Social anxiety in higher education

How many readers of The Psychologist have never felt anxious about meeting new people or being interviewed for a job? Who has not worried about comments on their appearance, performance or personality? Such concerns are common and reflect our innate sensitivity to other people (Purdon et al., 2001). But these anxieties become problematic when individuals seriously doubt their ability to please friends or impress colleagues. As a result, they may develop 'a marked and persistent fear of social or performance situations [which] tend to be avoided or endured with extreme distress' (Veale, 2003, p.258). This is social anxiety.

The self-presentation model of social anxiety proposes that it arises 'in real or imagined social situations where people are motivated to make a desired impression on others but doubt that they will do so' (Schlenker & Leary, 1985, p.176). While this conflict is probably familiar to us all, there is a tendency to high standards among people with marked social anxiety (Antony et al., 1998). They are over-critical of their current social performance and anxious about negative evaluation on future occasions. In the cognitive model of social anxiety (Clark& Wells, 1995), when an individual enters a social situation certain beliefs and assumptions are activated that are quite absolute in quality: 'If I don't give the right answer I'll fail'; 'People can't see anything to like about me', etc. These beliefs originate in earlier life experiences that have oriented the person to perceive certain situations as a threat to self-esteem. The resulting anxiety inhibits participation in social situations and reinforces beliefs about personal inadequacy.

The student experience

Social performance situations are commonly encountered by students in higher education: lectures, seminars, group projects, work experience and employment interviews. They are expected to speak in front of large groups of unfamiliar people – 200 in a lecture is not unusual – and, in seminars, to discuss their subject with knowledgeable authority figures (usually the tutor).

The assessment of student presentations contributes to degree grading, and there is an expectation from employers that graduates will possess good interpersonal skills. In this article we propose that while transient anxieties arise in most students in response to the social performance challenges of university learning, there is a significant minority for whom these lead to persistent, distressing anxiety and reduced engagement with learning.

Prevalence and impact

A review of epidemiological studies in Western hemisphere populations has estimated the lifetime prevalence of social anxiety to range between 7 and 13 per cent depending on the diagnostic threshold used (Furmark, 2002). Within universities, Russell and Shaw (2009) in the UK and Tillfors and Furmark (2007) in Sweden have documented clinically significant levels of social anxiety in 10 and 16 per cent of students respectively. Social anxiety often coexists with other mental health issues (Merikangas & Angst, 1995). It is evident in 20 per cent of cases of adult depression (Ohayon & Schatzberg, 2010) and is associated with alcohol and cannabis dependence (Buckner et al., 2008). Meta-analyses indicate that, for people suffering from persistent social anxiety, the quality of life and psychosocial functioning is significantly impaired (Olatunji et al., 2007). If untreated, only one third of individuals attain remission from social anxiety within 10 years (Keller, 2006), suggesting that identification and early intervention will be beneficial to individuals, families and the public purse.

In our surveys of over 1500 students at two universities, self-selecting participants reported frequent anxiety in learning situations that involved interacting with students and staff (Russell, 2008a; Topham, 2009). They described intense anxiety and embarrassment, physical symptoms (e.g. sweating, blushing), self-consciousness, fear of criticism, cognitive and behavioural impairment (e.g. forgetting, stuttering) and a tendency to dwell on past performance. Students habitually avoided public situations such as lectures, seminars and project groups by being absent or through non-participation. Their accounts are consistent with others (e.g. via Social Anxiety UK: www.social-anxiety.org.uk) and with DSM diagnostic criteria for social anxiety disorder.

Social anxiety and learning

Socially anxious students miss out on learning opportunities by avoiding interaction, physically or psychologically. Attention to academic information may be distracted by an excessive focus on their anxieties (Clark & Wells, 1995), while the ability to monitor and modify communication with colleagues and tutors may be distorted by fears of negative evaluation (Rapee & Heimberg, 1997).

But although it is distressing and causes disengagement from learning, there is limited objective evidence about the impact of social anxiety on academic performance in higher education. Studies have reported significant effects of social anxiety on failure to complete school (Van Ameringen et al., 2003), increased risk of exam failure (Stein & Kean, 2000), failure to graduate and reduced income (Wittchen, 1999).

Yet two studies of the impact on academic performance and retention in first-year college students produced conflicting results (Strahan, 1998, 2003). In the first study, socially anxious students were more likely to withdraw from college, but in the second study social anxiety was not a predictor either of persistence at college or of academic achievement. Strahan suggested that students manage despite their anxieties, but that institutions will vary in the anxiety-provoking demands they place on students and thus in the potential for anxieties to impact on academic performance.

