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Encyclopedia of Mental Health (in press)
Academic Press, San Diego, CA

Lynne Henderson

The Shyness Clinic
Portola Valley, California
              

Philip Zimbardo

Stanford University
Stanford, California

Outline

Glossary

Introduction

Shyness may be defined experientially as discomfort and/or inhibition in interpersonal situations that interferes with pursuing one's interpersonal or professional goals. It is a form of excessive self-focus, a preoccupation with one's thoughts, feelings and physical reactions. It may vary from mild social awkwardness to totally inhibiting social phobia. Shyness may be chronic and dispositional, serving as a personality trait that is central in one's self definition. Situational shyness involves experiencing the symptoms of shyness in specific social performance situations but not incorporating it into one's self-concept. Shyness reactions can occur at any or all of the following levels: cognitive, affective, physiological and behavioral (see Table 1), and may be triggered by a wide variety of arousal cues. Among the most typical are: authorities, one-on-one opposite sex interactions, intimacy, strangers, having to take individuating action in a group setting, and initiating social actions in unstructured, spontaneous behavioral settings. Metaphorically, shyness is a shrinking back from life that weakens the bonds of human connection.

Table 1: Symptoms of Shyness

Behavior Physiological Cognitive Affective
Inhibition and passivity Accelerated heart rate Negative thoughts about the self, the situation, and others Embarrassment and painful self-consciousness
Gaze aversion Dry mouth Fear of negative evaluation and looking foolish to others Shame
Avoidance of feared situations Trembling or shaking Worry and rumination, perfectionism Low self-esteem
Low speaking voice Sweating Self-blaming attributions, particularly after social interactions Dejection and sadness
Little body movement or expression or Excessive nodding or smiling Feeling faint or dizzy, butterflies in stomach or nausea Negative beliefs about the self (weak) and others (powerful), often out of awareness Loneliness
Speech dysfluencies Experiencing the situation or oneself as unreal or removed Negative biases in the self-concept, e.g., "I am socially inadequate, unlovable, unattractive." Depression
Nervous behaviors, such as touching one's hair or face Fear of losing control, going crazy, or having a heart attack A belief that there is a "correct" protocol that the shy person must guess, rather than mutual definitions of social situations Anxiety

I. Prevelance and Diagnosis

The percentage of adults in the United States reporting that they are chronically shy, such that it presents a problem in their lives, had been reported at 40%, plus or minus 3%, since the early 1970's. Recent research indicates that the percentage of self-reported shyness has escalated gradually in the last decade to nearly 50% (48.7% + /- 2%). The National Co-morbidity Survey in 1994 revealed a lifetime prevalence of social phobia of 13.3%, making it the third most prevalent psychiatric disorder. The comparison of the two disparate results suggests that the proportion of the population suffering from chronic, even debilitating, shyness is not reflected in the numbers of people who visit anxiety disorders clinics. Most referrals to shyness clinics meet criteria for generalized social phobia, and many meet criteria for avoidant personality disorder. Although it has been suggested that there is a greater heterogeneity of presentation among shy people than among those diagnosable with generalized social phobia, both shys and those with generalized social phobias demonstrate similar difficulties with meeting people, initiating and maintaining conversations, deepening intimacy, interacting in small groups and in authority situations, and with self-assertion. Other frequent co-morbid diagnoses are dysthymia, alcohol or substance abuse, generalized anxiety disorder, specific phobias, dependent personality disorder, and schizoid personality disorder. Obsessive-compulsive personality and paranoid personality are also seen. Chronically shy individuals frequently have obsessive and or paranoid tendencies.

Research has distinguished shyness from introversion, although they are typically related. Introverts simply prefer solitary to social activities but do not fear social encounters as do the shy, while extroverts prefer social to solitary activities. Although the majority of shy are introverted, shy extroverts are found in many behavioral settings. They are privately shy and publicly outgoing. They have the requisite social skills and can carry them out flawlessly in highly structured, scripted situations where everyone is playing prescribed roles and there is little room for spontaneity. However, their basic anxieties about being found personally unacceptable, if anyone discovered their "real self," emerge in intimate encounters or other situations where control must be shared or is irrelevant, or wherever the situation is ambiguous in terms of social demands and expectations.

