Internal Family Systems Therapy: A Compassionate Approach to Treating Anxiety and Depression10/31/2025 Author: Tarika Kinyon I. Introduction
In recent years, Internal Family Systems (IFS) Therapy has emerged as a powerful and compassionate approach to mental health treatment. Originally developed by Dr. Richard Schwartz, IFS offers a framework for understanding and healing the complex inner parts of ourselves that contribute to emotional distress. Individuals often seek psychotherapy with the intent of changing—rather than accepting—their unwanted behaviors, emotions, or thoughts, but a lack of self-acceptance can actually prevent true, lasting transformation. IFS fosters clients’ acceptance of all parts of the self and helps individuals cultivate a more compassionate internal relationship; as a result, it can be highly effective in treating anxiety and depression. In this blog post, we’ll explore the structure of IFS, the evidence behind it, and its promising potential in advancing the field of psychotherapy. II. What Is Internal Family Systems Therapy? Dr. Richard Schwartz earned a Ph.D. in marriage and family therapy and later became a therapist and researcher at the Institute for Juvenile Research in Chicago. There, he tried to demonstrate the effectiveness of a cerebral problem-solving therapeutic approach in a study of young individuals with bulimia, which was ultimately unsuccessful. In fact, he noticed that the more he tried to implement these techniques, the more this dangerous bulimic behavior occurred. He began asking clients about what was happening inside themselves, causing them to escalate behaviors. Clients described aspects of themselves as if each had autonomy, could make them do things they did not want to do, and had relationships with other aspects of themselves (Brenner, 2023). Schwartz observed a pattern: interactions between these components of people were like those of family members, therefore leading him to develop the notion of Internal Family Systems. Within the IFS framework, the core of an individual is defined as the “Self.” This is the inner leader and the foundation of who we are, characterized by qualities known as the “8 C’s” that emerge when people access their Self: compassion, calmness, clarity, courage, confidence, creativity, and connectedness. The goal of IFS therapy is to facilitate a relationship between the Self and the subpersonalities of an individual, referred to as “parts.” Parts make up an individual’s internal system and interact inside the mind as if they were individual people, all with different talents, roles, and temperaments. These different roles and functions are distributed into categories:
Schwartz believes people are born with parts, or the potential for parts, and as we mature, these parts emerge in response to lived experiences. Contextual influences, such as stress, trauma, broader socio-cultural factors, and childhood experiences shape the roles these parts take on. Although these parts can lead us to behave in harmful or negative ways, Schwartz emphasizes that parts of people are all inherently valuable and that compassionate conversations with harmful parts can help move them back into their natural, constructive roles. When clients are able to access a state in which they can empathize with their parts that trigger certain behaviors or emotions, such as anxiety or depression, their troubled parts are able to heal. III. IFS and Emotional Healing One of the most powerful aspects of IFS therapy is its compassionate view of the human psyche. Instead of labeling thoughts or emotions as “bad” or “irrational,” IFS allows clients to understand that symptoms like anxiety or depression often come from parts of us that are attempting to protect or manage our pain. In IFS, anxiety might be seen as the voice of a Manager who tries to prevent failure by keeping us constantly alert. Depression might stem from an Exile part holding deep sadness, shame, or unprocessed grief. These parts carry emotional burdens, but they are not inherently pathological, as traditional psychotherapy suggests. Rather, they are trying to help and protect us, even when their strategies may be harmful or negative. Through IFS, individuals learn to “unblend” from these parts, meaning they are able to challenge the mind’s tendency to self-identify with current thoughts and emotions. One is able to do this by framing their feelings as coming from a part—individuals can thus disengage with overwhelming, all-encompassing emotions and not view them as the Self, but rather as a part of the Self. The goal is not to eliminate these parts, but to get to know them with curiosity and compassion through the Self’s calm, centered, compassionate inner presence that exists within everyone. Only then can individuals begin to heal and guide their parts without becoming overwhelmed by them. This shift from inner conflict to inner connection is often what creates long-lasting solutions to feelings of anxiety and depression. IV. Research on IFS for Depression and Anxiety Haddock et al. (2016), a study on the efficacy of IFS therapy in depression among female college students, found that IFS is a promising alternative to established treatments for depression. In the randomized controlled trial, 37 participants experiencing moderate to severe depression were assigned to 16 weekly IFS sessions or one of three other treatment-as-usual (TAU) conditions, including Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), and supportive counseling. Results showed that all groups experienced significant reductions in depressive symptoms, with no significant differences between IFS and other treatments. Although there are a few limitations of this study, such as it being a pilot study with a small sample size and short-term follow-up, these findings ultimately suggest that IFS may be just as effective as more widely used therapeutic approaches for treating depression in this population. In addition, IFS is now being explored in online group-based formats, offering more accessible care for populations struggling with trauma-related symptoms, including depression and anxiety. A 2024 pilot study by Comeau et. al (2017) tested a program called PARTS (Program for Alleviating and Resolving Trauma and