Social anxiety and work: a qualitative investigation in a low-income, minority sample

Abstract

Social anxiety disorder (SAD) is associated with employment problems. However, understanding of mechanisms through which SAD impacts employment is limited, and few studies examine employment experiences among racial minorities and economically disadvantaged individuals with SAD. Qualitative interviews were conducted with 12 unemployed individuals with SAD. Participants described interactions between feelings of social anxiety and anger, in addition to more typical SAD symptoms. Participants also perceived negative judgments from employers based on socio-economic status, appearance, and criminal histories. Participants reported using a range of coping strategies for social anxiety. Clinical implications related to the interplay between poverty, unemployment, and SAD are discussed.

The Diagnostic and Statistical Manual of Mental Disorders defines social anxiety as a “marked fear or anxiety about one or more social situations in which an individual is exposed to possible scrutiny by others” (American Psychiatric Association, 2013). Social anxiety disorder (SAD) is among the most common mental health disorders in the United States, with lifetime morbid risk at 13.0% (SE =.05; Kessler, Petukhova, Sampson, Zaslavsky, & Wittchen, 2012). It has been linked to significant impairments in a variety of life domains (Liebowitz, Gorman, Fyer, & Klein, 1985), even when controlling for concurrent depression (Stein & Kean, 2000) and other psychiatric disorders (Kessler, 2003). Core symptoms of SAD include anxious sensations, anxiety-inducing thoughts related to humiliation and embarrassment, and avoidance of social situations. Notably, SAD is strongly and uniquely associated with problems in the employment domain. Individuals with SAD report substantial overall occupational dysfunction (Wittchen, Fuetsch, Sonntag, Muller, & Liebowitz, 2000), including increased problems with work performance and productivity as well as higher levels of absenteeism compared to non-anxious persons (Davidson, Hughes, George, & Blazer, 1993; Schneier et al., 1994; Wittchen et al., 2000). Employment problems in SAD are associated with reduced income (Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996; Patel, Knapp, Henderson, & Baldwin, 2002) and increased financial dependence (Schneier, Johnson, Horning, Liebowitz, & Weissman, 1992). Furthermore, SAD can cause problems with employment mobility as one in five have turned down a job offer or promotion as a result of social fears (Stein & Kean, 2000). Finally, while SAD has a strong direct relationship with work problems, it may also indirectly affect employment outcomes. Individuals with SAD have lower educational achievement, and are more likely to report scholastic difficulties and drop out of school (Davidson et al., 1993; Magee et al., 1996; Mogotsi, Kaminer, & Stein, 2000; Stein & Kean, 2000). Thus, SAD may indirectly interfere with job attainment through its negative impact on education and training, while at the same time SAD may impede an individual’s ability to effectively maintain employment.

Longitudinal studies provide evidence of the strong association between employment problems and social anxiety. For example, in a study of over 600 female welfare recipients, SAD was the only mental disorder among those assessed that was associated with persistent reliance on welfare (Tolman et al., 2009). Similarly, in a longitudinal study of over 500 primary care patients, those who met criteria for SAD were more than twice as likely to be unemployed compared to patients without SAD, and this relationship persisted even when controlling for other anxiety disorders and depression (Moitra, Weisberg, Keller, & Martin, 2011). Despite compelling evidence that SAD negatively impacts individuals’ ability to secure and maintain employment, we know comparatively less about the mechanisms through which SAD influences employment experiences and outcomes.

A second important gap in the social anxiety literature involves the limited amount of research related to SAD among minorities and the poor. National prevalence rates indicate that SAD is less prevalent among African Americans compared to non-Hispanic White Americans (Asnaani, Richey, Dimaite, Hinton, & Hofmann, 2010). However, when African Americans and Blacks of Caribbean descent meet diagnostic criteria for SAD, symptom severity is higher (Himle, Baser, Taylor, Campbell, & Jackson, 2009). Furthermore, the psychiatric literature has consistently demonstrated that groups with low socio-economic status are at a higher risk for anxiety disorders (Brook & Schmidt, 2008; Merikangas, 2005). Despite this, there have been no in-depth, qualitative investigations of SAD among impoverished members of racial and ethnic minority groups and none that relate specifically to SAD and the world of work.

Cognitive-behavioral therapy (CBT), is the best-practice, research-supported psychosocial treatment for SAD, with superior outcomes over numerous control conditions (Blanco et al., 2010; Norton & Price, 2007). Although CBT is effective in reducing fear and avoidance among individuals with SAD, impairments in functioning, including employment problems, often persist after treatment (Blanco et al., 2010). One promising approach that could be used to address this shortcoming would be to provide CBT in vocational service settings and to adapt CBT for SAD to enhance work outcomes for unemployed sufferers.

However, substantial treatment access disparities remain and many individuals with SAD do not receive CBT (Wang et al., 2005). Treatment utilization is especially low in impoverished (Alegria, Bijl, Lin, Walters, & Kessler, 2000) and minority populations (Neighbors et al., 2007). Further, CBT has primarily been developed and tested with higher income, white populations. Given this, there is a need to both increase access to CBT for minorities with SAD and to improve our understanding of experiences of SAD among groups that have been underrepresented in mental health intervention and services research. Specifically, there is a need for qualitative research focused on exploring the experiences of underrepresented groups with SAD in order to successfully tailor CBT interventions to fit the needs of these groups.

This qualitative study reports the results of thematic analysis of twelve, in depth interviews conducted as part of an NIMH-funded intervention development project aimed at designing a specialized cognitive-behavioral treatment for unemployed persons with SAD. These interviews provided a unique opportunity to both inform the development of the intervention and to learn about participants’ perceptions of the relationship between social anxiety and work and to examine the nature of social anxiety among an impoverished, largely African American study population.

Method

Sampling and recruitment

Participants were recruited from an urban-based employment services agency that offers a range of employment services including job interview training, resume development, assistance with job leads, and career counseling. All participants were seeking comprehensive vocational services aimed at securing employment. The primary purpose of the qualitative inquiry was to explore participant perceptions about the relationship between social anxiety and employment to inform the design of an intervention for unemployed persons who had experienced social anxiety-related barriers to employment. Individuals receiving vocational services were eligible to participate if they screened positive (score of 6 or greater) for SAD based on three-item MINI-Social Phobia Inventory (Mini-SPIN; Connor, Kobak, & Churchill, 2001). As part of an ongoing community agency and university collaboration focused on understanding and intervening with unemployed individuals with social anxiety, the agency included social anxiety screening into its standard intake packet for all potential clients. After screening, potential participants were further assessed using the Structured Clinical Interview for DSM-IV Axis-1 Disorders – Patient Edition (SCID-I/P; First, Spitzer, Gibbon, & Williams, 1995) and the Liebowitz social anxiety scale to determine the presence of SAD and its severity. All individuals provided written informed consent prior to completing the assessment and received 25.00 USD for their participation.