II. Research Summary: Experimental and Naturalistic

Prior to 1970, virtually all research on shyness was focused exclusively on children, especially adolescents, studied by developmental psychologists usually relying on reports of teachers and parents. However, that changed in the early seventies with research instituted by the Stanford Shyness Research Program, headed by Philip Zimbardo. Zimbardo's interest in shyness in adults stemmed from observations made in a mock prison study he and his colleagues conducted in 1971. Preselected normal, healthy college student participants played the randomly-assigned roles of prisoners and guards within a simulated prison environment. The scheduled 2-week study had to be terminated after only 6 days because of the pathology that became evident in the "breakdowns" of those playing the prisoner role in response to the sadistic use of power by the student- guards. Many of the prisoners adapted to a shocking degree to the coercive and arbitrary tactics of behavior control imposed arbitrarily by the guards. They seemed to need desperately the approval and acceptance of their guards, from whom they rarely got it, and ended up trading autonomy for the role of "good prisoner," internalizing negative images of themselves in the process. The guard mentality is designed around ways to limit prisoners' freedom of action, thought and association in order to more easily manage prisoner behavior individually and collectively. The prisoners, in this dynamic dyadic interaction, are cast in a reactive mold to either rebel and get punished for their heroism, or conform to the coercive rules, and though "good prisoners," come to despise themselves for surrrendering their freedom, and be despised by their guards as weak and ineffectual. Similarities became evident between the mentality of the guard/prisoner roles and the thinking of shy people who incorporated both of these roles. The guard-self imposes the coercive control rules, which the prisoner-self ultimately accepts, and together, they thereby limit the shy person's freedoms. Expecting others to act like powerful and harsh critics who ultimately reject any contribution or action of theirs leads shy people to develop coping strategies of minimal involvement in social life and avoidance of situations that carry potential risk of rejection. This prisoner-guard metaphor led to conceptualizing shyness as a self-imposed prison of silence and solitary confinement.

When a literature search of shyness in adults failed to find any substantial research, Zimbardo and his students conducted a large- scale survey first with open-ended questions, then a self-report checklist which was administered to more than thousand people in the United States and many other countries. In addition to survey research, the Zimbardo research team conducted hundreds of in- depth interviews, numerous case studies, experimental-behavioral research, and cross-cultural research on shyness for more than 20 years, culminating in the creation of a treatment program for shy adults.

In addition to the 40% of respondents who reported being chronically shy; another 40% indicated that they had considered themselves as shy previously but no longer, 15% more as being shy in some situations, and only about 5% believed they were never shy. The reported 40% statistic has increased by about 10% in a recent partial replication of Zimbardo's work by Bernard Carducci at Indiana University Southeast where 1642 students were surveyed between 1979 and 1991. Strangers, authorities, and persons of the opposite sex in both group and one-to-one interactions continue to comprise the most difficult situations.

Since Zimbardo's pioneering efforts, shyness has been studied primarily in university student populations by personality theorists and social psychologists who have been interested in the subjective experiences of shy people, links between shyness and self processes, behavioral responses to shyness-arousing stimuli, and the consequences of shyness.

The consequences of shyness are deeply troubling. People for whom shyness is an ongoing problem don't take advantage of social situations, date less, are less expressive verbally and nonverbally, and show less interest in other people than non-shys. Shy students, particularly if they are interacting with a socially confident person, anxiously focus on themselves rather than on the other person or the conversation. Shy individuals are frequently painfully self-conscious, and report more negative thoughts about themselves and others in social interactions, seeing themselves as inhibited, awkward, unfriendly and incompetent, particularly with people to whom they are sexually attracted. They also see themselves as less physically attractive, although research indicates that shyness is uncorrelated with observers' ratings of attractiveness. Ten to twenty percent of shy individuals may also lack basic social skills. This may mean not knowing what to say or do(content), how to do so (style), and when best to respond (timing). Objective ratings have shown that some shy individuals talk less, initiate fewer topics of conversation, avert their gazes more often, touch themselves nervously, and show fewer facial expressions. They agree more often than not, however, with non-shys about what constitutes appropriate social behavior. Their lowered likelihood of enacting social behaviors appears to be related to their lowered confidence in their ability to carry out the required behaviors, to their lack of self efficacy beliefs.

Research has been limited by the dearth of naturalistic studies, and recent studies of both adults and children have shown greater variability and specificity in behaviors related to shyness. For example, in initial, unstructured heterosexual interactions, shy men exerted avoidant control over mutual gazes by denying female partners opportunities to initiate and terminate them. That is, they looked away when women met their gazes, and terminated their own gazes quickly, which promoted negative reactions in interaction partners. Women's shyness also limited the frequency of gazing behavior, but, in contrast to men, women's shyness did not seem to induce negative reactions in interaction partners or inhibit their verbal interaction. This suggests that the cultural burden of shyness may rest more on men, who are expected to take the initiative in heterosexual encounters. Studies where shy women have had a negative impact on an interaction partner involved same-sex dyads, and for many women, shyness may be more of an issue with same-sex peers.

Although shy individuals are perceived as less friendly and assertive than others, they are not usually viewed as negatively as they fear. Shy people remember negative feedback more than do less socially anxious people, and they remember negative self-descriptions better than positive self-descriptions. They overestimate the likelihood of unpleasantness in social interaction and are exquisitely sensitive to potential negative reactions in others, dealing with perceived threat by rumination and worry. In fact, cognitive distraction has been shown to interfere more than anxiety with social interaction, particularly sexual encounters, in the form of lowered pleasurable arousal, with social phobics reporting more sexual dysfunction than controls, in the form of erectile difficulty and orgasmic inhibition. Shy individuals underestimate their own ability to cope with social situations and are pessimistic about social situations in general, failing to expect favorable responses even when they believe that they are able to perform appropriately and efficaciously. Shyness thus becomes a self- handicapping strategy--a reason or excuse for anticipated social failure that overtime becomes a crutch, " I can't do it because I am shy." Shy men have been found to marry and have children later than their peers, to have less stable marriages when they do marry, to delay establishing careers, and to achieve less, although shyness and grade-point average is uncorrelated in both men and women. Shy college students are less likely to utilize resources for information and guidance in career planning and more likely to experience loneliness. They are more likely to forget information presented to them when they believe that they are being evaluated, but not when they think they are evaluating the speaker. Shy students do not expect to engage in assertive behaviors in job interviews, and shy male students do not think assertive behaviors will receive a favorable response by potential employers. Shy extroverts perform well socially, but experience painful thoughts and feelings. Shy people have been found to use alcohol in an effort to relax socially, which may lead to abuse and to impaired social performance, although there is some evidence that suggests that socially phobic individuals drink more frequently, but consume less than others. In any case, the suppression of the fear response by alcohol reinforces the avoidance of emotional experience and prevents desensitization.

