How AI is saving billions of years of human research time | Max Jaderberg

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2:59This is TEDHealth. I'm Dr. Shoshana Ungerleiter. Socializing is a crucial part of our lives, yet it can be daunting and anxiety-provoking for many. In her 2021 TEDx Talk at the University of South Florida, licensed clinical psychologist Fallon Goodman sheds light on the root causes of social anxiety and offers practical tips to manage it. Afterwards, I'll talk to psychiatrist and science journalist Dr. Jesse Gold. We'll discuss how we can all do our best to ease the burden of social anxiety for the people that we care about. So stick around.

3:50Each person who entered our therapy clinic answered a stack of questions before beginning treatment. And during my years as a therapist, Sarah, there was one question I always reviewed before meeting with a new client. It asked this, what is your purpose in life to find as a central motivating life vein, something you're trying to accomplish? Now, to be fair, this is a difficult question. Identifying a single purpose in life feels really hard. It also feels consequential. Many people spend years searching for and developing their purposes and some never find it. But typically we see responses like this.

4:24To be an engaged parent. To make meaningful change in my community. To build a career I'm proud of. To live for a long time. Just keeping it simple. But then there was the answer of one young woman who I worked with. Before meeting with her, as I always did, I flipped to see how she described her purpose. And she wrote this, to avoid being noticed by other people. This young woman, a bright, witty, compassionate high schooler, decided that her purpose in life was to make sure that other people did not know that she existed. This is the power of social anxiety. At its core, social anxiety is about the fear of being rejected.

5:10When we feel socially anxious, we become hyper-focused on how we are appearing to others. We scan the room, looking for signs of threat and disapproval, signs we might have slipped up and are at risk for rejection. And then we seek comfort in signs of approval, smiles, head nods, laughs, and so on. And while social anxiety can be exhausting, it exists for a reason. Social anxiety tries to protect us from rejection, and it does that by tuning us into the nuances and norms and dynamics of a social group so we can match our behavior to fit in with them and ultimately avoid being rejected. Now, this is a good thing because humans are social.

5:47We exist in social groups. We rely on each other, whether or not we like that, but also more simply because rejection is painful. Take a moment to think about your own rejection experiences, however cringeworthy we all have them. Maybe you were ghosted after a first date. Been there? Maybe you were rejected from your dream job. Maybe you were ousted from a friend group. Rejection's unpleasant, and social anxiety tries to protect us from it. But social anxiety becomes problematic when it begins to interfere with the life you want to live. And this happens when your fear of rejection becomes intertwined with your view of yourself.

6:25when you believe you will be rejected because you think you have some inherent flaw, deficiency, or failing of character. You were ghosted after that first date, and you believe it's because you are not lovable or attractive enough. You were turned down from your dream job, and you believe it's because you are not intelligent or competent enough. You were ousted from that friend group, and you believe it's because you are not interesting or funny enough. Our fear of rejection is really a fear of being less than. Less than we want to be, less than we think we should be, or less than we believe society wants us to be.

7:02And over time, this belief system can develop into social anxiety disorder. When a person has social anxiety disorder, they become overly concerned about other people, scrutinizing them, evaluating them harshly, and ultimately rejecting them, so much so that they begin to construct their lives around avoiding rejection. Because if you can avoid being noticed by other people, then those people have fewer data points on which to reject you. Now, social anxiety disorder is one of the most common mental illnesses in the world. In the United States alone, more than 12 % of Americans at some point in their lives will have diagnosable social anxiety disorder.

7:43That's roughly 40 million people. Now, worldwide, the estimates are lower. They're 4%, which in and of itself is interesting. But based on current population estimates, 4 % of the world's roughly 300 million people that will potentially have social anxiety disorder at some point in their lifetime. And despite how prevalent it is, it's widely misunderstood, widely misdiagnosed, and often missed entirely. This is because several myths about social anxiety pervade our culture. The first myth is that people with social anxiety are happier alone. The stereotype of someone with social anxiety is a recluse who'd rather be hiding away alone in their bedroom than out interacting with the world.