In order to obtain a broad range of perspectives and experiences to inform intervention development, a subsample of participants who completed the assessment interview were invited to complete a semi – structured, qualitative in-person interview focused on their experiences with social anxiety and how it had affected their work life. Stratification based on sex and social anxiety severity was necessary in order to obtain perspectives that supported our ability to build an intervention that was compatible with the specific social anxiety-related challenges met by men and women and by individuals with both lower and higher levels of social anxiety. The subsample of participants were selected using a Stratified Purposive Sampling Strategy (Patton, 2002) based on their sex and social anxiety severity. Participants were stratified into two severity groups defined by established cutoff scores on the Liebowitz Social Anxiety Scale [LSAS; Total Score = 30–59 (mild) vs Total Score≥ 60 (severe)] that differentiated generalized versus specific social phobia (Mennin et al., 2002). Given that the study population was over-whelmingly low-income, homeless and African American, participants were not stratified according to race or socioeconomic status. Based on the stratified purposive sampling strategy, individuals were were selected and invited to complete interviews until interviews yielded no new or unique information. The final sample included 12 participants, eight men (67%) and four women (33%) with an average age of 43.8 (SD = 11.7). Over 80% of the sample (N = 10) identified as African American. The majority indicated they were never married (N = 10; 83%) and had earned a high school diploma or less (N = 9; 75%). See Table 1 for further sample characteristics.

Table 1.

Sample characteristics (N = 12).

	N (%)
Sex
Male	8 (67%)
Female	4 (33%)
Race
African American	10 (83%)
White	2 (17%)
Marital Status
Married	1 (8%)
Separated	1 (8%)
Never Married	10 (83%)
Education
8 years of less	1 (8%)
9–11 years	5 (42%)
High School Graduate	3 (25%)
13–16 years	3 (25%)
Employment Status
Currently working for pay	1 (8%)
Not currently working for pay	11 (92%)
Social Anxiety Severity*
Mild	6 (50%)
Severe	6 (50%)
	Mean (SD)
Age	43.8 (11.7)

Social anxiety severity was assessed via established cutoffs on the Liebowitz Social Anxiety Scale. Scores ≤59 = Mild; Scores ≥60 = Severe.

Data collection

All of the semi-structured, in-depth qualitative interviews were conducted by a trained master’s level social worker. This phenomenological qualitative study, guided by an inductive approach, was aimed at exploring the impact of social anxiety on work and the expression of social anxiety in this population. This knowledge directly informed the design of a specialized intervention for SAD that addressed work-related concerns (Work-related Cognitive Behavioral Therapy – WCBT; Himle et al., 2014). All interviews were audio-taped, and informed consent, including participant permission to audio record interviews, was required prior to participation. All study procedures were approved by an Institutional Review Board.

Initial interview guides were developed based on the stated content areas and in collaboration among the research team, who have expertise in SAD and the world of work (see Table 2 for representative interview guide questions; the full interview guide is available via e-mail from the corresponding author). The research team members who developed the interview guides included the senior author, a Ph.D.-level academician and anxiety disorder expert, a Ph.D.-level academic community psychologist with considerable background and expertise in qualitative methods, two vocational service professionals each with decades of experience in vocational counseling, two doctoral students majoring in psychology or social work, and a master’s level social work project coordinator with considerable mental health expertise. It is important to note that although the questions in the interview guide focus on work-related situations, participants shared many insights relevant to social anxiety outside of the workplace. Interviews were modified during the data collection phase in order to pursue issues and topics raised by research participants. As the initial interviews were completed, the research team listened to selected portions of the interview tapes on a weekly basis to guide subsequent questioning and refine the interview guide.

Table 2.

Representative interview guide questions.

Domain of Inquiry	Representative Questions
Work History
	Would you mind telling me a little bit about some of the past work experiences you’ve had?
	What was your favorite job? How come you liked this job?; What was your least favorite job? How come you didn’t like it?
Job Search Behaviors
	What kinds of things have you done in the past to look for jobs? What has worked well? What didn’t work?
	Sometimes people ask other people they know for help finding a job. Have you ever done that? Would you ever do that? Who have you asked/would you be likely to ask? What was that/would that be like for you?
Job Interviewing
	Is there any specific job interview that stands out to you? Could you tell me about it?
	What goes through your mind before an interview? After an interview?
	What’s it like for you to talk about your skills, abilities, and accomplishments in a job interview?
Ability to Fulfill Job Duties
	Have you ever had any job duties that made you feel awkward, nervous about what others might think, or shy?
	What were they? What made you nervous about this? How did you handle it?
	Have you ever had trouble getting or keeping a job because it was difficult to get to work? Why was it difficult for you?
Relationship with Supervisors
	How do you feel about engaging in small talk with your boss? What’s that like for you?
	Are you able to talk to your boss about issues at work when you need to?
	Have you ever/Would you be willing to ask your boss for help or assistance?
Interactions with Coworkers
	Do you often make friends with your coworkers?
	Would you ever ask a coworker for help at work?
	Have you ever invited a coworker to do something with you outside of work?
	If Yes: What was that like? If No: What has held you back from doing that?

Data analysis

Thematic analysis, following Braun and Clarke (Braun & Clarke, 2006), was conducted to identify key themes from participants’ lived experience with social anxiety and the world of work. In order to familiarize ourselves with the data and to generate initial codes, the investigative team met weekly to listen to portions of completed interviews during the data collection phase. Themes were identified when group consensus was achieved. Initial themes that were developed via group consensus with the investigative team were explicitly designed to focus on elements critical to cognitive-behavioral therapy intervention development, such as avoidance, distorted thinking, and dysfunctional beliefs (Heimberg, Brozovich, & Rapee, 2010). Although this study was designed to inform intervention development, coders were trained to identify all themes emerging from the qualitative interviews. All interviews were transcribed verbatim. Transcripts were coded using a qualitative software program (NVIVO). This program facilitated many of the processes involved with the analysis of text such as coding, reorganizing text segments, making comparisons, and annotating important text from the transcripts. In initial open coding, the interviews were broken down into individual segments that expressed a single idea or theme (e.g., a specific social anxiety coping mechanism) and then labeled with appropriate codes. Transcripts were read by two investigators, one who coded the data in NVIVO and a second investigator who re-read the interviews and reexamined the codes. The second investigator checked the coding for consistency and added new thematic codes if she thought it was necessary. Subsequent axial coding grouped these codes into meaningful themes and examined relationships among themes. Once data were coded, NVIVO was used to compile comprehensive sets quotations for each of the identified themes. The research team then reviewed the data for each theme and findings were developed through group consensus.