Two of the more profound, though less obvious, negative consequences of shyness include: a) greater health problems from lack of a social support network, so essential for health maintenance, and failure to disclose fully personal or sensitive problems to medical and psychological care givers; and b) making less money in less suitable jobs due to less frequent requests for raises, lowered visibility on the job, interview setting difficulties, and limits on job advancement that require greater verbal fluency and leadership skills. If shyness becomes chronic and continues into the later years of life, chronic social isolation leads to increasingly severe loneliness and related psychopathology, and even to chronic illness and a shorter life-span.

Comparisons between laboratory and naturalistic research lead to cautions about over-generalizing the findings regarding the patterns of behavior of shy people from the laboratory to natural field settings. A recent naturalistic study with children who were continuously monitored in everyday situations, and who were free to move about, revealed that shyness was unrelated to heart rate reactivity in unfamiliar situations, in contrast to findings from laboratory situations. Yet another study demonstrated that lower social self-esteem was not characteristic of chronically high shyness with strangers during preschool or early elementary school, also in contrast to findings by researchers studying adolescent and adult shyness. A major review of the literature regarding peer relations and later adjustment, published in 1987, reflected inadequate findings that demonstrated that shyness was predictive of later maladjustment. The authors further caution against generalization from abstract conceptualizations of adult shyness to children, maintaining that conclusions drawn from these sources were premature. The best summary of conceptualizations, research, and treatment perspectives on shyness can be found in a 1986 edited volume of 26 chapters by Jones, Cheek, and Briggs.

III. Shyness and Children: Interaction of Genetics and Environment

The research literature supports an interactionist interpretation of the origins of shyness: strong genetic predispositions in some newborns and strong experiential factors operating with some adolescents and adults to create shyness. Being born timid, easily aroused, and not responsive to social engagement overtures leads to less frequent social interactions with parents, siblings, family and friends, thus promoting a shy response style. Although many children who are shy overcome it in time, many others remain shy all of their lives. However, research also shows that some people have become shy in adulthood who were not so previously, usually due to experiences of rejection, conditions that lower self esteem, and fears of failure in social domains.

Research with infants conducted by Jerome Kagan, Nancy Snidman, and their colleagues at Harvard University has shown that physiological differences between sociable and shy babies show up as early as two months. Approximately 15 to 20% of newborns may be quiet, vigilant, and restrained in new situations. Stimuli such as moving mobiles and tape recordings of human voices trigger an easily arousable sympathetic nervous system that manifests itself in an increased heart rate, jerky and vigorous movements of arms and legs, excessive crying, and urgent signals of distress. High heart rates have been detected in utero in neonates later defined operationally as timid, or shy. At four years, another sign of sympathetic arousal is shown, a cooler temperature in the right ring finger than the left in response to emotionally evocative stimuli. The timid children also show more brain wave activity in the right frontal lobe, in contrast to normally reactive children who display more left side activity. Other research has shown that the right side of the brain is involved in anxiety.

At the opposite end of the continuum are another 15 to 20% bold newborn children who are sociable and spontaneous regardless of the novelty of the situation. The rest of newborns fall between these extremes of timidity and boldness. Longitudinal studies into the eighth year suggested that 75% of shy children and the same percentage of sociable children may maintain their behavioral styles. Furthermore, many shy adolescents up to the age of 14 were previously identified as "inhibited" when they were toddlers. Evidence that these biological components of shyness are a manifestation of a genetic predisposition is found in parents and grandparents of inhibited infants who report childhood shyness more often than relatives of uninhibited children. Furthermore, inhibited infants are more often born in September or October, a time in which the body is producing more melatonin, a neurally active hormone which may be transmitted to the fetus. Other biological correlates are blue eye color with blond hair and pale skin, and allergies, especially hay fever, which have been reported more frequently in families of inhibited children and in the most introverted and fearful of a sample of college undergraduates.

When continuities in shy children were traced into adulthood using archival data, adult males were described as lacking poise, aloof, withdrawing when frustrated, disliking demands, and reluctant to take action, but adult females in midlife evidenced no particular problems, following more conventional patterns of marriage and homemaking than their non shy counterparts. These results were discussed in terms of cultural fit, that is, shy women were seen as more dispositionally suited to traditional roles than shy men.

