain over one billion nerve cells.

When you learn that Alexander the Great tried to conquer the world, as did Napoleon, your brain ties these people together into a neural association in your brain concerning history, historical events, and leaders who lived in the past.

When you learn to tie your shoes, ride a bicycle, drive a car, use a computer keyboard, or learn a musical instrument, your brain gradually develops the neural pathways to make your “practicing” become automatic.

The more you practice, and the more quality time you put into your practice, the more that your brain pathways change. Fairly soon, you know how to tie your shoes and you don’t think about it anymore. This practice you did has made tying your shoes become automatic.

Learning a musical instrument works the same way. At first, it is difficult and hard, but the more you practice, the better you get. As you take one step at a time, and practice thirty minutes a day on your instrument, you continue to improve and get better.

What is happening? Your brain is arranging a new neural pathway or association for learning to play that instrument. As your brain develops this new pathway (it grows the more you practice and learn), you get better and better at playing your instrument.

It is exactly the same way with cognitive (learning) therapy for social anxiety.

As you learn, and then practice, the cognitive methods, strategies, and concepts, a new neural pathway begins to form. The more you practice, the more this new neural pathway or association grows.

Progress is slow at first, just like it is when you learn any new skill, but if you continue to practice, you continue to get better. If you practice enough, the habit becomes more and more automatic over time.

What you learn changes the neural associations in your brain. What is in those neural pathways or associations becomes permanent.

Now, how do brain chemicals, neurochemistry, and “imbalances” of brain chemistry fit here?

Your neural pathways and associations influence and decide which neurochemicals, and at what “strength” pass through the synapse (i.e., synaptic gap). Your neurochemistry is determined by your neural pathways and associations, not the other way around.

Medication or pills can change your brain chemistry temporarily. But, medications has no power to change neural pathways or associations. There is no cure for social anxiety in medication. There is a temporary, chemical change in your brain brought about by the medication. But it lasts only as long as the medication is synthesized to last, from four hours to longer periods. But it is never permanent. You always need to take another pill.

The only permanent solution is to change your neural pathways and associations. This can only be done by learning new strategies, rational concepts, and new methods to extinguish social anxiety. Then, these new strategies and methods must be practiced and practiced. This is why we always talk about repetition.

Without repetition, neural pathways and associations cannot change. To have a permanent solution for social anxiety, our neural pathways and associations MUST change.

When our neural pathways and associations change, our brain chemistry also changes. This is a permanent change, because you have practiced the new methods and concepts (i.e., the cognitive therapy) into your brain repetitiously, thus creating new neural associations. The more dense these neural associations are, the more you have recovered from social anxiety.

Everything in life works like this. Whatever you really learn causes new neural pathways in the brain, and, over time, with repetition, you gradually become better and better at something.

Cognitive therapy is nothing more than learning the appropriate strategies, methods, and concepts so that our brains can change. Our new neural pathways continue to grow and our new feelings, beliefs, and thoughts changed automatically, too.

The human brain is not limited in terms of learning. You can learn all you want, and keep learning until the day you die.

Cognitive therapy, if used correctly, creates permanent changes in your brain neurology, and these changes then affect your brain chemistry.

Everyone, barring brain diseases, can learn to overcome social anxiety. The cognitive therapy necessary is nothing more than a learning process… that must be repeated, repeated, and repeated …. so that our neural pathways and associations can gradually change.

This is a simplified version of what occurs in the brain, but it is an accurate portrayal of what happens as we learn to overcome social anxiety.

Some people have done a little cognitive therapy — without the practice and the repetition — and then said, “cognitive therapy didn’t work for me”.

That, of course, is not true. They did not know, or were not told, that cognitive therapy for social anxiety works in the same way that learning anything new works (e.g., learning to play a musical instrument).

It does work, but it takes persistence, practice, and repetition. The brain’s neural pathways must change so that your beliefs, thoughts, and perceptions become more rational. This can only occur if you change your neural pathways by practicing repetitiously the new methods and concepts learned in cognitive therapy.