Stress), which also delivered 16 weeks of AFS-based group sessions and individual support entirely online. Participants included 15 adults with PTSD, many of whom also experienced significant symptoms of anxiety and depression. The results concluded that over half of the participants saw reductions in PTSD severity, and many also reported meaningful improvements in emotion regulation, self-compassion, and decentering—all of which are relevant to managing depression and anxiety. While this study was small and did not include a control group, its findings support the idea that IFS is not only effective in physical settings or in treating trauma but also holds promise for individuals dealing with mood and anxiety symptoms in online settings. V. Real-World Application and Accessibility One of the most exciting aspects of IFS is how accessible it can be for individuals from diverse backgrounds. IFS offers a flexible approach that meets people where they are, whether that’s in a therapist’s office, an online support group, or even an individual mindfulness practice. In clinical settings, IFS can be integrated into treatment plans as either a stand-alone treatment or alongside other therapeutic approaches. A therapist may use IFS as the primary therapeutic framework or combine it with other techniques, such as Cognitive Behavioral Therapy, to address both symptom management and deeper emotional patterns. Since IFS is trauma-informed and non-pathologizing, it’s especially accessible to individuals who struggle with traditional symptom-focused models. Beyond clinical spaces, IFS concepts are applied in coaching, peer support, and self-help communities. For those who may not have access to therapy, the growing availability of IFS resources—including books, podcasts, online courses, and guided meditations—make it easier than ever to explore IFS. Programs like Mediate Your Life (MYL), created by John Kinyon, offer another accessible path for individuals seeking emotional balance outside of traditional therapy. Integrating principles from both IFS and Nonviolent Communication, MYL coaches individuals on how to mediate internal and interpersonal conflict with empathy and understanding. Mainstream media has also taken notice. In a recent NPR article, “Ever Felt So Stressed You Didn’t Know What To Do Next? Try Talking to Your ‘Parts’”, IFS is introduced as an accessible, non-pathologizing way for people to relate to their stress and anxiety. Seth Kopald, a certified IFS practitioner and coach, illustrates a beautiful analogy for the therapy: “You can think of Self as the sun, which is often covered by clouds, i.e., your parts. Remember the sun is always in its full power, even on a cloudy day…. Like clouds parting, we can ‘remove the things that block our light.’” Kopald explains that through IFS, he “tends to live more in the light of [his]self”. VI. Conclusion Internal Family Systems therapy offers a hopeful and empowering approach to healing emotional distress. Rather than fighting against anxiety or depression, or simply medicating symptoms, IFS invites individuals to be curious about the parts of them that carry painful emotions and drive harmful behaviors. As early research continues to support its effectiveness, IFS stands out as a flexible, non-pathologizing model that invites people to relate and connect to themselves with empathy instead of criticism. By listening to our parts, rather than trying to silence them, we can move toward deeper healing. REFERENCES Aubrey, A. (2024, October 27). Ever felt so stressed you didn’t know what to do next? try talking to your “parts.” NPR. https://www.npr.org/sections/shots-health-news/2024/10/25/nx-s1-5055753/parts-work-therapy-internal-family-systems-anxiety Comeau, A., Smith, L. J., Smith, L., Soumerai Rea, H., Ward, M. C., Creedon, T. B., Sweezy, M., Rosenberg, L. G., & Schuman-Olivier, Z. (2024). Online group-based internal family systems treatment for posttraumatic stress disorder: Feasibility and acceptability of the program for alleviating and resolving trauma and stress. Psychological Trauma: Theory, Research, Practice, and Policy, 16(Suppl 3), S636–S640. https://doi.org/10.1037/tra0001688 de Boer, Kathleen, Jessica L. Mackelprang, and Maja Nedeljkovic. 2025. “The Relationship between Symptoms of Complex Posttraumatic Disorder and Core Concepts in Internal Family Systems Therapy.” Clinical Psychologist, February. doi:10.1080/13284207.2025.2467123. Brenner, E. G., Schwartz, R. C., & Becker, C. (2023). Development of the internal family systems model: Honoring contributions from family systems therapies. Family Process, 62(4), 1290–1306. https://doi.org/10.1111/famp.12943 Haddock, S. A., Weiler, L. M., Trump, L. J., & Henry, K. L. (2017). The efficacy of internal family systems therapy in the treatment of depression among female college students: A pilot study. Journal of Marital and Family Therapy, 43(1), 131–144. https://doi.org/10.1111/jmft.12184 Schwartz, R. C. (2013). Moving from acceptance toward transformation with Internal Family Systems Therapy (IFS). Journal of Clinical Psychology, 69(8), 805–816. https://doi.org/10.1002/jclp.22016
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Understanding the emotional, social, and psychological barriers to breaking free. |
 | About the Author: Marisol is attending California State University Northridge as she intends to attain a bachelor’s degree in Psychology. Her goal is to become a counselor and academic advisor for students and guide them through their educational journey by effectively listening to their issues and providing them with appropriate resources. Other than working on her degree, Marisol likes to listen to music, try out new foods, and spend time with her loved ones. |
Author: Cate Cabri
Connections with others have a major impact on our happiness as well as our well-being. One way that many people seek to strengthen these connections with others is through the use of social media. Social media has become so commonly used in our society as a main method of communication for many people, sometimes even replacing face-to-face interactions. Although there are some positive aspects of using social media, there are also major concerns, including raising levels of anxiety and depression.