Parallel evidence for a substantial genetic contribution to behavioral inhibition in animals has been found in puppies, rhesus monkeys, cats, and rats. In addition, behaviorally inhibited animals are more likely to be submissive, acquiescent, and more timid in their heterosexual interactions, patterns that are common in shyness and social phobia in humans. Based on conditioning and ethological models of social phobia, the hypothesis has been advanced that a second-order general factor taps a common predispositional core that is a risk factor for the development of all the anxiety disorders, although other explanations are plausible. Evidence is cited in studies that demonstrate that introverts learn to inhibit responses to avoid punishment more quickly than extroverts. Introversion, negative affectivity, and constraint have all been hypothesized to relate to behavioral inhibition and to an ease of acquisition of aversive associations and avoidance responses. Therefore, traumatic experiences or vicarious conditioning may lead to higher levels of fear and avoidance in inhibited children and adults.

It is notable, however, that the physiological or genetic predisposition to inhibition does not develop into shyness 25% of the time. A reactive temperament may need to be aggravated by environmental triggers, such as inconsistent or unreliable parenting, insecurity of attachment in the form of difficult relationships with parents, family conflict or chaos, frequent criticism, a dominating older sibling, or a stressful school environment. Empirical evidence of familial factors has been found in retrospective studies of the childhoods of social phobics relative to those of normal controls; these include criticism for not overcoming fears or embarrassing the family, fewer parental friendships, fewer family social activities, and teaching social skills by correction rather than modeling. In addition, shyness was negatively correlated with perceived maternal acceptance, but positively correlated with maternal psychological control in shy female college students. Furthermore, many children overcome shyness themselves, some through altruism, others through an association with younger children that promotes leadership behaviors, still others through contact with sociable peers. Nothing succeeds in overcoming shyness as does experiencing social successes, if the child or adult takes the initial risk of engaging in some social activity. Shyness correlates with empathic concern on measures of empathy, and youngsters' emotional responsiveness may promote compassion for others. Parents who are supportive of a child's temperament, but not overprotective, appear to facilitate overcoming an initial inhibition in new and developmentally challenging situations. Overprotected children, however, are more at risk for anxious self-preoccupation, which interferes with taking others' perspectives, another aspect of empathy that becomes increasingly important as children become adults.

IV. Biology of Shyness

The biological foundation of the social fear/anxiety component of shyness is found in the action of the amygdala and hippocampus. The amygdala appears to be implicated in the association of specific stimuli with fear. The more general, pervasive conditioning of background factors related to the conditioning stimuli is known as contextual conditioning. This diffuse contextual conditioning occurs more slowly and lasts longer than most traditional CS-US classical conditioning. It is experienced as anxiety and general apprehension in situations that become associated with fear cues, such as classrooms and parties, for shy people. Contextual conditioning involves the hippocampus, crucial in spatial learning and memory, as well as the amygdala. The bed nucleus of the striate terminalis (BNST) is also involved in emotional-behavioral arousal and extends to the hypothalamus and the brain stem. Both the hypothalamus and the brain stem relay anxiety to the rest of the body. The hypothalamus triggers the sympathetic nervous system and the physiological symptoms of shyness, among them, trembling, increased heart rate, and muscle tension.

V. Attribution Style, Affect, and Shame-based Self-concept

Our research with community college students, as well as our clinic population, has shown that fearful and privately self-aware people blame themselves and experience shame in social situations that have perceived negative outcomes. This tendency appears to be exacerbated by private self-awareness. Shy individuals are higher than controls in state-shame in social situations with negative outcomes, and in trait-shame. Shame may be experienced internally and/or be expressed verbally. The results are consistent with previous research suggesting that shy people reverse what is known in social psychology as the "self- enhancement bias." Ordinarily, people tend to take credit for success and to externalize failure, or at least attribute it to unstable, specific and controllable factors. This attribution style protects self-esteem and promotes continuing efforts toward interpersonal and professional goals. In contrast, self-reported shy individuals reverse this bias in social situations by blaming themselves for failure while also externalizing success. Furthermore, when they fail they often see the failure in stable, global, or uncontrollable terms. This attribution style engenders state-shame, a painful affective state that interferes with both cognition and behavior. Many shy individuals report self-abusive cognitions and "freezing" in social encounters, which lowers self-esteem and interferes with motivation and proactivity, frequently leading to an avoidant and passive interaction style. Those who engage in self-blaming attributions are also higher in trait-shame. While self-blame among the shy is often confined to specific types of social situations, over a life time of shyness this self-blame can become an insidious part of the mechanism that leads to loneliness, isolation, and depression. In chronic depression this reversal of the self-enhancement bias becomes much more pervasive, generalizing to virtually all areas of life.