Cognitive therapy is nothing more than “learning” the appropriate methods, strategies, and concepts to help your brain develop new neural pathways that are more rational than the old anxiety-ridden pathways.

This is more fully explained in the audio therapy series, “Overcoming Social Anxiety: Step By Step” and the cognitive therapy provided throughout this series directly relates to overcoming social anxiety altogether.

This, as you can see, takes practice, persistence, and repetition. But, it works. It has to work because, as you continue, your mind really does change. You are developing new neural pathways and associations as you learn (and continue to learn and reinforce) appropriate cognitive strategies.

People can and do overcome social anxiety.

The solution is in the practice, repetition, and constant reinforcement. Progress can be made relatively quickly, faster than most people expect, but there is no substitute for practice and repetition. This does take time and patience, but every three weeks or so, if you practice each day, you will find you have made some major progress.

Continuing on until social anxiety is a thing of the past is the right choice to make.

-Thomas A. Richards, Ph.D.
Director, Social Anxiety Institute

“There may be no rest for the wicked, but compared
to the rest that anxious people get, the wicked
undoubtedly have a pastoral life.”
Russell Hampton, The Far Side of Despair

Here’s how most introverts view the phone: It’s an interruption that drains energy and requires losing internal focus, which you have to gain again; it requires expending energy for the “on-the-feet thinking.” Introverts can have so many dips of energy during the day that they are not able to expend energy at the drop of a hat.
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Studies have shown that introverts often have trouble multitasking in social situations. This means that they are so focused on regulating their antsy feeling and expending energy interacting with others that they do not realize how other people react to them. For example, introverts often don’t pick up on the fact that other people like them, and so the relating doesn’t seem as enjoyable. In other words, they may not notice social signals that someone is responding to them in a positive way by smiling, leaning toward them, and seeking them out.
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Adjusting to Change
Researchers have found that introverts (tortoises) often adjust better than extroverts (hares or racehorses) to life changes such as aging, retirement, illness, or injury. Racehorses are used to galloping along, amassing lots of trophies for their winning style. As a result, they often have trouble handling a slower pace. Tortoises, on the other hand, are used to measuring out their energy, and they find it easier to adapt.
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Many introverts come to terms with the fact that they will not have as many friends, be able to work as much, or do as many things as extroverts do. But their friendships are deeper, they do meaningful work, and they enjoy the smaller, quieter more precious moments of life. The more you are able to appreciate the advantages of being an introvert, the more you will be able to accept the fact that you have limitations.

Introverts walk around with lots of thoughts and feelings in their heads. They are mulling–comparing old and new experiences. They often have an ongoing dialogue with themselves. Since this is such a familiar experience, they may not even realize that other minds work in different ways. Some introverts aren’t even aware that they think so much, or that they need time for ideas or solutions to “pop” into their heads. They need to reach back into long-term memory to locate information. This requires reflection time without pressure. They also need to give themselves physical space to let their feelings impressions bubble up. During REM sleep or while dreaming, this pathway integrates daily experiences and stores them in long-term memory, where they are filed in many areas of the brain. Introverts are in a constant distilling process that requires lots of “innergy.”
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Often introverts have trouble finding the word they want when they are speaking out loud. Our brains use many different areas for speaking, reading, and writing; therefore, information needs to flow freely between separate areas. Word retrival may be a problem for introverts because the information moves slowly. One cause of this is that we use long-term memory, so it takes longer and requires the right association (something that reminds us of the word) to reach back into our long-term memory to locate the exact word we want. If we are anxious, it may be even more difficult to find and articulate a word. Written words use different pathways in the brain, which seems to flow fluently for many introverts.

Introverts can be confusing; as their energy ebbs and flows, they may not appear consistent. 1 day their batteries may be well chargeed and they’re chatty and outgoing. Another day they are draggin’ their wagon and can barely talk at all. This can confuse and confound the people who know them.