8:27And this is simply not true. In research conducted in my lab, we find that people with social anxiety disorder desire strong, healthy, intimate relationships to the same degree as those without mental illness. And they do socialize. They're not robotic aliens. And when they socialize, they often enjoy doing so. In fact, when we ask people with social anxiety how happy they are, they report feeling happier when they are with other people than when they're alone. This is because not all social interactions are stressful. Maybe someone feels socially anxious with friends, but not their romantic partner.

9:05Or they feel anxious with strangers and acquaintances, but not people like their neighbors or co-workers. So even though some interactions are stressful, people with social anxiety are not devoid of the basic desire for human connection. They just have trouble obtaining it in certain situations with certain people. Okay, so maybe then people with social anxiety do socialize, and when they do, they enjoy it, but it's with a small, tight-knit group of people. And really, social anxiety is about avoiding the spotlight. And this is the second myth. Social anxiety is not necessarily about a fear of public performance.

9:44Well, this is true of some people, other people with social anxiety find performing in front of others less anxiety provoking than smaller, more intimate conversations like where they have to carry a conversation one on one. Many people with social anxiety excel in careers that are intertwined with social evaluation and social performance, modeling, acting, sports. In May of 2021, Naomi Osaka declined to participate in press conferences of the French Open. She courageously and preemptively shared that they exacerbated her social anxiety. Shortly thereafter, she received a wave of public backlash and scrutiny.

10:26She goes on to play her first match, of course wins, and then she withdraws from the French Open. Many people were perplexed about how someone could have social anxiety and also be the number one ranked tennis player in the world, lead a fashion campaign with Nike, good choice, and on the cover of Sports Illustrated in a swimsuit. In an interview the year prior in discussing her social anxiety, Osaka explained, on the court is completely different. I love playing at Arthur Ashe because it's the biggest stadium and you feel the rumble of the crowd. You kind of feel like a gladiator because it's super big, quote, and there are so many people watching or match.

11:08But off the court, if I was ever thrown into a situation where I had to speak in front of 100 people, I feel like I would start shaking. There is no one-size-fits-all profile of social anxiety. Just like people who are depressed have different collections of symptoms at different times for different reasons, social anxiety looks different in different people. And last, and maybe the most problematic myth, that social anxiety is fleeting and harmless. Social anxiety is not just something you grow out of. It doesn't magically disappear when you graduate middle school or high school. Without intervention, many people struggle with social anxiety for years, for decades.

11:51And social anxiety can influence every aspect of a person's life. It can influence the hobbies they choose, maybe opting for solo activities like reading, writing, rather than things like team sports. It can influence the careers people pursue, maybe opting for careers with more individual, like computer time, versus things like sales or customer service. And social anxiety can influence people's everyday lives. Ricky Williams, star NFL running back, Heisman winning running back, dazzled millions of people in the football field every week. And yet he shared that he struggled with social anxiety, and because of it, He had difficulty interacting with teammates, running everyday errands where he'd have to interact with people, and even interacting with his own daughter.

12:41The real tragedy of social anxiety is that it robs individuals of their greatest resource, other people. Other people help us overcome adversity, like recovering from illness or after you bomb a job interview. Other people help us celebrate milestones, like showing up to the birth of our child or a wedding or a graduation. And other people help us overcome loss, like grieving the death of a loved one. Our fear of rejection gets in the way of obtaining and appreciating the benefits of being accepted, the benefits of other people. And in our modern world, it is harder than ever to manage social anxiety.

13:23We are more connected today than any time in human history, and yet we are lonelier, more depressed, and more socially anxious than ever. We have endless tools to socialize, and yet we are seeing a decay in social connection. In a rapid amount of time, our social structures have been upended and rewritten. Technology and social media have created new standards for social relationships and interactions. Do I post it? Do I share it? Do I like it? Do I love it? We create these bizarre extensions of ourselves through curated profiles and now avatars. We try to make sense of unlimited feedback from a massive and often invisible audience.

14:01And the cost of social blunders are higher. Things you do and things you say can live online forever and subject you to unforgiving scrutiny, reputation loss, and even job loss. It is a tough time to have social anxiety. But the world will become more, not less connected. and the influence of technology and social media will grow, not shrink. Now is the time to address social anxiety. And here's how. The first and maybe easiest thing we can do is identify early. Early detection is critical because of those who go on to develop social anxiety disorder. More than half will have developed it before their 14th birthday, more than half.