In a recent sample of unselected high school students, half acknowledged self-blaming tendencies, and those who did so were significantly higher in social anxiety, fear of negative evaluation and social avoidance and distress. Private self-awareness was associated with these self-blaming tendencies. The sample was notable in that it consisted of students who were well above average in mental ability and had striking advantages in terms of academic and social opportunity. In another similar sample of shy adolescents, shyness, self-blame, and private self-consciousness were significant predictors of social anxiety. Self-blame and private self-consciousness were significant predictors of fear of negative evaluation, while shyness and self-blame were significant predictors of social avoidance and distress. Self-blame was the common contributor to all three indicators of distress. Furthermore, correlations of self-blame with social anxiety, fear of negative evaluation, and social avoidance and distress were .47, .56, and .40 respectively. In all three cases, however, the willingness to make a second effort was a significant negative predictor, and a belief in control of the impression one was making on another was a significant negative predictor of social anxiety. Furthermore, a non-blaming attribution style was negatively correlated (-.38) with shyness. The belief in the control of one's behavior also showed a negative correlation with shyness, r= -.39. A body of reliable research reveals that attributing both successful and failed heterosocial interaction to controllable causes is associated with reduced anxiety and a more adaptive balance of positive and negative thoughts during the conversation.

Frequent self-blaming appears to lead to negative biases about the self due to organizing all self-relevant information around highly elaborated negative beliefs about the self. Furthermore, people high in private self-awareness evidence greater reliability of self-reports across time than those lower in private self-consciousness, which suggests that private self-awareness contributes to the consistency of these beliefs. Information that is inconsistent with these well articulated beliefs is less likely to be assimilated, and is frequently discounted altogether. This means that positive information about the self, which is necessary for the development and maintenance of self-esteem and motivation, may not actually be processed. In fact, research has demonstrated that socially anxious subjects perceive unfavorable feedback as more accurate than non-socially anxious subjects do; they discount positive feedback and exhibit marked discomfort in the face of positive feedback. Therefore, fearful and/or shy adolescents may be at significant risk for the development of shame-based self-concepts, and thus for the belief in personal inadequacy.

Accumulating evidence suggests a positive role for high self-complexity in coping with failure and stress. Self-complexity involves holding many different views of the self rather than a simpler, narrow conception of one's self. Higher levels of self-complexity serve as a buffer against failure and the effects of stress, with research showing that performance after failure improves in subjects with high self-complexity. But if that complexity is organized around negative components, then we can expect the opposite outcome. Self-awareness is aversive when people compare themselves against unrealistically high, vague, or shifting standards. The desire to escape from the resulting painful self-awareness is common to many self-defeating behavior patterns, such as withdrawal and the cessation of problem-solving. When shy or fearful individuals are self-blaming and shame prone, private self-awareness may contribute to a highly articulated negative view of the self that contains predominantly negative beliefs about the self, particularly in the face of perceived social failure. This composite is likely to contribute to self-defeating behavior. A major implication of these findings is the need to attend to the importance of the development of self-complexity in shy adolescents, and its positive/ negative valence.

Cognitive biases about social interaction and the self combine to inhibit social performance even when appropriate social skills are available. In fact, shy clients who show the most cognitive change are more likely to maintain treatment gains. In some cases, however, behavioral change may precede cognitive and affective change. Shy males who participated in positively biased social interactions with friendly, facilitative confederates showed increased dating frequency and long-term reduction in heterosexual anxiety, without any other intervention, in a follow up after six months Because self-consciousness and negative self-evaluation interfere with shy people's ability to pay attention to social cues and the needs of others, they must also learn to actively observe other people and to attend to others' wants and needs. This facilitates social interaction and reduces anxiety. In general, we would conclude that all shyness treatments, both professional and lay-based, should include two basic features: facilitate success experiences in social situations tailored to the individual that proceed over trials in a hierarchy from safe to more risky; encourage shy individuals to focus on what they actively can do to help others, which is essential in order for shy people to break out of their passive egocentric preoccupation.

VI. Shyness and Culture

Research in the United States typically indicates that shyness is highest among Asian Americans and lowest among Jewish Americans. This difference prompted efforts to assess shyness across diverse cultures. Using culturally sensitive adaptations of the Stanford Shyness Inventory, colleagues in 8 countries administered the inventory to groups of 18 to 21 year olds, usually in college or work settings. The overall pattern of results indicates a universality of shyness since a large proportion of participants in all cultures reported experiencing shyness to a considerable degree-- from a low of 31% in Israel to a high of 57% in Japan and 55% in Taiwan. In Mexico, Germany, India and New Foundland, shyness was more similar to the 40% U.S. statistic. Other data from this cross-cultural research shows that the majority in each country perceive many more negative than positive consequences of being shy, and 60% or more consider that shyness is a problem (except for Israel where the figure is 42%). There is no gender difference in reported shyness, but men have typically learned tactics for concealing their shyness because it is considered a feminine trait in most countries. In Mexico males are less likely than females to report shyness.

One explanation for the cultural difference between Japanese and Israelis lies in the ways each culture deals with attributing credit for success and blame for failure. In Japan, an individual's performance success is credited externally to parents, grandparents, teachers, coaches, and others, while failure is entirely blamed on the person. The consequence is an inhibition to initiate public actions and a reticence to take risks as an individual, relying instead on group-shared decisions. In Israel, the situation is entirely reversed. Failure is externally attributed to parents, teachers, coaches, friends, anti-Semitism, and other sources, while all performance success is credited to the individual's enterprise. The consequence is an action orientation toward always taking risks since there is nothing to lose by trying and everything to gain. The concept of "chutzpa" emerges from such a positive risk-taking orientation as bold assertiveness regardless of personal skills or even requisite expertise. Much additional research is needed to more fully appreciate the role of culture and societal norms in fostering shyness as a life style or as an unacceptable response pattern, along with an analysis of the ways social agents transmit these values across generations. It is also important to distinguish between cultural values that promote shyness as a social control mechanism or a desired form of modesty and respect for authority, on one hand and personal values on the other hand that make shyness an undesirable constraint on autonomy and self-development.