If used in an unhealthy way, social media can take a major toll on people's mental health. A few warning signs to look out for that social media could be negatively affecting your mental health include:
However, if used in a healthy way, there are many positive aspects of social media.
Research on the impacts of social media on anxiety has shown that anxious people tend to rely on social media as a means of escaping from what they are worried about. However, once on social media, new stressors become an issue that fuels the initial anxiety that the person was already experiencing. Individuals with Generalized Anxiety Disorder, for example, often compare themselves negatively with others on social media, which leads to a higher level of anxiety than they were initially experiencing.
Social media can be an addictive platform. Research has shown that posting a photo and getting lots of likes and positive, validating comments can be addictive. When you receive positive feedback on a post, this triggers the release of dopamine in the brain (a “reward” chemical). This can cause people to want to continue posting to get more of this validation. This is something to keep in mind when using social media - what is your intention and why are you choosing to post? There is not necessarily one correct intention with posting on social media but it is something to consider, as using social media for the wrong reasons (like for the purpose of only using it to try to get validation or trying to fit in with others) can lead to an unhealthy relationship with social media and can contribute to feelings of anxiety and depression.
Overall, there are positive aspects to social media when used in a healthy way, and it is important to consider your own social media use and how it is affecting your life. Check in with yourself on your social media use and consider any adjustments that you could make to ensure that social media is affecting your life in a positive way.
Sources:
Social Media and Mental Health
The Impact of Social Media on Youth Mental Health
Anxiety and Social Media Use
Does Social Media Cause Depression?
If used in an unhealthy way, social media can take a major toll on people's mental health. A few warning signs to look out for that social media could be negatively affecting your mental health include:
- Finding yourself constantly comparing yourself or your life to others on social media. Even though many of us are aware that social media only shows the highlights of someone’s life, we can still feel inadequate compared to others when seeing beautiful vacation photos or hearing about someone’s latest life achievement.
- Feeling stress or pressure to post often or immediately respond to a friend’s post. Feeling pressure to come up with the perfect comment or post the perfect photo can create more stress and feelings of anxiety.
- Frequently using social media as a “security blanket” when feeling anxious or sad to avoid these feelings. In social situations when we are feeling anxious, we will often rely on our phones by scrolling through social media instead of trying to get through the sometimes awkward silences by making an effort to talk to people. This can be problematic because face-to-face interaction with those we are spending time with is generally something that is shown to ease anxiety. By scrolling through our phones, we are denying ourselves of this interaction and anxiety levels continue to be heightened. Additionally, many people use their phones to avoid their emotions whether with others or by themselves, using the phone to distract them, as opposed to feeling their feelings, or engaging with their thoughts.
However, if used in a healthy way, there are many positive aspects of social media.
- Fostering communication with loved ones. One positive aspect of social media is the ability to easily communicate with friends and family members who you may not be able to see often otherwise. Living far from loved ones or not being able to see people as often as you would like can make catching up on social media a great way to stay in touch, especially now, with the Covid-19 pandemic.
- Having a creative outlet to express yourself. Creativity and self-expression is another positive aspect of social media for many people. Having the freedom to post things that you are passionate about or that show your personality and style can be a great way to express yourself.
