How is post-COVID social group anxiety affecting us?
Studies have shown that about 8% of the population  men and women almost equally have some type of social phobia or shyness problem that shows up in group situations. An underlying component for those who suffer from social group phobia is the fear of being humiliated and embarrassed in such situations. In other words, although a person may feel comfortable with one or two friends, that same person may feel overwhelmed in a group situation and avoid it at all costs. For many of these individuals, the social isolation aspects of COVID-19 have been a relief and have provided a socially acceptable way to avoid group situations. However, as we return to a post-COVID-19 world, some people may be suffering from a recurrence of past difficulties. Sam, a 43-year-old married man with three teenage children, called me up to get help with his fear of going back to his workplace. He is a programmer for a hi-tech company and was able to work at home up until recently. I had initially treated Sam when he was in his 30s. At that time Sam was suffering from social anxiety. He told me that when he was seven years old, he made aliyah from St. Louis with his mom, dad and younger brother. cnxps.cmd.push(function () { cnxps({ playerId: '36af7c51-0caf-4741-9824-2c941fc6c17b' }).render('4c4d856e0e6f4e3d808bbc1715e132f6'); });  if(window.location.pathname.indexOf("656089") != -1){console.log("hedva connatix");document.getElementsByClassName("divConnatix")[0].style.display ="none";}  During the initial treatment he told me that as a first grader in St. Louis, he was a good student, had many friends, loved playing baseball and was a happy boy. When the family made aliyah, they moved to a small village in northern Israel. No one spoke English, and he did not speak Hebrew. Kids started to make fun of him. He felt rejected and hopeless. He became angry, started to act out, got into many fights and, looking back, he did not know how he survived those early childhood years. Perhaps his choice of profession, a programmer, really reflected his social anxiety and his desire to avoid social interaction. During our first treatment, Sam was able to share his feelings about his sense of humiliation, loneliness and, at times, depression. The computer was an easy replacement for Sam. During his teenage years, he would lose himself for hours playing computer games. Therapy was successful and Sam was gradually able to become comfortable with social group experiences. I remember doing cognitive therapy with Sam and helping him to change his approach to these group encounters from anger to a perspective of I can deal with this and it will be okay.  During the past year, the social isolation took a heavy toll on Sam and he lost much of the confidence that he had gained from his first round of therapy. Sam started to have anxiety attacks when he thought about going back to his workplace, attending group meetings and entering community life events. During Sams second course of treatment, I once again applied a cognitive-behavioral therapy approach. The following techniques proved to be very helpful. Fear hierarchy and exposure technique  I asked Sam to construct a fear hierarchy of the social group situations that he was afraid of and rate them according to difficulty. Once this list was completed, we started with the least anxiety-provoking social group encounter and worked our way up the list. In order to work on his list, I taught him many skills, including relaxation and deep breathing exercises, imagery techniques, mindfulness, and communication skills, and helped him to change maladaptive beliefs to more positive thoughts about the group situations he encountered. The reversal imagery technique  I asked Sam to describe one of his recent group interactions. He talked about a work meeting. I asked him to tell me who was there and to tell me about what he thought about these people, what he believed they thought about themselves and what they thought about him. It was not surprising to me that Sam described most of the group members as thinking highly of themselves and thinking very critically of him. I asked Sam how his thoughts made him feel. He quickly told me that he was filled with anxiety and was fearful that he would be looked down upon by his colleagues. I told Sam that I wanted him to try a small experiment, which I call the reversal imagery technique. I asked him to imagine that all of the members of this group felt scared that they would sound stupid when they talked at the meeting. For instance, I suggested to him that we could imagine that one person is really shy and afraid that you will be overly critical of her comments. Another person, perhaps, is sure that the boss favors Sam over him. A third person could be fearful that you will not like him and he is very afraid of your rejection. My point was to get Sam to use some imagery to diffuse his own inner self-doubt and negativity by trying to imagine that all of the group members potentially worry about the same things that he was afraid of. I helped Sam to realize that we are all human beings and have many of the same insecurities that he sees in himself. Sams ability to internalize this idea had a positive effect on how he felt. Sam was helped to realize that he could change the direction of his thoughts and therefore drastically reduce his social group anxiety. The reversal imagery technique helped Sam take on a different perspective about how he perceived people in a group situation and empowered him to have more confidence in these encounters. So, if you are like Sam and reconnecting to your group environment is making you very anxious, dont be hard on yourself. After all, you are probably out of practice. Perhaps, previous life experiences may have made you vulnerable to social group anxiety. For Sam, treatment helped him to move back to a previously obtained level of self-confidence in his social group interactions. Sam made a very wise decision.   The writer is a marital, child and adult cognitive-behavioral psychotherapist with offices in Jerusalem and Raanana and global online accessibility. drmikegropper@gmail.com, www.facebook.com/drmikegropper  The fear of social groups is more common than some would believe.