VII. Shyness and Technology

The steadily increasing percentage of young adults who report being shy (from the earlier 40% to the current nearly 50% level) may be analyzed as negative acculturation to a confluence of social forces operating in the United States. We maintain that this rise in shyness is accompanied by spreading social isolation within a cultural context of indifference to others and a lowered priority given to being sociable, or in learning the complex network of skills necessary to be socially competent. A number of interacting social, technological, and economic processes are operating to reduce daily, ordinary, "real time" face-to-face interactions with other people. This lessened frequency of shared social experiences means that young people may not be learning the complex verbal and non-verbal language of social interaction. Without observing models engaging in pleasurable interactions, and without regularly practicing in this social exchange medium, there is a failure to develop adequate social skills, an awkwardness when having to interact with others, and thus a lowered priority for doing so. In addition to the failure to develop social skills, there seems to be an emerging reduction in emotional exchanges that promote intimacy, and in social sharing that promotes reciprocity.

The new Cyberspace generation of the nineties may be seen as an accretion on the TV generation that fostered passive, often isolated viewing of television for many hours a day. The use of video games, CD-rom games and stories, web surfing, email, and other technological marvels all obviate the need to take time to seek out direct contact with other people for fun, friendship or work exchanges. Indeed, social time is being replaced with nanosecond-based efficient exchange of information within a highly structured, externally imposed format. While some shy people benefit from using the anonymity and structural control features of email, the danger is that for many others virtual on-line reality may become a substitute for the reality of human connectedness. We have been told by concerned parents of their young children who prefer "chat time" on their computers than actually talking face to face with their class mates. Computer interaction enables the user to maintain a higher degree of control over the interaction than in direct, informal social communication.

Other societal forces are also contributing to lessened personalized exchanges between people, and thereby may also be promoting shyness in the current generation. Among them are: automation of many services, fear of crime in the streets, smaller, more mobile, less intact nuclear and extended families, and a changing economic structure that is creating deep levels of existential anxiety among many workers through the enactment of obvious corporate values of enhanced profits take priority over any sense of job security.

Automation is replacing people serving people with machines, just as computers are doing so with chips. I n many areas of everyday life, from bank ATMs to gas stations and telephone services, it is possible to complete needed interactions without ever dealing with a human being. Fear of crime has meant that one rarely sees children playing in groups in the streets, learning essential social skills on their own, without close adult supervision. Today's children are growing up in families with relatively few members, rarely with relatives living together or nearby, with a single parent, or both parents working full time, with little socializing to be observed in their home of neighbors and friends enjoying being with them and their parents. In recent years, as many U.S. businesses are feeling the need to be ever more competitive in the international global market place, the nature of the American work place has been changing dramatically. Fewer workers are expected to produce more in less time, thereby enhancing productivity and raising profits through the extensive use of "downsizing." This destructive force is changing workers' sense of loyalty and their self-image that is often based on their job definition. As job anxiety and related work stress gets carried over to one's private life, there is a growing sense of being busier, working harder, and having less time and energy available for friends, family, hobbies and recreational activities. Recent national surveys reveal that those negative social consequences are becoming normative for the majority of the population.

We would like to propose that the recent increases in statistics of shyness prevalence may be diagnostic not only of the extent of personal social anxiety, as viewed within the framework of a traditional medical model, but also as diagnostic of societal pathology, within a public health model. As such, we may want to take note of increasing levels of shyness as a warning signal of a public health danger that appears to be heading toward epidemic proportions.

VIII. Assessment and Treatment

This final section outlines methods of evaluating prospective clients for shyness treatment and details about the treatment protocols we have developed over a number of years of successfully treating shyness in adults at our Shyness Clinic, in both individual and group therapy.

The Initial Evaluation

An initial evaluation generally involves a structured clinical interview, using either the SCID or the ADIS IV, and an Avoidant Personality Disorder questionnaire. In addition to the structured interview, frequently used self-report questionnaires are: the Stanford Shyness Inventory, a social anxiety or reticence questionnaire, the Beck Depression Inventory, a self-esteem inventory, the Fear of Negative Evaluation Scale, the Social Avoidance and Distress scale, a shame scale, and Spielberger's State/Trait Anxiety and Anger scales.

The MMPI is used to assess current symptomatology, and the Millon to assess the presence of personality disorders, long standing traits or patterns of behavior that have been maladaptive in work or interpersonal relationships. The Multi-modal Life History Questionnaire may be taken home and allows clients to record any stressful or traumatic events that may not have been discussed in the screening sessions, either due to the discomfort of discussing painful memories with a stranger, or because the significance of an event had gone unrecognized previously.