Results

Respondents provided rich information about the nature of their social anxiety problems both within and outside of the work environment and identified strategies they use to cope with social anxiety. In the following section (and summarized in Table 3), we report findings from our thematic analysis of the twelve semi-structured interviews examining how social anxiety impacts work among a sample of unemployed, low socio-economic status, mostly racial and ethnic minority participants.

Table 3.

Summary of thematic analysis.

Core Theme	Themes	SubThemes	Representative Quote
Perceptions of SAD Symptoms	Social Anxiety Sensations		“I could feel it coming on. I had to jump up and go upstairs to my room, ‘cause when it happens–I bottle up like this and I can’t unbend for about 20 minutes when it does that, so I just try and calm down and try and, you know, keep ‘em, you know, from bending up on me.”
	Cognitions	Being Judged	“That’s why I’m trying to get–at least have a GED and, you know–it’s hard. Shoot … and by me being in a shelter, they might look down on that.
		Judging Oneself	“Yeah. I mean, something that, you know, [at] 46 [years old], you should have a whole lotta years of interviewing, but I don’t.”
		Predicting Negative Outcomes	“I hope for the best, but I know the worst gonna come.”
		Mind Reading	“I get nervous in the first–like I get on the bus when I leave here, and if a [person] staring at me–if somebody staring at me, that’d make me nervous. ‘What are they looking at me like that for?’ You know what I’m saying?”
	Worries About Appearance and Presentation		“[You] got to least look half way decent. Come on now ‘cause ain’t nobody gonna hire you if you dusty and smelling. Your breath ain’t up to par. You got matter in your eye. So I try to do the right thing far as dress appropriately and speak all right.
	Avoidance		“I always go to the one where there’s the least–you know, not too many people. I never go to the one where there’s a whole bunch of women talking. I just don’t like being around a lotta people … ”
	Anger and Aggression		“Cuz I felt very anxious at the way I started getting upset and started getting, you know, jitters, you know? And I was like, it isn’t–I just wanna sock him in his face. I just wanna hit him, I just wanna hit him and we was right near the pans and he was getting that close to getting that pan across his head.
Coping Strategies	Positive Coping Strategies	Positive Self-Statements	“It’s almost a–it’s just a self-talk in my head I have to do or whatever. ‘You know, you can do it. Don’t–there’s nothing to be afraid of’ or, you know. I don’t know, it’s almost just like a pep talk or whatever, I have to do and I have to stay optimistic or whatever, you know.”
		Relaxation Techniques	“Just try to relax and take a deep breath and try not to fidget around or anything like that … ”
		Tuning Out	“And one of the way–part of the way that I do that is not to think about it.”
		Spirituality	“Well I just … I pray. Pray on it.”
	Potentially Harmful Coping Strategies	Using Drugs or Alcohol	“After, I didn’t, they didn’t hired me. It discouraged me so bad I went and bought a drink and I went downhill real fast and then … ”
		Looking Tough	“Mm-hmm. I always was the scary type, you know, bad ass, you know … Yeah. I always been like that.”

Our thematic analysis identified two core themes that most widely captured participants’ experiences with social anxiety, with particular attention to its relationship to their work life: 1) Perceptions of SAD symptoms; and 2) Coping strategies to manage problems associated with SAD. Each core code and associated sub-themes are presented below.

Perceptions of SAD symptoms

Participants shared their perceptions of and experiences with SAD symptoms. Their insight suggests that these participants experience many SAD symptoms in a manner consistent with how the disorder is commonly described in the literature; however, analysis also indicated that this understudied, vulnerable population may present with SAD symptoms that are not typically identified or found in existing literature.

Social anxiety sensations

Throughout the interviews, respondents reported a range of SAD-related sensations, thoughts and avoidance behaviors, some of which were typical of SAD symptom descriptions found in the literature and others were not (Darlymple, 2009). For example, some respondents used somewhat different language to describe anxious sensations (e.g., fidgety, shaky, nerves, jumpy, scary) compared to persons with social anxiety who present in typical clinical settings in more affluent or highly educated areas. One respondent described feeling “shaky” or “fidgety.” When asked to explain these sensations, she remarked, “[I get] Sweaty palms. Didn’t I tell you, I get like Don Knotts, I’m telling you. Just the whole nine, child. I put on deodorant. But I don’t stink but I still, you know. I get nervous. I get real nervous.”

Other respondents described panic symptoms related to challenging social situations. In these circumstances, the fear of these panic sensations and their potential consequences, both social (e.g., appearing to be very nervous, blanking out during a conversations) and nonsocial (e.g., passing out, having a heart attack), were prominent motivators of avoidance behavior. When asked what is was like for her to be around other people, a participant responded:

I just don’t like being around a lotta people, ‘cause I panic a little bit. Like the other day, we was in the movie room. I could feel it coming on. I had to jump up and go upstairs to my room, ‘cause when it happens–I bottle up like this and I can’t unbend for about 20 minutes when it does that, so I just try and calm down and try and, you know, keep ‘em, you know, from bending up on me. But ever–since I been at [shelter] I don’t have my medicine, so I just try and stay away from people. That’s scary.

While some respondents reported experiencing panic attacks when faced with anxiety producing social situations, many others reported their anxiety sensations as uncomfortable and frightening or simply annoying. These participants reported that they worried about their anxiety symptoms being observed by others and that they might be seen as weak or “crazy.” Many respondents expressed concern that showing weakness might lead to victimization from their peers who lived with them in a halfway house or whom they would regularly see on the street. It also matched with an overall sense from the interviews that respondents generally viewed mental health as an either/or phenomenon; respondents described themselves as either crazy or normal without much in between. This is exemplified by one participant who shared concerns about “feeling stupid or saying the wrong thing.” She explained, “And then when I try to–if I did go and ask about it I probably couldn’t get the words out right … maybe I be looking crazy to them, ‘cause a lotta people always ask me … am I okay?”

Cognitions

Not only did respondents report experiencing the sensations associated with SAD, but they perceived that their anxiety affected their cognitions in ways that impeded their ability to acquire and maintain employment. This group most often reported that they felt like they were being judged and struggled with self-criticism. Often, as a result, respondents made assumptions that others viewed them in a negative light.

Being judged.

A core symptom of social anxiety is the fear of being scrutinized. As expected, concerns about a range of negative social judgments were common among this group of socially anxious individuals. Many of their concerns related to perceived criticism or judgment about their socio-economic status, and/or limited vocational and social accomplishments. One participant described these perceived social judgments, noting:

Well, I’ve been in different restaurants putting in applications, but everybody most of the time say you have to go on the internet and I know nothing about computers, so that’s kinda hard … and then even in little McDonald’s or whatever you gotta have a GED, you know? So it’s kinda hard. And you know … it makes you wanna say just forget it. But I don’t wanna do that. That’s why I’m trying to get–at least have a GED and, you know–it’s hard. Shoot … and by me being in a shelter, they might look down on that.