Introverts are more likely to:
- Keep energy inside, making it difficult for others to know them
- Be absorbed in thought
- Hesitate before speaking
- Avoid crowds and seek quiet
- Lose sight of what others are doing
- Proceed cautiously in meeting people and participate only in selected activities
- Not offer ideas freely; may need to be asked their opinion
- Get agitated without enough time alone or undisturbed
- Reflect and act in a careful way
- Not show much facial expression or reaction

There are 3 main differences between introverts and extroverts that cause rifts to widen into vast misunderstandings.
1. Introverts think and talk differently
Introverts need time to think and don’t speak with spontaneity unless its a familiar subject. Introverts can appear cautious or passive to extroverts. When introverts speak with hesitation, extroverts may feel impatient. Extroverts need to learn that introverts require time to form and articulate opinions. However, extroverts also ought to be aware that if introverts have carefully thought out their ideas on a subject, or know alot about a topic, then watch out – the formerly quiet intros’ lips will start flapping fast and furious.

2. Introverts are unseen
Introverts dislike interrupting, so they might say something softly or without emphasis. Other times comments made by introverts have more depth than the general level of the conversation; because this may make people feel uncomfortable, they ignore the comment. Later another person may say the same thing and receive a great response. The introverted person feels unseen. It’s frustrating and confusing for them. Introverts are usually just thinking about what people are saying. They will share their thoughts if asked.

3. Introverts pressure extroverts to stop and think
It unnerves extroverts when introverts suggest that they should slow things down, plan, think about consequences, and focus longer before acting.
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Growing up constantly being compared to extroverts can be very damaging. Most introverted children grow up receiving the message overtly and covertly that something is wrong with them. They feel blamed–why can’t they answer the question faster? And defamed–maybe they aren’t very smart. 49 of the 50 introverts I interviewed felt they had been reproached and maligned for being the way they were. Introverted children usually get the message loud and clear that something is wrong with them.

· Are territorial – desire private space and time
· Are happy to be alone – they can be lonely in a crowd
· Become drained around large groups of people; dislike attending parties
· Need time alone to recharge
· Prefer to work on own rather than do group work
· Act cautiously in meeting people
· Are reserved, quiet and deliberate
· Do not enjoy being the center of attention
· Do not share private thoughts with just anyone
· Form a few deep attachments
· Think carefully before speaking (practice in my head before I speak)
· See reflection as very important
· Concentrate well and deeply
· Become absorbed in thoughts and ideas
· Limit their interests but explore deeply
· Communicate best one-on-one
· Get agitated and irritated without enough time alone or undisturbed
· Select activities carefully and thoughtfully

You can be the hardest person in the world as I’m often portrayed or try to be. When it’s all said and done, I’m nowhere near what I appear to be. I tried to teach myself to fear nothing and not depend on anyone emotionally. I went about it the wrong way. Just today I realized that I’m just a frightened, misguided, lil girl trapped within myself.
“Don’t be scared to be abandoned” – but I am.
“Try to fit everybody’s image of you so they won’t question who you really are.”
“Don’t fear people” – but I do to a certain degree.
I’ve heard of what kind of first impression I make and how ppl think I am. I figure why would everybody else be any different? I’m supposedly stuck up, down to earth, nice, shy, funny, bold, stupid, smart.. the list goes on and on.
In my own lil world I’m safe from all of that. Even though I would love to be around people, I don’t know how to be. So, I don’t come in contact with a lot of people.

I can’t bring myself to deaden those fears.. don’t know how. And life just rolls along. I’m not getting any younger and I still feel childish. I want to be wanted..it gives me purpose. I want to change but I can’t. I feel days are becoming forced, which I hate. Everything I do is something I don’t wanna do or nothing. I get motivated half way to my goal and give up. That goes for everything in my life. I don’t know what to do and I’d be lying if I said I was gonna do something about it now. Too much to deal with. I’ve had a lot of suggestions on what I should do but they’re skipping steps. Once you find a root to a problem what the hell do u do with it?!

I’m back at square one again.