Current behavior in a feared situation is usually assessed using a BAT (behavior performance/assessment test), which consists of a brief role-play or impromptu speech, usually video-taped, and includes a small audience. SUDS (subjective anxiety) levels are usually assessed at intervals prior to the BAT for baseline and anticipatory levels, during, and immediately afterward. A hierarchy of ten feared situations is constructed with the client to role-play in simulated exposures in the group sessions and to practice in-vivo during self-assigned behavioral homework between sessions. Our clients are given copies of these hierarchies to guide their practice, and to be revised as goals are met or changed. Clients are also given social interaction diaries to record social anxiety, negative thoughts and emotions in situations in which shyness occurs. The initial evaluation lasts anywhere from three to six sessions depending on the client's degree of difficulty across situations and across diagnostic categories. Individual goals in shyness groups include improved social skills, better interpersonal communication, reduced physiological arousal, increased emotional well-being, more adaptive thinking about the self and others in social situations, a more adaptive attribution style, and a more realistic view of the self.

Self-report tests and the BAT are repeated immediately after treatment. Some of our clients are willing to give a standardized letter to two or more friends that is returned to the clinic with instructions to share it with the client or keep it confidential. Letters with permission to share with clients are xeroxed and sent to them. These include questions about changes in behavior, changes in observed comfort level and an open-ended question about anything the friend notices that is different. In some studies with social phobia treatment, follow-up has continued up to the fifth year.

Treatment

Effective treatments for shyness exist. Existing treatments generally include exposure to feared situations, usually simulated in treatment sessions or in-vivo, but sometimes to visualized feared situations in imaginal desensitization. They include some kind of anxiety management and/or coping skills training, such as coping self-statements. Recent research has shown, however, that the use of positive coping statements, while they reduce social anxiety, may also interfere with attending to the social task at hand, suggesting that challenging and reducing negative thoughts may be more effective. Flooding treatment -- exposure to the feared stimulus (imaginal and/or in vivo) until extinction (lowered anxiety or SUDS levels) occurs -- has also proven effective with significant reductions in SUDS and pulse rate reported over the course of treatment. According to some studies of flooding techniques, between session extinction as well as within session extinction is necessary, but other researchers report that within-session extinction is sufficient.

Our comprehensive treatment includes exposure and behavioral practice in feared situations, social skills training, cognitive restructuring for negative thoughts about self and others, communication exercises both for getting acquainted and deepening relationships, and assertiveness training for situations where shy individuals make requests of others or say no to unreasonable requests. Additional techniques that have been reported to be effective are the following: paradoxical intention, where clients deliberately intensify feared internal or external responses like blushing, and discover more control than they imagined; the use of affirmations, short positive statements about the self that are written up to 20 to 30 times daily; and relaxation training, including progressive relaxation by each major muscle group and/or controlled breathing.

Treatments for shyness and social phobia are similar, but more systematic treatment outcome research has been conducted and published in the area of social phobia. Analyses of cognitive-behavioral and pharmacological treatments of social phobia have reported effective treatments for social phobia, which are superior to placebo controlled conditions, with exposure-based techniques that combine anxiety management strategies showing the highest effect sizes. MAOI's demonstrate the largest effect sizes in studies of pharmacological treatments, but SSRI's such as Prozac, Zoloft, and Paxil are being used with some success. There is controversy over the use of stimulants such as Ritalin in the treatment of social phobia, with early clinical reports suggesting that they are efficacious in some cases. Controlled studies are needed to assess the effects of these agents. There are no significant short-term differences between pharmacological and cognitive behavioral treatment (CBT) approaches; attrition rates are similar (between 14% and 18%), but investigators in a study that combined approaches found that subjects who received CBT plus Buspirone did worse than those who received either treatment alone. Studies with phenelzine and cognitive behavioral group therapy (CBGT) showed that phenalzine had a faster onset (6 weeks in comparison to 9 weeks), but one-half of phenelzine responders relapsed during the follow-up period, while responders to cognitive behavioral group therapy maintained gains or continued to improve. A substantial number of generalized social phobics fail to respond to either, and combined treatments are being investigated. A methodological difficulty is that studies vary widely in diagnostic criteria for inclusion, particularly in terms of the inclusion of subjects who meet criteria for Avoidant Personality Disorder. Another caution is recognizing the degree to which shyness or social phobia is a consequence of inadequate social skills, which are not improved by merely taking medication, such as Prozac, which has been given media prominence as a shyness cure-all, a magic pill.