In addition, judgments related to past criminal activity, prior history of incarceration, or signs of former membership in gangs were commonly seen as grounds for negative judgments from others. When discussing a recent job interview, this participant explained:

… All the sudden it was just like okay, well, let’s just–we’ll call you or whatever … And I can almost just see him look at her and just like give her some type of eye contact to just let her know, move on. What it was, he pulled up my record … you know, he had already made up his mind. Ain’t nothing I could’ve said.

Given the literature demonstrating that former prisoners experience housing and labor market exclusion, criminal stigma and limited access to essential social service support (Pager, 2008; Petersilia, 2003; Visher & Travis, 2003), negative cognitions related to prior criminal history are understandable. As over half of this sample discussed their criminal background during interviews, it follows that this group would be somewhat less concerned about others judging them for seeming nervous compared to our experience with socially anxious individuals from higher socio-economic strata without a prior criminal history.

Somewhat related to these issues, respondents commonly perceived negative judgments regarding their spotty employment histories. For example, one respondent suggested his inability to secure long-term employment was due to his work history. When asked to review his work history, the respondent stated:

Well, because of my education–lack of my education and stuff it’s basically, you know, it’s hard for me to get a decent job. My work history’s been up and down because I have a felony, maybe two, three felonies … The most I ever–longest I ever worked was no more than maybe five, six months straight. …

Fears about being judged, for many persons with social anxiety, primarily center on the fear that others will silently criticize them. However, in this group, there was a common concern that they will be overtly attacked, discriminated against or criticized. One participant shared a situation in which he was asked to make an announcement about a new product and was criticized for mispronouncing the product name. He explained:

… It was my first time doing the announcement and I was a new person and I mispronounced the name. Everyone kinda like laughed. And for the longest time, whenever it was time for another announcement or somethin’, they’ll be like, ‘Okay you’re not doing it, someone else will do it.’

When asked about her least favorite job, another participant described a situation in which she felt wrongly criticized and threatened by a coworker who accused her of stealing from the grocery store where they worked. This respondent remarked, “I was feeling like he was trying to embarrass me. He trying to criticize me and plus he lying on me. I’m not gonna be no scapegoat.”

The above quotes demonstrate the respondents’ perspective that their limited work experience and low levels of education were central to their experience of social anxiety, particularly in employment settings. One factor that was consistent throughout the interviews was that people felt their backgrounds led others to pre-judge them.

Judging oneself.

Respondents not only reported a range of concerns about others judging them, but their statements also suggested that negative self-judgments were especially salient for this impoverished group. These judgments often centered on their limited educational or work related accomplishments. When describing his self-doubt, one participant explained comparing himself to others applying for the same job, stating:

But it’s just the background. They coming from college. You know, they got that college paper to say they from so and so. And I didn’t have none of that. And I was discouraged then.

Similarly, another participant shared:

Yeah. I mean, something that, you know, [at] 46 [years old], you should have a whole lotta years of interviewing, but I don’t. So you know … it’s, it’s difficult to try to conduct yourself at something that you ain’t used to doing.

Negative self-judgments also centered on participants’ status as persons with a criminal record and history of incarceration. More specifically, respondents reported that the “mark of a criminal record” (Pager, 2008) contributed to their employment instability. As this participant shared, “That’s the first thing come to my mind. You know, they already know I got a felony, so I go in and do already saying, ‘Well, it ain’t gonna do me no good no way.’”

Predicting negative outcomes.

Predicting that things will turn out badly is common among persons with social anxiety, and it is often an irrational thinking target in CBT (Heimberg et al., 2010). However, it is clear that this group has experienced a greater amount of definitive rejection and unfair treatment than many socially anxious individuals. Respondents who reported negative experiences in school and previous work situations predicted that their job search would yield similar outcomes. For example, when discussing his expectations on the job market, one respondent directly stated, “I hope for the best, but I know the worst gonna come. I look for the worst and I hope for the best. I go in (to job interviews) with attitudes like that.” Another respondent described getting dressed in interview clothes, going across town for an interview, but turning around because he “knew” they would not hire him.

Even when employed, some respondents reported that they often felt like “the other shoe is going to drop” and that they will eventually end up being negatively evaluated and fired. As this participant explained:

I never had a job that said, ‘we really need to let you go.’ For whatever reason I never–but always in my head, that’s, you know, somebody new come around and whatever. It almost feel like they’re judge me or think that I’m not good enough [and fire me] …

Respondents reported distress from feeling that termination was imminent. Some said that they walked off the job or initiated an argument with their boss to avoid being fired. Respondents said that their prediction of eventual failure, and employment termination, contributed to behaviors that undermined their job success, such as missing work, showing up late and not putting forth their best effort. One participant described an experience working in food service where, despite meeting expectations, she consistently felt criticized by her boss. The criticism, which she attributed to her status as a high school student who was younger and less educated than coworkers who were attending college, led her to become discouraged and disengaged at work. She explained, “I fired myself. I quit, because – -I felt discriminated, because I was the only high school kid there.”

In addition, respondents reported making negative predictions about unfair treatment and rejection in the workplace. For example, one respondent said, “But I guess he took one look at me and he didn’t like me, and he was just so nasty. So I just said, ‘No thank you. I don’t even want this job.’ And I got up and walked out.” Some respondents relayed that these predictions led them to avoid job interviews and requests for help in finding a job, and caused them frustration while looking over job postings. Furthermore, participants often reported feeling that there was no sense to try because they would just get rejected, or even worse, humiliated. Notably, such responses were particularly true among participants with felony records. For example, one respondent said, “It didn’t surprise me none. I got a felony. You know, I have to remind my wife sometimes, I got a felony. I got a felony. They ain’t gonna hire.”

Mind reading.

Many respondents reported a strong belief that they could tell just by looking at someone that they were being judged negatively and that they would be rejected. One participant noted, “But I guess maybe when people take one look at me, sometime they be like, ‘No I don’t want him (for a job),’ you know what I’m saying?”

These types of predictions were reported as justification for avoidance. Many respondents gave examples of times when their assumptions about being judged negatively without real grounds were confirmed. For instance, some respondents reported examples of negative looks and assumed negative judgments from strangers during their day in the community. As one participant shared, “I get nervous in the first–like I get on the bus when I leave here, and if a [person] staring at me–if somebody staring at me, that’d make me nervous. ‘What are they looking at me like that for?’ You know what I’m saying?” Sadly, it is true that many respondents were likely correct in their assumption that some people were judging them harshly based on a very small amount of information.

Respondents were particularly concerned that these negative judgments were appearance related or based on brief statements they made that would indicate that they were poor or had limited formal education. Several respondents reported that they took practical steps to avoid these hasty judgments.