- Using social media as a way to stay informed. Social media can also allow us to become aware of significant issues going on in the world and access important information. It is easy to open Instagram and immediately have access to and share information about current events instead of having to search for information elsewhere, although it is important to use your best judgment to stay informed and not allow yourself to be only informed by the opinions of others.
- Consider whether you’re using social media as a replacement for real-life social interaction. Humans need face-to-face contact. Replacing this face-to-face interaction with communicating over a screen leads to a higher risk for developing anxiety or depression. Chatting online or communicating through social media does not have the same benefits for your mental health as talking to people face-to-face. Even using methods such as FaceTime or video chatting is a better substitute versus social media. This way your brain can still pick up on tone, body language, and other physical cues that are all part of communicating with another person.
- Are you actively or passively using social media? Passively using social media, meaning scrolling through social media feeds without ever posting, can actually increase feelings of isolation. This passive use of social media can have even more negative effects on mental health than actively using social media, as you may feel more excluded or isolated. You can actively use social media by posting a photo you like and want to share or by commenting on a friend’s post.
- Does social media make you feel inadequate or disappointed with your life in any way? If so, this is a sign you may want to limit the amount you are on social media or modify the way you are using it. If social media is something that begins to impact your mental health in more negative ways than positive, you may want to rethink how you are using these platforms.
- Make an effort to use social media in moderation. Setting app limits on your phone can be a helpful way to make sure you are spending a healthy amount of time on social media (for example, setting a daily time limit on social media apps that will lock these apps after that amount of time has been exceeded). You can also look at your screen time each week to evaluate how much time you spent on social media apps and consider if this amount of time needs to be adjusted.
Research on the impacts of social media on anxiety has shown that anxious people tend to rely on social media as a means of escaping from what they are worried about. However, once on social media, new stressors become an issue that fuels the initial anxiety that the person was already experiencing. Individuals with Generalized Anxiety Disorder, for example, often compare themselves negatively with others on social media, which leads to a higher level of anxiety than they were initially experiencing.
Social media can be an addictive platform. Research has shown that posting a photo and getting lots of likes and positive, validating comments can be addictive. When you receive positive feedback on a post, this triggers the release of dopamine in the brain (a “reward” chemical). This can cause people to want to continue posting to get more of this validation. This is something to keep in mind when using social media - what is your intention and why are you choosing to post? There is not necessarily one correct intention with posting on social media but it is something to consider, as using social media for the wrong reasons (like for the purpose of only using it to try to get validation or trying to fit in with others) can lead to an unhealthy relationship with social media and can contribute to feelings of anxiety and depression.
Overall, there are positive aspects to social media when used in a healthy way, and it is important to consider your own social media use and how it is affecting your life. Check in with yourself on your social media use and consider any adjustments that you could make to ensure that social media is affecting your life in a positive way.
Sources:
Social Media and Mental Health
The Impact of Social Media on Youth Mental Health
Anxiety and Social Media Use
Does Social Media Cause Depression?
 | About the Author: Cate is a student at Loyola University Chicago where she is majoring in Psychology with a minor in Psychology of Crime and Justice. She plans on attending graduate school to become a clinical social worker. In her free time, she enjoys hiking and spending time with family and friends. |
Author: Katie Borrman
My work friends and I were all freshly vaccinated and looked forward to having another dinner party together after a year of isolation. Most of us had kept to our “pods” (a limited group of friends/family to socialize with during the pandemic), and hadn’t risked socializing outside of that. It was the first time in a year I expanded my social circle to an indoor party with friends in different pods. I was excited. What I didn’t expect was to feel an inescapable level of anxiety. I remember feeling like I was watching myself in the group, asking myself, “Why aren’t you talking more? Why are you so tired? Do they think you’re not having fun? Do they think you have changed during this year of isolation? Have I changed for the worse? Do you have anything to contribute? Why are you being so boring? Does anyone else feel like the volume is too high?” This anxiety-induced questioning led me to a full bodily shutdown, and I felt paralyzed. The last thing I expected during this reunion was for me to excuse myself at 9:00 pm to read a book and fall asleep before anyone else. After this event, I tried my hardest not to judge myself, and instead, evaluate psychologically what was going on.
