The second part of this blog is now posted, but please start here...

An astute clinician I have worked with for years, Randi Dodge, strongly encouraged our team to explore anxiety as part of our social thinking treatments for higher-functioning autism spectrum disorders, ADHD and similar diagnoses. While we had all come to realize we had been teaching strategies to reduce anxiety, we were not talking about “anxiety” and really starting at its impact on Social Thinking/social learning because, quite frankly, we are mostly a group of speech-language pathologists and that seemed to be crossing into the domain of mental health. However, the more Randi brought in materials for us to review about anxiety, the more we began to focus on how strong a role anxiety plays in the hearts and minds of our higher level students and how this affects their abilities to demonstrate their own improved social thinking to others. For those of you familiar with my work, you know that I encourage a very interdisciplinary approach with our students. Meaning, we all have to learn about social pragmatics, sensory systems, emotional regulation, counseling, behaviorism, educational demands, etc., to work with our students. As much as we try to uniquely assess a student using these different disciplines, they learn as whole people!

The more I explored anxiety treatments, the more I realized that different types of anxiety require different types of treatment. For example, there are “phobic anxieties” where students refuse to engage in a particular behavior due to irrational fear of a specific event (e.g., won’t flush a toilet; won’t go in an elevator, etc.). This type of anxiety is managed well with a cognitive-behavioral technique that works at recognizing when fear is healthy or reasonable and when it is unjustified (e.g. flushing a toilet). There are good programs that work on slowly desensitizing the client to their specific fear, exploring why it is irrational and developing a step-by-step plan to overcome their fear. Another type of anxiety is social anxiety. However, this is not as simple as addressing the irrational fear and desensitizing oneself to the situation. Social situations, unlike specific events, are much more dynamic and synergistic involving nonverbal, verbal, situational and perspective-taking cues. In a nutshell, there is far more that can go wrong in social situations and simply trying to desensitize a person to an irrational fear of relating to others is likely going to miss the point. This is not a linear skill but a complex concept that requires a number of perceived, synchronized social competencies in order for one to approach social interaction with a successful mindset. Therefore, students with social anxiety MUST be taught to increase or at the very least recognize their social competencies before any reduction in social anxiety is going to take place.

I have developed a tool to help students deal with the complexity of learning about their own social anxiety and how to help take control over it. It was developed in large part from lessons learned from our students over the years as well as from the study of techniques and teachings offered by a team in Australia who have created some very cool curriculums addressing the issue of social anxiety. In this blog and the next, we will review of concepts that led me to create what my students now call, “The Spirals”, e.g., “The Spiral of  Success" and “The Spiral of Failure."

Basics in Learning about Anxiety

A workbook we have managed to get a hold of for adolescents is called Cool Kids Adolescent Anxiety Program (Lyneham, Schiering, Wignall and Rapee, 2006). This curriculum teaches how our students with anxiety may over-focus on how uncomfortable they are rather than recognize that they may be misinterpreting the social dynamics and inaccurately reading the situation leading them to interpretations of their own incompetence. Lyneham’s team teaches students to explore the less biased “evidence” and develop their own ability to create a more neutral social judge within themselves. Without this type of thinking our more anxious students interpret that people think they are incompetent. A book published in the US to teach core concepts related to anxiety that we feel everyone should read (parents and professionals who do not have mental health training in their background) is Helping Your Anxious Child 2nd Edition (Ronald M Rapee, Ann Wignall, Susan H. Spence, Vanessa Cobham, Heidi Lyneham, 2008)

An “aha” moment I had after using this curriculum and working with our students on learning Social Thinking strategies is that if you are born to a social learning disability then you are born to the fact that you have less social competencies. For these students their “evidence” may be literally that they are not competent so teaching them to explore what their evidence is for their anxiety may in fact be that they don’t have the skills or competencies to be anything less than anxious when relating to others. This is particularly true for the group of students I call “Impaired Interactive Perspective Takers” (IIPT) as it is this group of students who have strong awareness of how they are perceived by others even if they are not able to develop natural social competencies. Those whom I refer to as “Emerging Perspective Takers” (EPT),  from my experience, are less likely to have strong social anxieties given they are more aloof or unaware of how people around them treat them or feel about their behaviors. This latter group still has a lot of anxiety but it appears more related to the anxiety of living in a less than predictable world where schedules change, people get their hair cut, some environments are loud, rules change when they were told rules don’t change, etc. Therefore, the Spirals I am going to review below are more for students who function at the level of IIPT than the EPT’s. For more information on IIPT’s and EPT’s, please read my article on this website, “The Perspective Taking Spectrum.”