Worries about appearance and presentation

Respondents often reported concerns about physical appearance. Our experience with socially anxious individuals across a range of settings clearly supports that appearance concerns are common in SAD, but for this group, appearance concerns were prominent. Some participants described themselves as unattractive, and cited this as a hindrance to their job search or work performance. Others reported more specific appearance-related concerns. One woman shared that being overweight was a large factor influencing her fear and avoidance of job interviews. When asked about her job search, she told the interviewer, “My weight, you know, I’m insecure about that so a lot of that plays a factor when I’m actually going to an interview or whatever, you know.” Another specific appearance concern was shared by one male respondent who relayed a particularly difficult experience he had when interviewing for a job:

I had a recent embarrassment. This one man when I was at the interview he was talking about my acne and … and he was the hiring manager and he was telling me that, you know, ‘You need to put on some makeup to hide the acne’ and everything else. I was like, okay, he was just, you know, trying to break me down.

In addition, respondents reported concerns about their access to proper clothing for job interviews and their ability to judge what would be appropriate attire for the work environment. When asked about the importance of appearance on a job interview, one respondent explained:

[You] got to least look half way decent. Come on now ‘cause ain’t nobody gonna hire you if you dusty and smelling. Your breath ain’t up to par. You got matter in your eye. So I try to do the right thing far as dress appropriately and speak all right.

Many respondents expressed concern over the fit of their clothing. They reported feeling that others would notice if their clothing did not fit them well and may have been obtained from a clothing bank or thrift store. As with previous fears of judgment, respondents’ primary concern focused on other’s detecting that they were poor. Many respondents worried that they would be judged as unsuitable for a job based on how they looked before the questioning even began.

Conversely, some respondents described putting substantial time and effort into their appearance, making sure to look especially well-groomed and dressing in ways they felt were appropriate for an interview; however they still were not hired. This was a point of great frustration for them. One participant explained:

I went to be interviewed. And the guys was over there and he was just, whatever they wanted to wear. Hat turned to the side, things like that. So I just knew I had this made in the shade, you know? But, quite actually, I didn’t. And I leaves with this, saying, ‘You know, it doesn’t matter how you look or who you are. I mean, it don’t matter if you got on a suit, tie, you know. You wasting your time.’ You know, I get to thinking like that … See what happened. You got all suited up and you still didn’t get nothing. They got it. So I say so on the next interview I probably would just go like I am. You know, ‘cause I was discouraged last time doing all that.

A similar experience was discussed by another participant who shared:

So I go down there. I put on my black pants and my server top. You know what I’m saying. Black and white and dress shoes. Right hair do and all. I take the resume’ to an African-American woman … doing interview[s] … She ain’t said jack. She didn’t say nothing. She just looked over the resume’ and said, ‘Okay, we’ll get in touch with you in a couple of weeks.’ I was so disappointed. I was really disappointed but I ain’t say nothing.

This level of frustration and disappointment may relate in part to how much effort is required to obtain proper clothing and to be well groomed when a person is impoverished.

Finally, when identifying prominent appearance-related concerns, participants reported fear of speaking in a way that was unacceptable. Respondents’ worries about their dialect, idioms, grammar, and mispronunciation of certain words were a source of significant distress. Participants also reported feeling anxious around potential employers who may use words that they did not understand or when expected to speak in a way that was not concordant with their typical speaking patterns. In fact, one participant addressed this concern, stating:

Because it’s more or less, you know, where the people that you gonna be in front of look[ing] for the job ain’t the same people that you been around all your life in the streets. You know? So the streets you more or less another way, but then when you go in front a some people, business people and all that, you have to be another way … So that’s where the difficult part come in at.

Overall, many of our respondents felt that their background did not provide them with the skills necessary to successfully interact with others at work, or that their appearance would signal to the potential employer their lower social class and impoverished life circumstances. They attributed their social difficulties at work in part to the challenge of making the transition from living on the streets to functioning in the work place. One respondent discussed some of the challenges making this transition, explaining:

I know I’m a good person at heart, I know that much more than people know. I care about things more than I let people know … The problem that I mostly have is things I did in the street trying to survive, not hurting people though. You know what I’m saying? But just doing the wrong things for years and years and really don’t have too much working background of working, and socialization with a lotta different kinds of people, you know?

Avoidance

As is typical for persons with social anxiety, avoidance was a common theme for the respondents. Avoidance was present both on the job and when seeking work. One clear theme was avoidance of job interviews. For example, when one respondent was asked how they handled being nervous about work, the respondent said that they simply did not go to the interviews. Others described the lengths they took to find employment without having to go on a formal interview, as exemplified by this participant who noted:

If I go to a temp service and fill out their application and feel that I needs the work … see they’ll give me a job. It might be not what I’m looking for … and I ain’t gotta worry about interviewing, all the other crud. They gonna send me to a job and when I get there, I know I’m gonna work … That way I eliminate the interview, filling out my resume, the application. So I eliminated a whole lot going through temp.

Here we see that although temp services may not provide the type of employment the respondent is “looking for,” he is able to avoid the interview, making temp work more attractive.

Avoidance also limited job leads that might result in an interview. Many respondents reported fear and avoidance of asking for help finding work. This problem is particularly notable given that networking with others to find job leads is among the most important strategies aimed at securing employment (de Janaz & Forret, 2008).

It is important to note that anxiety was not the only concern that reduced the use of this potentially effective job-search strategy. Many individuals cited pride and a desire to be self-reliant as a reason to avoid asking for help. Some respondents also reported that they did not want to ask for help finding employment because it might over-burden already stressed friends and acquaintances. One respondent said they didn’t want to put additional pressure on their friends and family members because, “you know, they like, why, they barely making it theyself.” The respondent went on, “[it’s unfair] for me to climb on them and they have to think about me, so that’d make more pressure toward them.”

Family and friendship discord was also frequently cited as a reason that they avoided asking for help with job leads. Respondents noted that this conflict made them anxious about communicating with significant others about their employment troubles. Respondents often reported that their family wasn’t “there for them,” and shared an overall feeling that their family and personal networks simply “don’t care about me.” One respondent, explaining these feelings in detail, said:

… I don’t really ask [my family] for nothin’ … The only time they want me around is like when I got something to offer, but if I ain’t got nothin’ to offer they don’t want nothin’ to do with me. So I’m out here by myself, just me and my boyfriend. We the only people we got right now.

The importance of the avoidance of seeking job leads and job interviews notwithstanding, even when respondents did attend a job interview, many avoided following up with an employer after the interview. As this participant explained, “Yeah. I don’t follow-up. Either they’ll call me or they won’t. I won’t call them … I don’t do that. Or I won’t go back and visit ‘em and say, ‘Oh, I applied a month ago. What’s going on?’”

