Is that a rash on your neck or are you just anxious to see me?

I go red when I’m nervous. And when I’m embarrassed. And frustrated. And amused. In fact, any time I experience the slightest increase in emotion or temperature, you will see it on my skin, clawing its way out of my collar and onto my face.  I discovered this delightful fact about myself in high school, when someone kindly pointed out that they would have presumed I was sunburnt, had I not been so deathly pale everywhere else.  They weren’t the only person to notice, either.  Every time it happened, someone would comment on it. Once the focus was firmly on me and my neck, I would get even more uncomfortable, more red, more comments, more anxious, more red, and the cycle would continue.

Fortunately most adults don’t feel the need to comment on every perceived flaw or defect in other people.  By the time I was training to become a psychologist, I worried less about whether people would notice me going red and focused my attention on more grown up fears, like whether they would discover I am a massive fraud who didn’t belong here and had probably been let onto the doctorate programme by mistake.

The Red CycleWhen I starting learning about CBT for social anxiety, it was like an emotional portal back to high school.  People with social anxiety tend to direct their attention inwards in social situations, focusing less on the other person and more on how they themselves appear to the other person, how they are coming across, and what they should be doing next.  As a result, people with social anxiety often miss the cues from other people that tell them things are fine, or they miss part of the conversation and struggle to keep up, thus making the interaction more awkward and reinforcing their belief that they can’t cope well in social situations.  This puts them on high alert again next time, and the cycle continues.

One of the most common concerns is that they will show visible signs of anxiety, like, say, going red from chest to cheeks.  When, say, presenting your doctoral research proposal to a room full of professors.  Because their focus is so closely on themselves, they often take their feelings as facts: if I feel this hot, then I must be bright red.  I feel this scrutinised, then people must be judging me.  If I feel this nervous, then I must not know what I’m talking about.

In CBT, there are some key experiments that we suggest for social anxiety.

1. Find out if your symptoms are as noticeable as you think they are.

2. Challenge your beliefs that people are judging you so harshly.

3. Check if your usual attempts to make things better are actually working.

4. As always, remember that anxiety is a perfectly normal human emotion and not a sign of weakness or gross incompetence. No matter what those dicks at high school said.

It has taken me roughly eight years to complete this set of experiments.  Turns out potential humiliation is a powerful predictor of avoidance.

Experiment 1 – Do you see what I see?

As a newly qualified psychologist, I ran a training day teaching the basics of CBT to a room full of social care and allied health professionals.  I decided to draw on a little personal experience to demonstrate how to use a quick poll (of a room full of people) to test out an alternative belief (that there was no way I could actually be as bright red as I felt like I was). I thought they would all reassure me, then spend their tea break discussing how impressively I could intertwine personal stories into a neat theoretical framework in a way that was both informative and touching, the mark of a non-fraudulent professional who definitely belonged here at the front of the room telling people what to do.

#NoFilter

#NoFilter

While telling this story I was, of course, extremely nervous.  When I managed to shift my attention back out towards the group, I saw only confusion and expectation.  It was later obvious that they were waiting for the second part of the story, the bit that explained why I had just drawn their attention to how extremely bright red I was whilst asking them to convince me otherwise.  When that part never came, a psychiatric nurse gently informed me of my flushed state, and then she very neatly tied it into a theoretical framework that was both informative and touching. A little something for the others to admire over a cup of tea.

Result: As the old saying goes, just because you’re paranoid, doesn’t mean that you’re not covered in red splotches.

Experiment 2 – Do you think what I feel?

I never intended to complete this part of the experiment.  I don’t mind asking if you can see that I’ve gone red, I don’t mind finding out if you could tell I was nervous, but I will fight to the death for my right to assume that you think I am competent.  I didn’t choose this experiment, it was handed to me along with a glass of sparkling shiraz after finishing my MC duties at my brother’s wedding.

“You looked so nervous up there!  Don’t worry – I don’t think people minded.  You did good considering how nervous you were. They’ve had heaps of champagne and people only care about the proper speeches anyway.”

Result: I guess I did good considering how nervous I was?

Experiment 3 – Is a roll neck the solution to all my problems?

Result: “It looks like that jumper might be giving you a rash.”

Experiment 4 – This is just my thing.

I spent a long time fighting the idea that my anxiety was directly related to my competence.  It took me a long time to realise that the correlation might actually be a positive one: I get nervous because I care about what I am doing, and because I believe the outcome matters.  I can feel calm, or I can be good.

Nowadays, when I choose talk about any of this during training or with my patients, I ask people to comment on how noticeable the redness is, and on what their thoughts were when they saw it.  Did they make any assumptions about me or my emotional state? Did it bring up anything for them?  Did their thoughts shift at all when I drew their attention to it and discussed it openly?

And then I tie it all up into a nice theoretical framework that I like to think teaches them a little something about CBT, anxiety, training skills, and maybe just a little bit about themselves. Because, after all, I’m a non-fraudulent professional, who knows she goes red in the face and almost certainly believes she definitely sort of belongs here.

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2 responses

  1. You’ve just printed out my life story except I’m not nervous in front of people–only that my “excited” state makes me blotch up. I have yet to find my solution other than try to “tan” it away.

  2. yes, surprised to see that i am not the only one with this problem. I called it rosacea, but it is not. only happens in situation of sudden change of temperature, glass of wine, high emotions… very hard to control… and the fear of people noticing and saying: “oh! my God what happened to you, you look so red!!!”. How to react? it only makes it worst of course, it is a vicious circle… but is there any laser treatment to eradicate this horrible problem???

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