Abstract
Social anxiety has as its common theme a discomfort, often acute and quite immobilizing, in interpersonal relationships and other social situations. Although the idiosyncratic statement of the fear can vary quite widely from patient to patient, the central core of social anxiety is that one will be judged poorly by others and eventually-in some form-be rejected. In addition, most patients who suffer from social anxiety add another layer to their troubles and become embarrassed (that is, socially anxious) about their anxiety. In fact, this second layer of anxiety may be worse than or even outlive the original focus of the initial anxiety. In what one might think of as extremely creative patients, a third layer may emerge: patients may examine their social track records and conclude that they are hopeless social failures doomed to a life of loneliness and social isolation, thereby creating the additional stress of depression. I have referred to these subsequent emotional problems elsewhere as symptom stress (Walen, DiGiuseppe, & Wessler, 1980) and often find them responsible for greater personal pain than the original issues.
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Walen, S.R. (1985). Social Anxiety. In: Hersen, M., Bellack, A.S. (eds) Handbook of Clinical Behavior Therapy with Adults. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-2427-0_5
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