Strikingly, some respondents extended this avoidance to not attending work after securing employment because of their interpersonal concerns. They cited a desire to avoid eventual rejection by quitting before their supervisor had a chance to fire them. When asked about their employment experiences, one respondent said that they walked off on “every one of [my jobs].”

When respondents stayed on the job, social anxiety-related avoidance behaviors often impacted their work relationships. One particularly problematic avoidance-related issue involved talking to supervisors. Our respondents often avoided “small talk” with their boss. They reported their bosses to be unfriendly, critical and untrustworthy. Several respondents suggested that avoiding conversations with their supervisors kept them “under the radar” in such a way that they would not be noticed at work. Most believed that keeping to themselves would limit the chance that their work would be negatively judged or that they would be observed while working. When asked why he avoided supervisors, one participant shared, “Cause I feel they get to really knowin’ you then they can really watch you. If they don’t really know you then they can’t really say too much about you.” It did not appear that most respondents considered that forming a friendly relationship with their supervisor might help them maintain work over time.

Small talk avoidance extended to coworkers as well. Participants commonly endorsed avoidance of small talk with coworkers, even though in many cases it likely resulted in reduced job-related satisfaction or respondents’ ability to form friendships with peers at work. Ironically, small talk avoidance with peers, although likely aimed at reducing stress, may have resulted in increased job stress over time given that friendships at work have been found to reduce job stress (Berman, West, & Richter, 2002). One participant discussed avoiding certain lounge areas where coworkers congregated, stating, “I always go to the one where there’s the least–you know, not too many people. I never go to the one where there’s a whole bunch of women talking. I just don’t like being around a lotta people … ”

Beyond small talk avoidance, respondents also avoided discussing core job-related issues with their bosses, including sharing good news or reporting problems at work. This pattern of behavior seemed to leave respondents at a disadvantage at work because their supervisors paid little attention to them and thus may have had a limited sense of their ultimate value to the organization. Our experience with this group of socially anxious job seekers also included accounts of workers failing to inform supervisors when they were experiencing personal challenges (e.g., health concerns) or when something went wrong on the job (e.g., a machine not working properly on an assembly line). This was exemplified by a participant who didn’t tell his boss when he was experiencing symptoms from untreated diabetes. He explained:

You know, when I was cutting meat, working at this supermarket and stuff. He’d get on me ‘cause I was always–I would drink more liquids and have to go right to the bathroom. And he would be like, you know, ‘Why you always going? Why you go to–running to the bathroom?’ I was diabetic. And I took off from–I got real sick that one time. I was out of work for a week.

Although not talking to the boss may have led to reduced anxiety in the moment, not sharing problems at work with supervisors often made what was initially a small problem into a much larger problem in the long run. For example, by not promptly informing supervisors of work related problems respondents’ ultimately put their jobs at risk because supervisors misinterpreted this anxiety-related avoidance as an indication that they did not care about their job or the company’s success.

Beyond avoidance of small talk and one-on-one conversation with supervisors and coworkers, respondents expressed strong fears and avoidance of performance situations, especially speaking in front of a group of people, either at work or in other settings. As this participant noted:

I went to Community College to take office education, right? And while I was there, they wanted me to take some public speaking crap. And I didn’t like speaking in front of people, although I would crush you out in front of a crowd, twenty-four seven. That was different. And I didn’t like to get up in front of people give no speeches. And in front of strangers, hell no!

This type of fear and avoidance was particularly notable in jobs that involved direct customer contact, and also when respondents were required to speak over a microphone, as is often required of workers in a fast-food or retail situations. One respondent explained:

Now, if we had to ask … about something–I forget what it was–we had to say our name–that’s right, we had to say our name, then say thank you for coming to Taco Bell, or welcome to Taco Bell. And that’s what I was so nervous about.

Despite the range of avoidance behaviors our respondents engaged in, as described above, many participants also reported that their life circumstances made it impossible to avoid interpersonal situations as much as they might like, due to the necessity of interacting with human service providers or the need to eat and sleep in communal facilities (e.g., shelters, churches). Basic needs related to survival in some cases trumped the desire to limit exposure to anxiety-evoking interpersonal situations. Interacting with others through necessity may have led the respondents to endure social situations with dread and anxiety more often than socially anxious people in high-resourced environments, who may be able to meet their basic needs with limited social interaction. Our respondents continued to meet criteria for social anxiety disorder despite their communal living arrangements and the need to interact frequently with human service professionals. Social anxiety that persists despite these social exposures suggests that these respondents may have more severe social anxiety than a typical person with this problem, given that it continues to trouble them despite the large number of exposure experiences in the lives of these individuals.

Anger and aggression

For many respondents in our sample, challenging work-related social situations elicited a mix of anger, fear and aggression. This stands in contrast to common perceptions of socially anxious persons as conflict avoidant and passive. For some, aggressive behavior led to substantial hardships in the workplace. For others, anger, and the potential to act on it, led them to quit their jobs or avoid starting a new job when they were hired. Many suggested that they engaged in these forms of avoidance to protect themselves against hurting others and potentially exposing the respondent to legal jeopardy. This group was particularly sensitive to the prospect of getting arrested for aggressive behavior, given that many respondents were on parole or probation where immediate incarceration could result from a violent confrontation. One respondent provided an example of their aggressive feelings toward a coworker, sharing:

I just quit. Mm-hmm. Cuz I felt very anxious at the way I started getting upset and started getting, you know, jitters, you know? And I was like, it isn’t–I just wanna sock him in his face. I just wanna hit him, I just wanna hit him and we was right near the pans and he was getting that close to getting that pan across his head.

Additionally, aggression also was employed as a strategy to reduce the likelihood of future contacts with others. Respondents reported that they could keep people away by behaving in a threatening way. One participant shared a specific example of this strategy, stating:

Stare at ‘em. Just like a Rottweiler do. Just sit there just–because you know, when you take your eye off of ‘em they gonna attack you. You wanna be a dominator, I’m gonna be more a dominator … That’s how I feel like, I don’t wanna be bothered.

Another participant described the connection between feelings of anxiety and anger, explaining:

When it’s a crowd of people that I do not know. You know what I’m saying? Or like as far as when I came up here last Friday for orientation, that lobby was crowded out there and they was like bumpin’ and bumpin’, you know, just like in a sardine can … I was nervous and mad all at the same time; you know what I’m saying?

Our experience with this group was that aggression was a more prominent response to interpersonal situations than is typically observed among people with SAD. This appeared to relate at least in part to the common experience of being treated unfairly and to very strong beliefs that being disrespected was not to be tolerated under any circumstances. The importance of respect in interpersonal situations was reiterated by this participant who explained:

I’m just saying they’re like the times when the boss basically picks on you or throws orders around and all like that, and sometime I have a tough time following orders when it’s not given to me, you know, in a reasonable way or voice. So I may lash out or get sarcastic or something.