The Self-Defeater

You and I use an “inner coach” or “private voice” in our heads to encourage ourselves we can do things that are making us uncomfortable or to remind ourselves that we have the competencies to get through the social demand or task we are stressing over.

The opposite of this is having a “self-defeater” voice in our heads. This voice, rather than encouraging us to get through something we don’t want to do or recognize we have the competencies to do it, instead tells us that quite frankly, “you suck at this” or “you have never been able to do this, so you won’t be able to do it now.” Those who have a loud “self-defeater voice” in their heads will default to avoiding the uncomfortable task at hand, those with an “inner coach” have a far better chance of pushing themselves through the uncomfortable task.

Those with strong “self-defeater voices” also tend to find a lot of benign excuses for avoiding the task at hand. Many of our students don’t recognize that what they are saying is in fact making excuses for not pushing themselves through an uncomfortable moment. Instead, they default to their excuses. We explore what excuses look like, and they are not as explicit as the classic student’s excuse of “the dog ate my homework.” Instead their excuses look more sophisticated. Here are some of the many excuses we hear and have then explored for not making phone calls to friends at school even after they had proven in the clinic they had developed the social competencies:

• I was busy. 
• I had too much homework to call someone on the phone.
• I will do it tomorrow, I promise.
• I will do it next year when I am in a new school. 
• I got mad at my mom.
• I could not find my cell phone.
• I had to study for a test (we had calculated the phone call homework would take no more 1.0-1.5 minutes per call and they only each had to make three calls).

Train the Brain

We discussed how our brains are always learning, all the time, how anytime we are awake we are learning from our experiences. If we “default” to what we are used to then we constantly teach our brains we can only do what we are used to doing. So if our students are used to not being able to feel like they can use a cell phone to call others, the only thing they have taught their brain, related to this set of competencies, is that they simply cannot do it. We study our default patterns (what our brain is the most comfortable doing) and then study what our brain has learned by repeatedly attempting the stressful task over and over again. Students explore that their brain has literally learned they cannot do it; is that what they really wanted to teach their brain? To teach their brain they can do it now means they have to push themselves to use different strategies for which they have proven increased competency by practicing these strategies in the clinic successfully and then having to push them to practice these strategies outside of the clinic.

We have also learned that anxiety, once it attaches to a person, had really, really deep roots. Once it shows up it does not want to go away! This means that as our students prove to themselves they have increased competencies (which may come after years of learning social thinking strategies, etc.) their anxiety may not allow them to use their strategies until they explicitly work to minimize their anxiety and allow their new learning to come into play. In other words, anxiety is not going to go away without a fight. As our students learn strategies, we then work with them on making a choice: are you going to default to anxiety or strategies? Our students have to work at changing their focal point.

The Spiral of Success

1. You will encounter some stress approaching this situation that you are used to bailing out of from your anxiety. However, instead of starting by doubting yourself, explore what strategies you can use to help yourself deal with the uncomfortable social situation.
2. Use your inner coach to remind yourself how much better you will feel once you use your strategies, that you are capable of using these strategies as well as what the strategies are to use.
3. You feel better about yourself when you see yourself demonstrating your abilities or social competencies.
4. This encourages your to implement the use of the strategies.
5. Resulting in the fact you are training your brain that “you can do it” better than you have done it before!

In the next blog, we'll look at this information graphically so that we can better use the concepts of the Spiral of Social Success and the Spiral of Social Failure with students, and explore more aspects of this topic.

Please read the second part of this blog, which is now posted.

© Michelle Garcia Winner 2011
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