Stanford/Palo Alto Shyness Clinic Treatment: Social Fitness Training

Treatment for shyness at the Stanford/Palo Alto Shyness Clinic continues to focus on a health or wellness model, with techniques described as enhancing social interaction and increasing pleasure and emotional well-being in interpersonal relationships. Because controllability appears to be an important negative predictor of shyness, a model of cure that implies a passive recipient is unlikely to be useful or efficacious. The most recent innovation at the Shyness Clinic has been the development of the Social Fitness Model, which is analogous to a physical fitness model. People are provided with a tool kit, (like tennis drills or calisthenics) that includes education and training in positive social behavior, exercises to convert maladaptive thoughts, attributions and self-concept distortions to more adaptive cognitive patterns, and training in effective communication skills, including healthy assertiveness and negotiation. People move from social dysfunction, withdrawal, passivity, and negative self- preoccupation to adaptive functioning, increased social participation, a proactive orientation, and empathy and responsiveness to others, that taken together is referred to as "social fitness." The intent of shyness treatment is not to create perfect social performers. Few people are world class physical athletes, but most can enjoy physical exercise, from sports that involve high degrees of precision and finesse like tennis, windsurfing, and dancing, to those that simply involve moving in enjoyable, healthy ways, like hiking and walking. There are many choices about activity and degree of skill. What is important is a sense of health and well-being. Analogous to the physical fitness model, few people are world class social athletes, but all can connect with other people in ways that are emotionally satisfying and productive. The best strategies for satisfying social interaction frequently develop in the group itself. What is provided is a safe situation, tools, and an educative framework.

Treatment at the Shyness Clinic consists of 26 weeks of cognitive-behavioral group psychotherapy beginning with 12 weeks of in-group simulated exposures (that is, role-plays of feared situations with other group members and/or "confederates" who come into the groups specifically for a given interaction) and between-session in-vivo exposures called behavioral homework. Between group sessions clients enter feared situations and stay in them long enough to meet specific behavioral goals, such as starting and maintaining a conversation for several minutes, making eye-contact and saying hello to a specified number of people at a social gathering, making a comment about the weather at a check-out stand in a supermarket, or asking someone to go out for coffee or to a movie.

The initial phase of treatment is followed by 10 to 11 weeks of verbal and nonverbal communication training, including skills such as active listening, self-disclosure, trust-building, handling criticism, and managing and expressing anger constructively. The last three to four weeks are spent writing and practicing scripts for situations in which clients need to assert themselves. Video-taped feedback is provided for those clients who are willing to use it (see Table 2).

Table 2: Multi-Modal Treatments for Shyness in Individual and Group Therapy

Description Individual Group
Social Skills Training modeling, behavioral rehearsal, video feedback modeling, role-plays with coaching and feedback
Simulated Exposures to feared stimuli therapist and staff assisted therapist, group members, confederates
Flooding therapist and staff assisted, behavioral homework
In-vivo exposures therapist assisted, behavioral homework group members behavioral homework
Communication Training modeling; behavioral rehearsal, therapist and staff assisted, bibliotherapy, behavioral homework modeling, behavioral rehearsal, therapist and group assisted, bibliotherapy, behavioral homework
Assertiveness Training modeling, behavioral rehearsal, script writing, behavioral homework modeling, behavioral rehearsal, script writing, behavioral homework, video feedback
Thoughts/attributions/self-concept restructuring training, identification, and practice during simulated exposures, therapist and staff assisted training, group identification and practice during simulated exposures and communication exercises

Outcome data for six-month treatment groups at the Shyness Clinic demonstrate statistically significant reductions in fear of negative evaluation, social avoidance and distress, social anxiety, depression, and guilt. There has been a trend in shame reduction, which became significant with our recently increased focus on self-blame and self-concept distortions in the cognitive restructuring techniques employed in our Social Fitness Model. Many clients get clinically significant reductions on these variables, meaning that they move into the normal range on standardized questionnaires. Some do not, but if they continue behavioral homework, most continue to improve. Some relapse without continued group support. Clinical observation suggests that this effect is related to a loss of motivation related to persistent self-blaming tendencies and self-concept distortions.

Because most of the Shyness Clinic clients meet criteria for generalized social phobia and generalized anxiety disorder, and many for avoidant personality disorder, schizoid personality disorder, dependent personality disorder, and some for passive aggressive disorder and paranoid personality disorder, these results hold out a good deal of hope for highly distressed clients as well as those with more circumscribed difficulties. Our research at the Stanford Student Health Center with eight-week groups for students using the Social Fitness Model demonstrates similar findings, including significant reductions in shame and general fearfulness.

Long-Term Groups

Although there is little outcome data published for unstructured interpersonal long-term psychotherapy treatment groups, clinical observation strongly suggests that they are effective for shyness in that they provide a place to practice communication skills, to develop spontaneous expression of thoughts and feelings, to participate more fully in a group setting, and to assume leadership roles. Some data suggest that drop-in groups may be more useful for some kinds of shyness than groups that carry a commitment to weekly meetings.

Clients at the Shyness Clinic enter a long-term group after an initial six-month group if they need continued practice in performing new behaviors, changing negative thinking patterns with concomitant negative emotional states, and in developing trust and intimacy. Members work to build a culture free of the destructive evaluation of self and others. Shame arises in manageable doses, occurring when clients are dissatisfied with specific behaviors and have immediate opportunities to try new skills. The group becomes an environment for the emergence of stifled talents and self-expression, a phase that is highly gratifying for group therapists.

It has been our mission to persuade therapists and mental health professionals to recognize the serious need for treatment of shy adults and children, and to develop treatment approaches to liberate the millions of people who are trapped in their silent prisons of shyness.

Bibliography

(Limited for requirements of the Encyclopedia of Mental Health)

Contact Information:

Palo Alto Shyness Clinic

© 2008 Lynne Henderson, Ph.D., All rights reserved.