Flinders University researcher discovers writing short, compassionate letters to yourself could be all it takes to fix your social anxiety disorder

SA researcher Dr Jeremy Stevenson has discovered writing letters to yourself can ease – and even eliminate – debilitating Social Anxiety Disorder, which affects millions of Australians. He explains to Roy Eccleston how it works.

Flinders University researcher Jeremy Stevenson.

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ROY ECCLESTON: It’s not unusual to feel a bit nervous meeting new people, but when is it a problem?

DR JEREMY STEVENSON: Many people experience moments of social anxiety, but Social Anxiety Disorder (SAD) is when this fear reaches intense levels. Research indicates about one million Australians or 4.2 per cent of us, will be diagnosed with SAD within any 12-month period, and around 8.4 per cent will be diagnosed at some point in their lives. They fear their behaviour will be scrutinised or criticised by others, so they tend to either avoid social situations or endure them while suffering intense anxiety.

RE: How limiting is it?

JS: The distress affects people’s work and physical health. It’s associated with lower employment rates, less household income and higher levels of drug dependency. People with SAD are more likely to be single, unmarried or divorced.

RE: What drew you to this research?

JS: I don’t think I’ve had SAD, but I was a shy child so I’m familiar with many social anxiety symptoms. I grew out of my shyness and I think confronting my fears was a major part of this process, but I also went along a gradual path of self-acceptance. I know that increasing social confidence is possible, and your attitude is central to this process. Therefore, I’m interested in both social anxiety and self-compassion.

RE: What is the usual treatment?

JS: The current gold standard for treating SAD is cognitive behavioural therapy (CBT), which aims to change the way people think or behave. One commonly used component is cognitive restructuring, to identify thoughts that cause social anxiety. For instance: “If I speak, people will criticise me.” Restructuring this thought can make it more helpful: “When I’ve spoken in the past, I’ve rarely been criticised.”

RE: Why ask sufferers to write letters of self-compassion?

JS: Compassion has been plucked from eastern contemplative traditions and is growing in popularity – a bit like mindfulness. A growing body of evidence indicates that compassion-focused strategies can alleviate various forms of suffering. It could be used to treat social anxiety, but this research is in its infancy. It’s also unclear how self-compassion might fare against the cognitive restructuring technique, so we’ve compared the two. We did this through online delivery because of its lower cost, increased accessibility for participants, and its appeal for people averse to face-to-face treatment. We chose to   focus   on   participants   preparing   self-directed compassionate letters because this format has been used in previous research and it’s quite an intuitive approach.

RE: Can you give us some examples?

JS: The letters commonly include expressions of understanding, such as “I am sad that you feel distressed. I know that you want to feel calm and connected with others”. There were messages of validation, such as, “It makes sense that you feel distressed given what was going through your mind”. There were also reminders of the universality of suffering, such as “Although you feel alone and different right now, there are many other people in the world who feel like this, too”.

To encourage the participants to hold a compassionate frame of mind, they were prompted to imagine what they would say to a close friend in a similar situation and then visualise themselves providing self-compassion.

RE: How often did people write?

JS: Participants wrote these letters daily for two weeks. We designed a website where they could be completed, and participants were instructed to only spend between five and 15 minutes on the task. On average, participants wrote about 100 words for each letter and took a little more than five minutes to complete each one, but there was a fair range of variability.

RE: And did it work?

JS: After the two-week period, participants from both groups reported similar reductions in social anxiety symptoms. One fifth showed an excellent response, and their reduced social anxiety saw them drop below the cut-off point that defines SAD.

RE: Were you surprised?

JS: I was surprised that there was no significant difference between the two groups we tested – one using cognitive restructuring, the other using “self-compassion” exercises – especially because cognitive restructuring is a more established form of treatment. I thought this was very interesting due to the significantly shorter amount of time the “self-compassion”   group   spent  on   their  exercises.  This  might  suggest  that  self-compassion is more potent than cognitive restructuring, but more research needs to be done to confirm this.

RE: So other sufferers of social anxiety can benefit from doing this?

JS: These findings show some promise for self-compassion, but because CBT remains the gold standard for SAD, people suffering from social anxiety need to talk with their GP about what might work best for them. Self-compassion could also complement more common treatments.

When people are undertaking cognitive restructuring,  they  might  consider  doing  it with  an  emphasis on  self-compassion  – although this dual approach has not yet been researched.

RE: For how long should people write to themselves, and are certain lengths of letter better?

JS: The jury is still out on these questions. According to our study, spending just five minutes on writing a self-compassionate letter seemed to produce benefits.