14:42And social anxiety puts people at risk for developing other mental illnesses later on. Of adults who are diagnosed with both social anxiety disorder and depression, social anxiety came first 70 % of the time. Of adults who are diagnosed with both social anxiety disorder and alcohol use disorder, social anxiety came first. It was developed first approximately 80 % of the time. What these data suggest is that social anxiety starts early and it puts people at risk for developing other mental illnesses. But here's the incredible part. Social anxiety can be reliably and accurately flagged by asking just a few simple questions.

15:23Questions like, does your fear of rejection, is it among one of your worst fears? And is your fear of rejection get in the way of doing things that you otherwise want to be or enjoy doing? The cost of asking these questions is like 30 seconds and zero dollars. We don't have to create new infrastructures. We don't have to upend existing ones. We can embed early detection programs into our existing structures, like at schools, new year orientation, one-on-one counselor meetings, and in primary care settings. Because if a doctor can screen for depression, then she can also screen for social anxiety.

16:01Early detection and then appropriately intervening can significantly alter the trajectories of young people. the second thing we can do is harness our platforms one of the benefits of living in this hyper-connected world is that a single person can have a ton of power they can use their platforms to create meaningful and lasting social change i mentioned ricky williams and osaka who have used their platforms to share about their social anxiety and just from these two people we've seen the ripple effect. In response to Osaka's announcement, Viola Davis, Oscar, Emmy, Tony award-winning actress shared that she struggles with social anxiety.

16:44A woman whose job it is as an actress to embody and express the complexities of people in very vulnerable and very public ways. Frankly, these celebrities are not the poster children for social anxiety. They are just three of the millions who suffer who are brave enough to talk about it. And we can do the same with our platforms, however big or small, in our schools, in our workplaces, in our communities, and in our homes. Because regular, candid, and forthcoming conversations about mental illness ultimately reduce stigma, correct harmful myths, and get people the help that they need. The last thing that we can do is foster social courage.

17:30Adressing social anxiety is not about preventing or avoiding rejection. Addressing social anxiety is about fostering social courage. Being socially courageous means pursuing experiences and knowing that your chances of rejection are not zero. In fact, the chances that you get rejected at some point in your life, at some point this year, are high. And worse, you may be rejected as a function of who you are. Things about yourself that you cannot change. where you come from, what you look like, or who you love. Being socially courageous means pursuing experiences because they are important to you and knowing that the successes of those pursuits are not contingent on your worth as a human being.

18:16Being socially courageous means knowing your worth and finding people and social groups that love and accept that person. And being socially courageous means asking that person out. applying for that job, speaking up at that meeting or that party, or giving that big talk on that big stage, knowing that rejection lurks around the corner. But the opportunity for growth and for purpose shines brighter. A purpose not defined by ensuring that you go unnoticed in this world, but a purpose that makes you feel most alive, most present, and most authentically you. Thank you.

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20:39Hi, listeners. It's Shoshana again. Yes, social anxiety is a medical diagnosis. It's something that's probably experienced by many of the people that you know. Maybe that even includes you. Right now, we're also entering a time of much greater awareness and openness about discussing mental health, being led in part by a younger generation. I can't think of anyone in my life who doesn't have a therapist. And that probably isn't new, but what's new is that I know about it. So since we're more aware of mental health now and more ready to make space for it, how can we set the tone or set the table for others to help ease their social anxiety, assuming that many, many people around us will have it?

21:26To talk about this, we have a special guest today. Dr. Jessie Gold is an assistant professor in the Department of Psychiatry at Washington University School of Medicine in St. Louis, specializing in college mental health, medical education, and physician wellness. Thanks so much for being here, Jessie. Thanks for having me. Jessie, some estimates suggest that up to 13 % of people may experience some degree of social anxiety symptoms at some point in their lives, anywhere from mild all the way to severe. So if social anxiety is so common, why does it often seem invisible? I think people just assume it's their personality, like they're shy or they're introverted.

22:10And I think if you're introverted, a really good book to read on that is Quiet by Susan Cain. But it's very different than being shy and introverted. But we kind of just assume if we don't want to hang out with people, it's our problem, or there's something wrong with us, or that's just how we've always been. And it makes it really hard to go, okay, that's something I should get help with. And it's true, because it isn't just like, I can't hang out with people. It's when I hang out with people, I worry all of the time about what they're thinking about me. I'm fearful of hanging out with people.