Responding aggressively to perceived disrespect is an example of a strategy that may have some benefits in certain high crime, urban environments (e.g., bus stop, homeless shelter) but is considered counter-productive in most work environments. While having a reputation as a person who reacts in an aggressive way in response to disrespectful treatment may lead others to think twice about taking advantage of a respondent in a half-way house, aggression in response to disrespect may lead to immediate dismissal in a work environment. This may be especially true in today’s workplace, given recent, highly publicized incidents of workplace violence.

Coping strategies to manage problems associated with SAD

Our interviews with this sample clearly indicated that social anxiety presented substantial challenges in participants’ day-to-day life. Overall, most participants reported that their anxiety was difficult to manage. Many respondents shared that they felt shame and humiliation at not being able to more effectively handle what they considered to be routine social interactions. Despite these challenges, respondents reported a range of coping strategies, some positive and some potentially harmful, aimed at reducing their anxiety and avoiding contact with others.

Positive coping strategies

Respondents in our sample described several positive coping strategies that they commonly used to either re-frame assessments of themselves during an anxiety producing situation or to gather strength to make it through these situations. We detail the most frequently reported strategies below.

Positive self-statements.

Many respondents attended to their self-talk in challenging situations; reporting that they tried to think positively to reduce fear and improve performance. In a similar vein, other respondents reported that they reviewed a range of their positive attributes before facing a challenging situation. For example, when asked about how they coped with an anxiety producing interaction, one respondent said,

You know, I know I’m a good person at heart, I know that much more than people know. I care about things more than I let people know. I’m kind hearted more than people know. And to me I’m a good person in heart.

When talking about preparing for a job interview, another participant shared:

There’s doubt in my abilities or whatever, and I just have to, you know … you know you can do the job, you know. It’s almost a–it’s just a self-talk in my head I have to do or whatever. ‘You know, you can do it. Don’t–there’s nothing to be afraid of’ or, you know. I don’t know, it’s almost just like a pep talk or whatever, I have to do and I have to stay optimistic or whatever, you know.

Relaxation techniques.

Despite the fact that most respondents had not had formal training in methods to control physiological arousal, several reported using relaxation strategies when confronted with job interviews or other challenging social situations. For example, one respondent said that when confronted with an anxiety producing situation, they, “Just try to relax and take a deep breath and try not to fidget around or anything like that … ”

Others reported using some practical strategies as a way to cope with challenging social situations. As this participant explained:

Yeah I do get nervous before an interview. Like I say, one of the things I do when – I always wear a t-shirt underneath my shirt … Exactly. Right. ‘Cause I know that, you know, otherwise if I weren’t doing that I probably would be just like, you know, so I try to not to fidget a lot and these are some of the things that I do to, you know, keep that control.

Tuning out.

One interesting coping strategy reported by our respondents was to purposefully avoid thoughts related to challenging situations or to try to imagine they are elsewhere when they find themselves in a challenging interpersonal situation (experiential avoidance; Hayes et al., 2004). This is exemplified by a participant who stated, “And one of the way–part of the way that I do that is not to think about it. I don’t know if that’s good or bad, but I just wish that it wasn’t there.”

Spirituality.

Finally, this group of respondents often reported strong religious beliefs and used prayer as a method to cope with challenging social situations. For example, when asked about handling anxiety during an interview, one respondent noted, “Well I just … I pray. Pray on it.”

Potentially harmful coping strategies

Although the above section outlines a range of positive coping strategies, some participants also reported using methods that may reduce anxiety in the short-run but are likely to have negative consequences over time.

Using drugs or alcohol.

Beyond cognitive strategies to reduce attention and distress in challenging social situations, many respondents reported using substances as a way coping or “tuning out.” There is a substantial body of quantitative research that establishes a link between social anxiety and substance use (e.g., Buckner et al., 2008; Himle et al., 1999). It is important to note that 75% of respondents (N = 9) reported receiving treatment for substance use during their lifetime.

Many of our respondents reported using substances as a coping strategy for their anxiety and other negative emotions. One respondent who reported using alcohol to cope with discouragement related to the inability to find a job, problems at work, and job loss, explained:

… I feel like I’m being used all the time. I can’t get no support from no one. Things like that piled up on me, so I just, you know, go to what I know best. Sometime I just go in my little corner, pick up a bottle, and drink. Not meaning nobody no harm, you know? And I’m pretty much about upset about it now. You can tell, you know, I’m very emotional about my life, ‘cause I mean good, but just that–just going through a lot of things in life.

Another participant similarly shared:

After, I didn’t, they didn’t hire me. It discouraged me so bad I went and bought a drink and I went downhill real fast and then, but what had happen was I had lost my job there at the Salvation Army …

Some respondents also experienced job attendance problems related to substance use. As this participant stated:

And it started going in that direction so I ended up relapsing up in there somewhere and didn’t go back to the job. Just left the job … .But again, you know, nobody had any complaints about me … but I did end up relapsing right after that, after I got the job …

Some respondents reported that they began to use drugs or alcohol as a method to cope with worries about not meeting expectations at work. One respondent directly related their worries about meeting work expectations to the gap in their work experience caused by their extended substance abuse history. This participant said:

That’s one of the things … that plays in my head–one of the things that because of the drug experience and the drug usage and everything, it’s okay, you get this job–or I’ve been out of work for a while, am I really able to do the job. You know what I mean? Or am I gonna be able to keep up or have I–has too much time passed or whatever.

Looking tough.

Our overall experience with socially anxious individuals is that many present themselves as meek or shy in order to reduce the likelihood that people will approach them. However, acting shy in this population can be dangerous or even deadly for many of our impoverished respondents, as acting this way may make an individual vulnerable to victimization by others on the street (Anderson, 1999). Most of our respondents had to frequent communal sites for meals and sleep in shelters even though they hoped to avoid them. For many, a shelter, although challenging given the large number of people staying there, was preferable to a potentially deadly, frigid night on the street. In these settings, our respondents reported that they often acted in a particularly tough and threatening way such that others would not approach them. One participant shared, “Mm-hmm. I always was the scary type, you know, bad ass, you know … Yeah. I always been like that.” Another similarly explained, “And I really have a guard–some people say I have a guard up and I’m–I don’t trust people like I used to … ”

Discussion

This study represents the first, in-depth qualitative analysis of the impact of social anxiety on job seeking activities, behaviors on the job, and job tenure available in the literature. Additionally, we know of no other study that has investigated the various ways that social anxiety affects the lives of disadvantaged, largely racial minority group members with SAD. The strength of this type of qualitative research rests in its ability to provide insight on complex social phenomena through the investigation of social processes, allowing researchers to identify intervening variables and provide critical insight into the experiences of hard to reach and vulnerable populations (Adler, 1990; Berkwits & Inui, 1998; Singer, 1993; Wiebel, 1990). This project employed qualitative methods to understand how SAD impacts the employment-related experiences of Detroit residents with low SES. We did not seek to predict participant outcomes or establish statistical generalizability. However, given our intention to provide insight on the relationship between SAD and employment, these research findings have analytic generalizability (Yin, 2009), or transferability (Lincoln & Guba, 1985) to similar processes in poor urban settings with large racial and ethnic minority populations.