The DSM-V describes social anxiety disorder with 10 main criteria, but for my situation, the first 3 criteria pertain the most directly:
These symptoms checked out with how I was feeling at the reunion. Social anxiety had never been a controlling element in my life, and I knew that the Covid-19 lockdown was a major contributor to this psychological state. As a society, we are going through something difficult, unpredictable, and traumatic. According to the Center for Disease Control and Prevention (CDC), “Elevated levels of adverse mental health conditions, substance use, and suicidal ideation were reported by adults in the United States in June 2020. The prevalence of symptoms of anxiety disorder was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%).” Whether or not you have had experiences with social anxiety before, or are recently feeling its crippling effects, there are many reasons why an increase in this type of unhelpful habit of thinking may have developed over the past year:
Expectations for personal growth during lockdown
Lockdown brought about many opportunities for people to explore new interests, pick up old hobbies, or “reset” their bodies in a way that was not afforded to them while working full-time. It’s hard not to compare your own personal growth to those who share their experiences freely on social media. But not all experiences during lockdown are seemingly “self-enhancing.” According to the American Psychological Association’s Stress in America Report, since the pandemic started: 61% of adults reported experiencing undesired weight changes, nearly 1 in 4 adults reported drinking more alcohol to cope with their stress, nearly half of Americans said they delayed or canceled health care services, essential workers were more than twice as likely as nonessential workers to have been diagnosed with a mental health disorder, and Gen Z adults were the most likely generation to say that their mental health has worsened.
Those dealing with social anxiety might fall victim to an illusion of unworthiness, or a cycle of thinking that minimizes their own experience. If this thinking has dominated your thoughts during the lockdown, then assimilating back into social circles face-to-face might bring about the same negative cycles of thinking - that your own experience is inadequate, disappointing, or depressing compared to those around you.
Conflicting media information
There are endless amounts of information one can digest through media outlets pertaining to Covid-19, and after a year of deciphering which information feels the most accurate, we are bound to come into conflicting points of view on the safety, regulation, and validity of the information we are taking as truth. The CDC has methods for tracking the deaths, outbreaks, and hospitalizations of Covid-19, as well as which public health measures seem to be working. However, according to the CDC, “...counting exact numbers of COVID-19 cases is not possible because COVID-19 can cause mild illness, symptoms might not appear immediately, there are delays in reporting and testing, not everyone who is infected gets tested or seeks medical care, and there are differences in how completely states and territories report their cases.” This ambiguity can cause tension within our community and social circles due to a lack of consensus and trust. These disagreements can turn into confrontation or avoidance, and in turn, exacerbate anxiety levels while socializing with new or familiar groups.
Grief, loss, and survivor’s guilt
For anyone grieving the loss of loved ones close to them, or feeling loss and grief on a “global community” scale, reemerging from lockdown can feel emotionally overwhelming. According to the CDC, “...the prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%)”. Depression almost always contributes to anxiety levels, and after a year of isolation and social distancing, the question of how to reintegrate can feel nearly impossible to answer. The pressure to “reopen” may feel like too much too soon, and it’s important to let the phases of grief happen naturally and at whatever timeline feels right.
Unwillingness to return to “normal”
The “reopening” of our community structures is a relief for some, while for others creates a sense of dread. For some, this time in lockdown has given a much-needed dose of self-reflection and an opportunity to change personal circumstances and values. For others, reopening might feel simply unsafe. According to the APA Stress in America Report, when asked about feelings concerning the future, “...more than half said they feel uneasy about adjusting to in-person interaction once the pandemic ends (57% Black, 51% Asian, 50% Hispanic and 47% white).” The pressure to return to whatever “normal” was for us pre-pandemic might feel unaligned. I think the pressure becomes particularly more intense when our usual socializing habits have changed over the course of lockdown. Whether that be switching your social scene completely or having new boundaries around the time you spend socially, a new way of being can cause a lot of anxiety when confronting your peers.
These are only a few of the endless reasons why we may be facing social anxiety at this point in a major world transition. It might be hard to end cycles of negative thinking that are based on realistic responses to a global pandemic; so the question of how to manage this type of anxiety can be tricky to relieve. Acceptance Commitment Therapy (ACT) has the goal of adjusting the language we use in talking to ourselves about our anxiety. This method is not trying to eliminate the symptoms themselves - which oftentimes creates more of a problem as the more you try to get rid of it, the worse it can become - but rather manage the anxiety through acceptance, mindfulness, and committed action based on our personal values. This means going towards one’s values, despite the anxiety, rather than waiting to overcome the anxiety to move in the direction of your values.