22:41So I don't want to hang out with people. And I avoid them to that extent. People get really severe symptoms from it. And you kind of mentioned the spectrum of it. And I think when you're on the more mild and it's really easy to just be like, that's who I am. I'm just a person who doesn't like people. But I think people tend not to get help as a result. And there's like a lot of data about social anxiety and people not actually seeking help for it. Only about 5 % of people actually do. And about a third wait 10 years. And that's a really long time waiting 10 years to get help. So because our society sort of normalizes that as introversion or shyness, we tend to then wait till we need help until we have really severe symptoms or just not get help at all.

23:24So, so many people are sort of suffering in silence with this. Absolutely. As a psychiatrist, you take care of college and grad school age students. So how does social anxiety manifest for people in that age group? College is a really interesting time. So you're basically thrown into extreme socializing. You don't get away from people at all, right? So you might have lived at home with no siblings. You might not really interact with people if you don't play group sports or group activities. But all of a sudden, classes are with people. Eating is with people. You sleep in the same rooms as people.

24:04You literally can't get away from people. And that's a big difference. So sometimes you might have been OK at home in high school or even before in elementary school. But college is like being flooded with people as a person with social anxiety. And what you'll see is kind of like a constellation of like three categories of symptoms. So people have physical symptoms where in social situations, it kind of looks like panic, having their heart rate go up, feeling dizzy, feeling muscle tension. Sometimes their stomach hurts. Sometimes they blush, that sort of thing. There's a lot of physical reactions because the brain and the body are connected.

24:41And it's not necessarily always to the level of a panic attack, but it could be. Then there's sort of like the emotional reaction, which is social situations make you scared or anxious, not just a little worried or a little scared to the point where we actually call social anxiety, social phobia. Like you actually are that scared of being around people. And when you're around people, you have these like thoughts in your head that everybody's watching you and everybody's judging you and whatever you do, somebody is going to comment on. And it can feel like negative self-esteem, but it's much more than that.

25:18It's almost like I've had patients say they feel paranoid that everybody is watching them. That word is used kind of colloquially, but also to mean like an extreme sense of just worry about what everyone else is thinking. So those are like the emotions that are typical. And then I'd say behaviorally, we see that people either really avoid social situations or when they go into social situations, like in college, you really can't avoid it, right? You feel horrible. Like you just have those physical feelings, those emotional feelings, and it is really uncomfortable. So then when you have the chance, you're going to avoid them if you can.

25:56You're going to be socially isolated if you can. Or we see a lot of substance use in college kids for this reason too, I want to be in this situation, so I'm going to drink because drinking lets me be in this situation without worrying what everybody's thinking. But social anxiety apparently quadruples the risk of developing an alcohol use disorder. And there's studies in college students where it's really related to emotion. So they drink more if they're feeling really sad or angry in this situation or if it feels really personal or intimate. But like maybe not in the bigger situations where they can kind of put on a show and not have to be around people in this really intimate way where they are trying to have these severe conversations with them or something.

26:41But we see substance use a lot in college kids, obviously, but much more in the social anxiety because it lets them be the person they think they're supposed to be around other people, if that makes sense. Yeah, absolutely. Let's talk about another potential generator of social anxiety that young people are being bombarded by, social media. There's some evidence to suggest that social media use can really contribute to social anxiety. What are you seeing? So it's a really interesting question. I am a big believer that the social media data is very confusing and mixed anyway, and it tends to have people kind of going one side or the other, and it's not really fair because it's very mixed.

27:21And so you can't say all social media is bad or all social media is good, especially for people with pre-existing conditions. But for social anxiety, you can imagine that interacting with others through a computer is easier than interacting in person. Anybody might say that. I'm an extrovert. I like humans. I get energy from humans. But sometimes I just want to talk to people on social media because there is that distance and it feels nice. So it might be a way that they feel they can interact with people easier. But as a result, they might spend more time on social media and the time spent on social media could be related to increase in anxiety, increase in depression, increase in problems with self-esteem because of comparison to other people, trouble concentrating, trouble with sleep.