The literature has established that the impact of SAD is far-reaching, leading to difficulties in work, social relationships, and quality of life (Simon et al., 2002). The results of this study illustrate both the varied ways in which social anxiety can impact employment in addition to highlighting the complex interplay between poverty, unemployment and social anxiety. One of the unique features of this inquiry was the ability to investigate both how SAD functions as a diagnostic category for this population as well as how disadvantaged life circumstances, such as poverty, limited work history and criminal background, may influence the expression of SAD.

In general, respondents in this study described experiencing many of the same SAD symptoms that have been previously identified in the literature (Darlymple, 2009). Respondents reported anxiety sensations, anxiety related negative thoughts, and avoidance patterns typical of those targeted in CBT treatment for SAD (Heimberg et al., 2010). In particular, cognitions involving mind-reading and negatively predicting the future were common among our respondents. These symptoms directly impacted participants’ perceptions related to securing work, as respondents often reported feeling like there was no point in trying to seek employment, as they would either be too nervous to complete the interview or employers would judge them on their limited work experience, low levels of educational attainment or previous problems with the law. When discussing interviews and job-related interactions with both supervisors and coworkers, respondents often assumed that others were judging them negatively without clear evidence to support these conclusions. However, it was also apparent that respondents’ perceptions were likely impacted by common experiences in which they have been judged unfairly and treated with disrespect in their day-to-day lives. This was especially the case for respondents who were “marked” by their social circumstances, like former prisoners “marked” by a criminal record, the street homeless “marked” by their appearance, and the under-educated “marked” by the ways in which they communicated with others.

The complex interactions between one’s social circumstance, perceived treatment and history of actual discrimination, violence, and aggression presents a challenge for clinicians seeking to help clients strike a balance between “mind-reading” distortions and the realities of their lived experiences. In more privileged populations, statements such as “this company will never hire me” would be rightly categorized as a thinking error to address in cognitive therapy. Yet when individuals do not have a high school degree, or have a criminal record, it is clear that there is more reason to believe that a job interview will not result in an employment offer. A core element of CBT for SAD is that negative predictions can be disproven with repetitive exposure to anxiety provoking situations. However, the individuals in this study described many experiences of clear discrimination based on socioeconomic status, criminal history and sexual orientation that may lead clinicians to focus as much on building resilience in the face of setbacks as on disproving negative predictions.

Another interesting observation relates to the persistence of SAD in the face of necessary exposures to challenging interpersonal situations, such as those required to gain access to basic needs like food and shelter. For many of our respondents, it is simply not possible to isolate themselves when they depend on communal settings for a bed and a meal. These respondents utilized a series of strategies in order to cope with these environments, including: interacting as little as possible with others; drinking alcohol or using drugs; “tuning out;” and trying to appear threatening in order to limit the number of people who approach them. Strategies like these, sometimes called “safety behaviors,” are theorized to interfere with the learning processes associated with exposure to anxiety evoking situations (Wells et al., 1995). Successful treatment of SAD among our respondents would clearly need to include substantial efforts to eliminate these exposure-interfering behaviors. Perhaps the most important of these to target is the abuse of substances. Clearly, our respondents reported even higher rates of substance use disorders than the elevated rates typically found among individuals with SAD (Himle & Hill, 1991), and many of our respondents were currently receiving substance abuse treatment.

Perhaps the most interesting difference between this group of disadvantaged persons with SAD and those typically found in specialty care treatment relates to the connection between anxiety, anger, and aggression. Our respondents reported aggressive behaviors and anger that were prompted by unfair treatment, disrespect, discrimination and aggression initiated by others. In many ways, aggression and anger in response to these triggers was not dissimilar to what might be expected for most people when challenged in this way. This similarity notwithstanding, one important difference in this group was the number of respondents who were aggressive toward coworkers and superiors in the workplace. These accounts highlighted the need to contain these behaviors on the job, but many of the respondents were unable to do so. Limiting angry outbursts and other aggressive behaviors on the job is likely to be especially important given growing media attention related to workplace violence.

The anger and aggression reported by our respondents both on and off the job differs from stereotypical impressions of persons with SAD as passive and unassertive. This difference likely relates at least in part to the cumulative effects of discrimination and unfair treatment along with the nature of the environments our respondents have to navigate in their day-to-day lives. One clear message from respondents was that acting tough or even threatening has advantages in potentially unsafe situations like communal eating and sleeping sites, in that it made them less likely to be victimized by others. Beyond functioning as a deterrent for victimization, acting in an aggressive way also served as a method to reduce anxiety provoking social contact from non-aggressive peers. This approach is somewhat similar to the clinical presentation of some socially anxious individuals in typical clinical settings as judgmental of others while at the same time inflating their accomplishments in order to intimidate others. This type of aggression, although less overt, seems to function in a similar way in that it likely reduces the frequency and duration of social encounters in day-to-day life.

The realities of unfair treatment and discrimination notwithstanding, it is clear that our respondents reported several work-related and other hardships that can be directly attributed to their social anxiety difficulties. Many respondents described typical symptoms of social anxiety and several reported walking off jobs to avoid distress or the possibility of being fired. Finally, avoidance of conversation at work with superiors and peers seemed to put respondents at a potential disadvantage in the workplace, given that building strong relationships on the job is likely an important contributing factor in maintaining employment. Our ongoing impression has been that this type of avoidance may have contributed to short job tenure since it may be easier for supervisors to lay off someone they do not know well compared to cutting the job of a person with whom they have built a close relationship.

Despite the hardships associated with social fear and avoidance in this group of disadvantaged respondents, these unemployed socially anxious respondents also displayed impressive strength as they navigated their challenging environment in order to survive. In certain circumstances, our respondents were forced to endure a range of socially challenging situations from crowded shelters to challenging encounters with human service workers who control access to necessary resources. Despite these exposures, social anxiety persists in this group and many expressed a strong interest in receiving help for social anxiety symptoms as they relate to the workplace. Overall, these interviews provide compelling illustrations of the complex relationship between SAD and employment, providing clear evidence that this intersection is extremely important to address in both clinical mental health settings and vocational service centers.