Acceptance Commitment Therapy
The first step in this therapeutic process is Cognitive Defusion. The goal of this technique is to separate yourself from the personal sensations, (such as thoughts, feelings, images, and memories), that send anxiety down a self-deprecating spiral; to create space between our private experiences and the reactionary impulse of having judgments and trying to control them. A huge component of this technique is accepting that thoughts of pain and suffering inevitably happen. Trying to eliminate them is like swimming upstream - the harder you try to control them the more the anxiety will build. Ways to practice cognitive defusion are by the use of labeling thoughts as they pop up into your mind. For example, the thought I had at the reunion, “I am being boring”, could have instead been phrased as, “I am having the thought that I am being boring.” In this way, we are becoming mindful of the “judgment” aspect of the thought, without trying to eliminate the thought from happening. Instead, we are acknowledging that it is a thought, as opposed to an objective truth.
The second step is Acceptance. Letting unpleasant emotions come and go without resistance is a key factor in this therapeutic process. When we notice the anxiety emerge, we have a choice. We can let ourselves feel it - meaning we can let the anxiety be noticed, remaining in a state of curiosity. The other, more automatic, choice is having an anxious response to the experience of anxiety (i.e. having anxiety about having anxiety). This can be seen as the panic that follows social anxiety, focusing on your future actions, perceptions of others, and shaming oneself into a deeper level of discomfort (also known as “secondary emotions”). Meditative imagery is a useful tool in the acceptance process - imagining the anxious feelings being invited to sit down to tea with you; it can be there, without having to engage or push it away.
The third step is Mindfulness. Being in contact with the present moment is at the heart of Acceptance Commitment Therapy. It is necessary to be in a state of mindfulness to achieve acceptance and cognitive defusion. Remaining present will help you not become lost in your thoughts, and will help heighten your level of awareness around the secondary emotions that emerge during episodes of social anxiety. The most simple and effective tool for mindfulness is breathwork. Paying attention to your breath keeps your body regulated and fixated on the present moment.
The fourth step is establishing your Values. Affirming oneself in their values builds a strong emotional foundation. From this foundation, one can feel confident and assured in situations that might shake their emotional stability. By reverting to our values we can feel assured that our actions align with our emotional goals and commitments. In my situation, my value was to be connected with my friends and our community. Rather than going to the other room and going to bed early, I chose to stay with them, despite the anxiety and the anxious thoughts, and chose to instead be present with them and my experience.
And finally, Taking Action is the last step. Once one’s values are established, it becomes easier to take steps toward fulfilling goals. For people with symptoms of social anxiety disorder, those goals might be something like, “I want to reach out to someone I haven’t spent much time with”, or “I want to call a friend who lives in a different city”, or “I want to make sure I’m giving myself enough alone time, so I won’t feel drained in social situations.” Whatever the “action plan” is, the important thing is to keep the plan aligned with one’s values.
Conclusion
I tried to recall the feeling I had during the beginning of lockdown and remembered the “mourning” phase I went through in saying goodbye to the normal routine I had and prepared for the social, economic, and personal changes that were about to happen. This process changed my social routine, the way I interact with others, and the relationship I have with myself in ways that I didn't come to realize until being put back into a situation without the restrictions I had grown comfortable with. Having the psychological tools to ground yourself during moments of instability can make this journey all the more manageable. Unfortunately, we still have a long way to go. The next psychological phases have yet to present themselves, but they are surely going to change the way we live in a post-pandemic world. Looking at this time as an opportunity for growth and exploration is a comforting truth. We can all look to therapeutic techniques to support ourselves and each other.
Sources:
American Psychological Association (2021, March 11). Stress in America 2021 One Year Later, a New Wave of Pandemic Health Concerns. American Psychological Association. https://www.apa.org/news/press/releases/stress/2021/one-year-pandemic-stress
Arlin, C. (2021, March 23). The Use of Acceptance and Commitment Therapy in Treating SAD. VerywellMind. https://www.verywellmind.com/acceptance-and-commitment-therapy-for-social-anxiety-3024910
Centers for Disease Control and Prevention. (2021, March 23). About CDC Covid-19 Data. Center for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/about-us-cases-deaths.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fabout-us-cases-deaths.html
Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1external icon.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
The DSM-V describes social anxiety disorder with 10 main criteria, but for my situation, the first 3 criteria pertain the most directly:
- “The essential feature of social anxiety disorder is a marked or intense fear or anxiety of social situations in which the individual may be scrutinized by others. In children, the fear or anxiety must occur in peer settings and not just during interactions with adults.”
- “When exposed to such social situations, the individual fears that he or she will be negatively evaluated. The individual is concerned that he or she will be judged as anxious, weak, crazy, stupid, boring, intimidating, dirty, or unlikable. The individual fears that he or she will act or appear in a certain way or show anxiety symptoms, such as blushing, trembling, sweating, stumbling over one's words, or staring, that will be negatively evaluated by others.”