28:08Those sort of things that are related to social media use in some people, if you're using it a lot because that's where you're getting your social interactions, that can be problematic. Plus, they might also choose not to socialize in person because they think they're getting enough socializing online. And that's problematic, too, because we all need at least one friend and person we can rely on. And if you're only relying on Internet people, that can be pretty complicated. Jessie, so whether listeners feel like they have some degree of social anxiety or not, what are the ways that we can all show up and really support people that we care about who are facing this?

28:47We are really bad at open communication, period. Nobody taught us how to have conversations. Social anxiety means a lot of people are having thoughts about you and what you're thinking without you actually necessarily having those thoughts. Anything you can speak out loud to clarify that that's not what you're thinking or like that facial expression I made wasn't about you can make them feel better. I know that feels really weird and we don't speak a lot of those things out loud because no one told us to. I do as a psychiatrist, maybe more than some people do. But like, they're going to make assumptions about your body language, your interaction, you not responding to them and being aware that that's going on in their brain and trying your best to speak openly, to listen, to be empathetic, not to be like, hey, something's wrong.

29:32Why don't you just come out? And why is it so hard for you? Like, it is hard. And you have to understand that. I think we also can be really helpful by planning activities that don't require actually talking. So games, bowling, going for a walk, anything where the person can do something else and still be interacting with you. Sometimes we call that parallel play when people are like kids. Right. And I would say third, that people with social anxiety need like gradual steps into things. I mentioned that college feels like getting thrown into the deep end sort of socializing. like what we would do ideally with someone with social anxiety is somewhat what we would do with somebody with other phobias like let's say you're scared of a spider like we wouldn't go i'm going to throw you in a cage of spiders like they used to do on fear factor because that sounds actually horrible and that's like flooding of emotions is what we would call that sometimes it just extinguished extinguishes them because you're like oh wow that was as much as i could possibly feel i'll never feel anything again but that's not how we would like ideally help someone we would be like, let's imagine you're near a spider.

30:41Okay, let's look at a picture of a spider. Okay, let's play with a fake spider. Okay, let's go to a place where there is a spider, right? Like you kind of keep going until it's more time and a closer exposure. You have to think about social anxiety that way with your friends. So if you know your friend has social anxiety, or it seems like they really don't like interacting with other people in the same way you do, the answer is not to go like, let's go in a group of 10 people and go on a weekend trip and enjoy that. The answer is to be like, let's start somewhere small. And maybe that's having a conversation with them about what is small and what are they comfortable with and then sort of build them up and make it easier for them to interact because they feel more comfortable and safer with you.

31:24Yeah, baby steps makes really good sense to me. So I want to build on something that you mentioned before. Are there things that we can do to make, for example, workplaces and social spaces that we inhabit more approachable for people with social anxiety, whether we know someone has it or not?

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33:12So a really interesting thing that has come out over COVID, I think, is this idea that we don't all need to be in person places. And that has been really nice for people with social anxiety. I would say out of all of the groups of people that I see, even early on in the pandemic, people with social anxiety were the most often going, this is, I don't really know what people are complaining about. Like I like school from home and games from home and socializing from home, whatever. It takes the pressure off of also preparing to go to class and be around people. It takes the pressure off of having to act a certain way around people.

33:50And I'm just at home because we kind of have a normal version of school and work in our heads. We kind of throw people into in-person jobs, in-person schooling, that sort of thing, and assume it's right for everybody. And nothing's right for everybody. So being aware that maybe your kid would do better with college at home, being aware that maybe some employees would do better working from home. And they're not just saying that because it's like laziness or something, which I think is the way employers would go. But it's because it's actually their best way of working. And they're more efficient that way, more productive that way.

34:26And I think it's important to have workplaces where we can have open conversations like that. I don't like when everybody has to explain themselves. So a lot of my patients really don't like having to go to an employer and say, like, listen, I have social anxiety. That's why I need this. But I do think we need to understand that when people are asking for those things, there are often reasons and be more open to the flexibility in the workplace. I didn't mention, but performance anxiety is a component of social anxiety. So taking tests, giving presentations, that sort of thing can sometimes be a different version and only around tests.

