This story is a fictional case, but is made up of REAL clinical experiences from my 15+ years treating people with Social Anxiety Disorder.
To read previous therapy sessions with John, see the links below:
Session 1: Do I Have Social Anxiety? Meet John.
Session 2: Help, My Boss Scares Me (more from John)
Today’s session is about Eating in Public
Early on in our sessions, when we were talking about the common symptoms of social anxiety, I asked John if he felt anxious about eating in front of others.
“I never go out for dinner, I really like it, and I would love to be able to but I hate the feeling that I can’t escape, I panic”, he said.
I explained this is really common with Social Anxiety, that if you’re in a situation that it would cause you great embarrassment to leave, you panic. Even just thinking about the situation can cause people to panic, and so they avoid going.
But it was also true that John hated eating in front of others …
“I just get terrified that people will notice my shaking hands, or I’ll spill food on myself, or dribble sauce down my chin… it paralyses me!”
We talked about how eating makes us feel vulnerable. It’s a time when we’re often self conscious and in John’s case, he also was able to talk about how growing up his parents would often argue at the dinner table, and he wouldn’t be allowed to leave, he had to sit and listen. We also talked about how it is quite common for people to feel a little nervous eating out in public, and how his anxiety grabs hold of this nervousness and turns the volume up.
I suggested John practice ‘eating mindfulness’ in his own home, that he use the mindfulness skills we had talked about to just focus on the taste and sensations of eating, and to keep bringing his mind back to the sensations of eating. We also talked about how he could manage his “anticipatory anxiety” and decide to take his anxiety to dinner with him. John also came up with some strategies of his own, like getting up from the table and taking a quick break in the bathroom if he needed to, or getting “some fresh air” for a few minutes if he was really struggling. He imagined using this time to simply breathe and bring his focus back to the moment.
A few weeks later John arrived and triumphantly told me:
“ I did it! I went out to lunch with a friend. It was really hard, but I just kept noticing how good the food was, and kept bringing my mind back to listening to my friend and observing the other people at the café. I was really anxious on my way there, but once I got there it was actually OK. And we’re going to meet for lunch again next week.”
… “And my anxiety is invited too!”