- “Social situations almost always provoke fear or anxiety.”
These symptoms checked out with how I was feeling at the reunion. Social anxiety had never been a controlling element in my life, and I knew that the Covid-19 lockdown was a major contributor to this psychological state. As a society, we are going through something difficult, unpredictable, and traumatic. According to the Center for Disease Control and Prevention (CDC), “Elevated levels of adverse mental health conditions, substance use, and suicidal ideation were reported by adults in the United States in June 2020. The prevalence of symptoms of anxiety disorder was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%).” Whether or not you have had experiences with social anxiety before, or are recently feeling its crippling effects, there are many reasons why an increase in this type of unhelpful habit of thinking may have developed over the past year:
Expectations for personal growth during lockdown
Lockdown brought about many opportunities for people to explore new interests, pick up old hobbies, or “reset” their bodies in a way that was not afforded to them while working full-time. It’s hard not to compare your own personal growth to those who share their experiences freely on social media. But not all experiences during lockdown are seemingly “self-enhancing.” According to the American Psychological Association’s Stress in America Report, since the pandemic started: 61% of adults reported experiencing undesired weight changes, nearly 1 in 4 adults reported drinking more alcohol to cope with their stress, nearly half of Americans said they delayed or canceled health care services, essential workers were more than twice as likely as nonessential workers to have been diagnosed with a mental health disorder, and Gen Z adults were the most likely generation to say that their mental health has worsened.
Those dealing with social anxiety might fall victim to an illusion of unworthiness, or a cycle of thinking that minimizes their own experience. If this thinking has dominated your thoughts during the lockdown, then assimilating back into social circles face-to-face might bring about the same negative cycles of thinking - that your own experience is inadequate, disappointing, or depressing compared to those around you.
Conflicting media information
There are endless amounts of information one can digest through media outlets pertaining to Covid-19, and after a year of deciphering which information feels the most accurate, we are bound to come into conflicting points of view on the safety, regulation, and validity of the information we are taking as truth. The CDC has methods for tracking the deaths, outbreaks, and hospitalizations of Covid-19, as well as which public health measures seem to be working. However, according to the CDC, “...counting exact numbers of COVID-19 cases is not possible because COVID-19 can cause mild illness, symptoms might not appear immediately, there are delays in reporting and testing, not everyone who is infected gets tested or seeks medical care, and there are differences in how completely states and territories report their cases.” This ambiguity can cause tension within our community and social circles due to a lack of consensus and trust. These disagreements can turn into confrontation or avoidance, and in turn, exacerbate anxiety levels while socializing with new or familiar groups.
Grief, loss, and survivor’s guilt
For anyone grieving the loss of loved ones close to them, or feeling loss and grief on a “global community” scale, reemerging from lockdown can feel emotionally overwhelming. According to the CDC, “...the prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%)”. Depression almost always contributes to anxiety levels, and after a year of isolation and social distancing, the question of how to reintegrate can feel nearly impossible to answer. The pressure to “reopen” may feel like too much too soon, and it’s important to let the phases of grief happen naturally and at whatever timeline feels right.
Unwillingness to return to “normal”
The “reopening” of our community structures is a relief for some, while for others creates a sense of dread. For some, this time in lockdown has given a much-needed dose of self-reflection and an opportunity to change personal circumstances and values. For others, reopening might feel simply unsafe. According to the APA Stress in America Report, when asked about feelings concerning the future, “...more than half said they feel uneasy about adjusting to in-person interaction once the pandemic ends (57% Black, 51% Asian, 50% Hispanic and 47% white).” The pressure to return to whatever “normal” was for us pre-pandemic might feel unaligned. I think the pressure becomes particularly more intense when our usual socializing habits have changed over the course of lockdown. Whether that be switching your social scene completely or having new boundaries around the time you spend socially, a new way of being can cause a lot of anxiety when confronting your peers.
These are only a few of the endless reasons why we may be facing social anxiety at this point in a major world transition. It might be hard to end cycles of negative thinking that are based on realistic responses to a global pandemic; so the question of how to manage this type of anxiety can be tricky to relieve. Acceptance Commitment Therapy (ACT) has the goal of adjusting the language we use in talking to ourselves about our anxiety. This method is not trying to eliminate the symptoms themselves - which oftentimes creates more of a problem as the more you try to get rid of it, the worse it can become - but rather manage the anxiety through acceptance, mindfulness, and committed action based on our personal values. This means going towards one’s values, despite the anxiety, rather than waiting to overcome the anxiety to move in the direction of your values.