35:01I have that test taking anxiety. So I think it's important to note that not everybody can do those things. So flexible workplaces, giving people the opportunity to work from home if they want, realizing that they might not like speaking in front of other people and giving people people breaks and breaks as important too. It feels like we've reached a tipping point in people's willingness to talk about mental health in general. And almost everyone I know has a therapist, including me. And that may have always been true. But now I know about it, meaning that people are much more willing to discuss it openly.

35:40Can you talk about the ways that greater awareness and openness about discussing mental health in general is helpful? It is so incredibly important that we talk about this stuff out loud. Otherwise, you feel super alone in what you're dealing with and you don't identify with signs and symptoms. So if you've never seen someone like you say like, oh, that's social anxiety, you can't say that's what's going on with you. That's the problem with portrayals in the media or only white celebrities talking about things, right, is that other groups can't go. That's how I identify. Like, turns out that's what's happening to me.

36:16So we have to have diverse voices of people saying these things so that people can notice that they're not alone, notice that it's not a weakness, notice that it's not a problem if they're experiencing it and be able to at all identify it in themselves because you can't ask for help if you can't identify it. then I think it is important for people to realize that just because we're talking about it more doesn't mean we're actually getting more help for it. So I still think there's a lot of stigma around mental illness, especially medication. And I think it's important for people to realize that, yes, maybe, especially college students, and this comes up all the time for me as people are like, college students are so open about their mental health.

36:56Maybe they are, but they probably just are with their friend group or a friend, and they're not going to be the same about their family or their teachers or even getting help in the first place, because that step is like an added thing. Asking for help from a friend or talking to a friend sometimes is easier, which is why it's important for friends and family to listen, be empathetic, know signs and symptoms and help as they can, right? But it's also important that we know that just because we go, I identify with those signs and symptoms doesn't mean that if they're impacting our life, we shouldn't ask for help for them.

37:33I mentioned social anxiety has a long time before people get help. On average, people with mental illness wait 11 years before they get help for something from the first signs of symptoms. That doesn't mean they recognized them 11 years ago. That just means if I were to go back and ask them a history, I would get symptoms 11 years ago. That's a really long time. And what that usually means is by the time someone goes and gets help 11 years later, they're pretty sick. And the things that we can do to help them are much more limited. If you came to me or you came to a therapist 11 years ago, we probably would have been able to help a lot easier.

38:08Jesse, you've done something that few physicians, at least that I know about, have ever done publicly, which is speak openly about your own mental health journey. Why was this important for you? There was this time over COVID about July 2020 when a bunch of health care workers were talking about their mental health openly. And it was really cool, kind of like a fire hose moment where everyone's like, I did this, I did this. And I said, I went to therapy. And then I realized all these people were talking about medication, like too easily. And I had never spoken about medication. Now, I also fervently believe you owe no one your story and you don't have to tell the parts you don't want to tell.

38:47And if you're never ready to tell, that's also okay. But as a healthcare worker who sees healthcare workers and all day, every day tells healthcare workers, it's okay. I was like, what's up with that? And I brought that to my own therapist and realized like in my head, medicine had made me believe the same stuff that I told patients like was not true, which is if I'm on meds, I'm worse. If I'm on meds, people might not want me as a doctor. If I'm on meds, they're going to see me differently, et cetera, et cetera. And I have to work through that and be like, just kidding. Like, what am I doing?

39:21Like, I don't believe that. And so when I wrote about it and have talked about it, I really wanted to write about that conversation and not just say, I'm on meds. I've been on meds. Meds are great because I don't think that's helpful for people. I think it's helpful for people to realize that like I'm so in it and still I stigmatize it. So we have a long way to go. And so it was really important for me to have that conversation openly because I realized like, turns out I'm not practicing at all what I preach and that needs to change. And a lot of healthcare workers aren't and that needs to change.

39:56And maybe if they see me more openly talk about it, they'll feel okay too. And I kind of wanted to just say it out loud because of that. Dr. Jessie Gold, thank you so much for having this conversation with me and really for all that you do in the world. I'm grateful. Thank you.

40:21That's it for today's episode. Thank you so much for listening. This episode was produced by Dan O'Donnell and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Grace Rubenstein, Farrah DeGrange, Jimmy Gutierrez, Anna Phelan, Michelle Quint, and Colin Helms. I'm Dr. Shoshana Ungerleiter. I'll talk to you again next week.

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