“What’s the worst that could happen?” And immediately after: “And then?”. Two questions, almost irritating because of how simple they are. Especially when the brain has already transformed a presentation in front of strangers, a date or a job interview into a chain of disasters that more or less ends with voluntary exile from society.
Yet the mechanism behind it has a lot to do with tools used in cognitive-behavioral therapy. The first question forces us to give shape to fear. The second forces us to go beyond the feared moment: let’s even suppose that the bad impression arrives. What happens next?
Very often the answer is decidedly less cinematic than the imagined problem: you go home, you feel embarrassed, perhaps you think about what happened for a few hours. Then comes the next day.
Because social anxiety can turn an embarrassment into a catastrophe
Social anxiety disorder goes far beyond normal shyness. ISSalute describes it as a condition in which even common social contexts can cause strong anxiety and fear of being embarrassed or humiliated, to the point of limiting daily activities such as meeting friends or eating out.
Part of the problem takes place even before the meeting. He imagines himself not knowing what to say, blushing, stuttering, looking boring or ridiculous. Then, if the meeting happens, attention often ends up focused on every gesture and word. And then the replay can start: “Why did I say that?”, “Did they think I was strange?”, “Did they notice that I was nervous?”.
These are well-known mechanisms in cognitive models of social anxiety. People may overestimate how negatively they will be judged and hold beliefs such as “I will look stupid,” “I will have nothing to say,” or “others will notice that I am anxious.” A scientific review on the cognitive model of social anxiety, also authored by David M. Clark, describes these negative evaluations as central elements of the disorder.
The result can be avoidance: not going to the party, canceling the date, not speaking in a meeting. Or look for some crutches to handle the situation. The NICE guidelines on social anxiety disorder remind us, for example, that even the use of alcohol or other substances can become a way of trying to reduce anxiety in social situations.
The two questions bring the disaster down in scale
“What’s the worst that could happen?” alone it almost seems like an invitation to catastrophe. Cognitive restructuring instead serves to take that indistinct fear and put it on the table.
The Center for Clinical Interventions of Western Australia uses very similar questions in its social anxiety program: What’s the worst that could happen, would you be able to deal with it, would life go on, what could you do? Then it also invites us to ask ourselves what the most probable outcome is, which often lies several floors lower than the catastrophic one.
The second question, “And then?”, adds something very concrete. Imagine the dreaded silence during a date. And then? We change the subject. Imagine getting stuck during a presentation. And then? He starts talking again. We even imagine that someone judges us badly. And then? That judgment can be unpleasant without automatically becoming a definitive ruling on our social existence.
It is a form of decatastrophization: assessing how likely the feared event is, how serious it would really be, and what resources we would have to deal with it.
They function within a larger work
Two questions are not the same as therapy. However, they can reproduce a small piece of the work that cognitive-behavioral therapy does on negative thoughts and predictions.
For adults with social anxiety disorder, NICE recommends individual CBT specific to this disorder as the first-line psychological treatment. The protocols use behavioral experiments to verify negative beliefs, exercises to shift attention outwards and interventions on the rumination that precedes and follows social events.
There is an important difference here compared to simply telling yourself “everything will be fine”. The goal is not to guarantee that nothing unpleasant will happen. A conversation can be awkward. An interview can go badly. We can forget what we wanted to say in front of twenty people and briefly wish to be swallowed up by the floor.
The useful question becomes how much that consequence actually resembles the disaster we predicted and how capable we are of dealing with it.
In a randomized trial of 75 people with generalized social anxiety disorder, 16 sessions of one-on-one CBT were associated with greater reductions in negative emotions when reappraising negative beliefs about oneself, compared to waitlisting. The study also observed changes in the brain responses involved in this cognitive reappraisal. However, this is research into the complete treatment, not into the two questions taken alone.
When two questions aren’t enough
Trying this exercise can be useful when the classic avalanche of predictions starts: specify what we fear, ask ourselves what would happen immediately afterwards and what the most probable scenario would be.
However, if fear regularly leads to avoiding classes, work, friendships, appointments or even simple errands, we are on different ground. Social anxiety can become very limiting and available treatments range from CBT to guided self-help to, in some cases, medications prescribed by a doctor, as the British health service NHS also explains.
The fool, when it arrives, lasts as long as it lasts. The next day there is an alarm clock anyway. Anxiety had only begun to worry him well in advance.