When participating in a seminar or presentation, socially anxious students judge their competence poorly (Austin, 2004), in contrast to the more positive evaluations of observers (Strahan & Conger, 1998); the threat of negative social evaluation persists regardless of academic achievement. In undergraduate programmes, academic material becomes progressively more challenging, and anxieties rise where assessment includes performance or presentation. Students are encouraged to make use of peer and tutor support; class interaction increases amongst those students who are socially confident. Thus, for those who are socially anxious, there is a growing conflict between their need to engage with the programme and with colleagues, and their fears of exposure and embarrassment. This approach-avoidance conflict has been reported by several researchers (e.g. Todd et al., 2008) and is an important dynamic to appreciate in working with socially anxious students.

A hidden disability

Given its prevalence and impact, why has social anxiety not received more attention by universities and colleges? We suggest that the following factors are relevant.

It is not easy to identify social anxiety, and it may be attributed to shyness, being viewed as a personality trait rather than a problem. And it is not obviously distressing – Andersen (2006) described how MA students appeared confident and socially adept in routine daily encounters, with their substantial anxieties in learning situations concealed until they were asked to present their work to peers and tutors.

There may be an implicit belief in the academic community that anxiety is intrinsic to the process of learning, whereby overcoming academic challenges builds confidence, and fears of social evaluation recede. Concern has been expressed that over-focusing on anxiety and other emotions risks turning education into a therapeutic activity that diminishes rather than enhances the learner's sense of self (Ecclestone et al., 2005). Social anxiety may be unduly identified with pathology rather than maturation, and, for example, Stewart and Mandrusiak (2007) found no significant difference in levels of self-reported social anxiety between student counselling clients and other students.

Despite universities allocating and advertising considerable resources for student support, these depend on students feeling able to access them. Students with mental health issues are reluctant to seek professional help from university sources due to a fear of stigmatisation (according o a University of Leicester student survey in 2000), while feelings of shame are particularly common in people with social anxiety (Gabbard, 1992). Thus there may be conflict for the student between wanting help and fearing to expose their perceived inadequacies. The sense of shame extends to contact with therapists and other potential helpers (including academic staff) such that sufferers require skilled and sensitive handling if and when they do come forward (Eckleberry-Hunt & Dohrenwend, 2005).

Lastly, the government approach to higher education has been described as 'largely utilitarian' (O'Leary, 2007, p.483), with its institutions being expected to contribute to national prosperity. O'Leary suggests that this has contributed to an education culture where the ability to present oneself and one's work for critical evaluation is regarded as necessary for academic and occupational success. In this climate, the perception of the socially anxious student, ashamed to ask for help, is that the university and its staff are – albeit unintentionally – unsympathetic to their concerns.

Options for supporting students

Our conclusion is that students with persistent, troubling social anxiety fall uncomfortably between pedagogic and psychological perspectives. We suggest that there are low-cost options for supporting these students that can be adopted within current structures for staff training and student support.

Students assert that universities could do a better job of helping students get to know each other (Russell, 2008), while UK research has drawn attention to the importance of social integration in retaining students (Yorke & Longden, 2008). We note that university drama programmes spend considerable time on activities to build trust amongst new undergraduates (Vatcher, personal communication, 22 June 2009). Such approaches help to disconfirm beliefs about negative social evaluation, increase openness to feedback and reduce student anxieties through habituation.

The desire to succeed and the fear of failure coexist in many students. Sensitive appreciation of this conflict by staff, and the shame attached to asking for help, will facilitate conversations with students about their learning and their anxieties. Academic staff and students could collaborate to distinguish between anxieties that indicate a need for further academic support, and deep-rooted concerns about self that may require specialist help from counsellors or others. Those with dedicated support roles – advisers and counsellors – could routinely ask their student clients how they are coping with the demands and the outcomes of their learning in order to disentangle developmental from dysfunctional anxieties.

Students report lack of understanding and criticism from staff as unhelpful, while valuing interpersonal support and opportunities to develop skills in managing situations (Elliot et al., 2007). They would prefer, for example, not to be singled out for questioning in lectures or to have assessed presentations in their first term.

Tutors could encourage their student groups to practise presentations and to accept a degree of discomfort in so doing. Tutors could also discreetly support the persistently anxious student in arranging less challenging exposure or specialist help.

Overall, we suggest that it is developmentally unhelpful to treat students as unduly fragile and that balancing challenge with support is crucial. We do not think that it turns education into therapy if tutors invite students to reflect on their fears of social evaluation in learning and to explore those beliefs with trusted colleagues. And then, as any psychologist knows, change takes time and effort by all concerned.

Phil Topham
is at the University of the West of England
[email protected]

Graham Russell
is at the University of Plymouth
[email protected]

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