Acceptance Commitment Therapy
The first step in this therapeutic process is Cognitive Defusion. The goal of this technique is to separate yourself from the personal sensations, (such as thoughts, feelings, images, and memories), that send anxiety down a self-deprecating spiral; to create space between our private experiences and the reactionary impulse of having judgments and trying to control them. A huge component of this technique is accepting that thoughts of pain and suffering inevitably happen. Trying to eliminate them is like swimming upstream - the harder you try to control them the more the anxiety will build. Ways to practice cognitive defusion are by the use of labeling thoughts as they pop up into your mind. For example, the thought I had at the reunion, “I am being boring”, could have instead been phrased as, “I am having the thought that I am being boring.” In this way, we are becoming mindful of the “judgment” aspect of the thought, without trying to eliminate the thought from happening. Instead, we are acknowledging that it is a thought, as opposed to an objective truth.
The second step is Acceptance. Letting unpleasant emotions come and go without resistance is a key factor in this therapeutic process. When we notice the anxiety emerge, we have a choice. We can let ourselves feel it - meaning we can let the anxiety be noticed, remaining in a state of curiosity. The other, more automatic, choice is having an anxious response to the experience of anxiety (i.e. having anxiety about having anxiety). This can be seen as the panic that follows social anxiety, focusing on your future actions, perceptions of others, and shaming oneself into a deeper level of discomfort (also known as “secondary emotions”). Meditative imagery is a useful tool in the acceptance process - imagining the anxious feelings being invited to sit down to tea with you; it can be there, without having to engage or push it away.
The third step is Mindfulness. Being in contact with the present moment is at the heart of Acceptance Commitment Therapy. It is necessary to be in a state of mindfulness to achieve acceptance and cognitive defusion. Remaining present will help you not become lost in your thoughts, and will help heighten your level of awareness around the secondary emotions that emerge during episodes of social anxiety. The most simple and effective tool for mindfulness is breathwork. Paying attention to your breath keeps your body regulated and fixated on the present moment.
The fourth step is establishing your Values. Affirming oneself in their values builds a strong emotional foundation. From this foundation, one can feel confident and assured in situations that might shake their emotional stability. By reverting to our values we can feel assured that our actions align with our emotional goals and commitments. In my situation, my value was to be connected with my friends and our community. Rather than going to the other room and going to bed early, I chose to stay with them, despite the anxiety and the anxious thoughts, and chose to instead be present with them and my experience.
And finally, Taking Action is the last step. Once one’s values are established, it becomes easier to take steps toward fulfilling goals. For people with symptoms of social anxiety disorder, those goals might be something like, “I want to reach out to someone I haven’t spent much time with”, or “I want to call a friend who lives in a different city”, or “I want to make sure I’m giving myself enough alone time, so I won’t feel drained in social situations.” Whatever the “action plan” is, the important thing is to keep the plan aligned with one’s values.
Conclusion
I tried to recall the feeling I had during the beginning of lockdown and remembered the “mourning” phase I went through in saying goodbye to the normal routine I had and prepared for the social, economic, and personal changes that were about to happen. This process changed my social routine, the way I interact with others, and the relationship I have with myself in ways that I didn't come to realize until being put back into a situation without the restrictions I had grown comfortable with. Having the psychological tools to ground yourself during moments of instability can make this journey all the more manageable. Unfortunately, we still have a long way to go. The next psychological phases have yet to present themselves, but they are surely going to change the way we live in a post-pandemic world. Looking at this time as an opportunity for growth and exploration is a comforting truth. We can all look to therapeutic techniques to support ourselves and each other.
Sources:
American Psychological Association (2021, March 11). Stress in America 2021 One Year Later, a New Wave of Pandemic Health Concerns. American Psychological Association. https://www.apa.org/news/press/releases/stress/2021/one-year-pandemic-stress
Arlin, C. (2021, March 23). The Use of Acceptance and Commitment Therapy in Treating SAD. VerywellMind. https://www.verywellmind.com/acceptance-and-commitment-therapy-for-social-anxiety-3024910
Centers for Disease Control and Prevention. (2021, March 23). About CDC Covid-19 Data. Center for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/about-us-cases-deaths.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fabout-us-cases-deaths.html
Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1external icon.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
 | About the Author: Katie grew up in the Bay Area and received her Bachelors of Science in Cognitive Science at University of California Santa Cruz. She is preparing for graduate studies in clinical psychology with a focus on trauma, depression, and anxiety. Outside of her studies, she enjoys reading and writing comics, illustration, and biking and skating with friends on the streets of San Francisco. |
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