Keywords: social phobia, social anxiety, social anxiety disorder, posttraumatic stress disorder, PTSD, social avoidance, experiential avoidance, social interaction


Social avoidance in the concept of “avoidance of corrective emotional experience” is regarded as one of the pathogenetic factors that aff ect the course and development of mental disorders and increase distress.

We conducted a review of studies that studied the role of social avoidance in social anxiety disorder among individuals with or without post-traumatic experience. Inclusion criteria were: 1) subjects were diagnosed with social anxiety disorder; 2) social anxiety disorder and/or post-traumatic stress was a focus of the study; 3) some assessment or review impact of social avoidance was made; 4) subjects were adolescents or adults.

The study of the role of avoiding social events as a traumatic trigger and related socially signifi cant factors (stigma, discrimination, living at constant risk, etc.) indicates a correlation between the pathogenesis of social phobia and comorbid symptoms of post-traumatic distress. Managing social avoidance strategies and accepting the conscious experience of social interaction presupposes a person’s readiness to react fl exibly, stay in contact with their emotions and thoughts, and not spend internal resources to get rid of the inner concerns. In our opinion, this will help reduce the perception of social events as a traumatic (retraumatic) factor, reduce clinically signifi cant manifestations of social anxiety and prevent the development of post-traumatic distress. Limitations and implications of these fi ndings for the psychological support and modifying psychotherapeutic interventions of social anxiety disorder are discussed.


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Johnson H, Thompson A. The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev. 2008;28(1):36-47. doi:10.1016/j.cpr.2007.01.017

Morina N. The role of experiential avoidance in psychological functioning after war-related stress in Kosovar civilians. Journal of Nervous and Mental Disease. 2007;195(8):697-700. https://doi. org/10.1097/NMD.0b013e31811f44a6

Angelakis I, Gooding P. Obsessive-Compulsive Disorder and Suicidal Experiences: The Role of Experiential Avoidance. Suicide Life Threat Behav. 2020;50:359-371.

Berzonsky MD, Kinney A. Identity Processing Style and Depression: The Mediational Role of Experiential Avoidance and Self-Regulation, Identity. 2019;19:2, 83-97.

Espel-Huynh HM, Muratore AF, Virzi N, Brooks G, Zandberg LJ. Mediating role of experiential avoidance in the relationship between anxiety sensitivity and eating disorder psychopathology: A clinical replication, Eating Behaviors.2019;34.

Feldner MT, Hekmat H, Zvolensky MJ, Vowles KE, Secrist Z, Leen-Feldner EW. The role of experiential avoidance in acute pain tolerance: A laboratory test. Journal of Behavior Therapy and Experimental Psychiatry. 2006;37(2):146-158.

Campbell-Sills L, Barlow DH, Brown TA, Hofmann SG. Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion.2006;6(4):587-595. 3542.6.4.587

Collimore KC, Carleton RN, Hofmann SG, Asmundson GJG. Posttraumatic stress and social anxiety: The interaction of traumatic events and interpersonal fears. Depression and anxiety. 2010;27(11):1017- 1026.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. (5th ed.). Arlington, VA: American Psychiatric Publishing; 2013

Gold SD, Marx BP, Soler-Baillo JM, Sloan DM. Is life stress more traumatic than traumatic stress? Journal of anxiety disorders. 2005;19(6):687-698. doi:10.1016/j.janxdis.2004.06.002

Long ME, Elhai JD, Schweinle A, Gray MJ, Grubaugh AL, Frueh BC. Differences in posttraumatic stress disorder diagnostic rates and symptom severity between Criterion A1 and non-Criterion A1 stressors. Journal of anxiety disorders. 2008;22(7):1255-1263. doi:10.1016/j.janxdis.2008.01.006

Boals A, Schuettler D. PTSD symptoms in response to traumatic and nontraumatic events: The role of respondent perception and A2 criterion. Journal of anxiety disorders. 2009;23(4):458-462. doi:10.1016/j.janxdis.2008.09.003

Pinto RJ, Henriques SP, Jongenelen I, Carvalho C, Maia ÂC. The strongest correlates of ptsd for firefighters: number, recency, frequency, or perceived threat of traumatic events? Journal of Traumatic Stress. 2015;28(5):434-440. doi:10.1002/jts.22035

Cândea DM, Szentagotai-Tătar A. Shame-proneness, guilt-proneness and anxiety symptoms: A meta- analysis. Journal of anxiety disorders. 2018;58:78-106.

López-Castro T, Saraiya T, Zumberg-Smith K, Dambreville N. Association Between Shame and Posttraumatic Stress Disorder: A Meta-Analysis. Journal of traumatic stress. 2019;32(4):484-495.

Kashdan TB, Julian T, Merritt K, Uswatte G. Social anxiety and posttraumatic stress in combat veterans: Relations to well-being and character strengths. Behaviour Research and Therap.2006;44(4): 561- 583.

Kashdan TB, Morina N, Priebe S. Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: experiential avoidance as a contributor to distress and quality of life. J Anxiety Disord. 2009;23(2):185-196. doi:10.1016/j.janxdis.2008.06.006

Hofmann SG, Litz BT, Weathers FW. Social anxiety, depression, and PTSD in Vietnam veterans. Journal of anxiety disorders. 2003;17(5):573-582.

Knowles KA, Sripada RK, Defever M, Rauch SAM. Comorbid mood and anxiety disorders and severity of posttraumatic stress disorder symptoms in treatment-seeking veterans. Psychological trauma: theory, research, practice, and policy. 2019;11(4):451-458.

McMillan KA, Sareen J, Asmundson GJG. Social anxiety disorder is associated with PTSD symptom presentation: an exploratory study within a nationally representative sample. Journal of traumatic stress. 2014;27:602-609.

McMillan KA, Asmundson G. PTSD, social anxiety disorder, and trauma: An examination of the influence of trauma type on comorbidity using a nationally representative sample. Psychiatry research. 2016;246:561-567.

McMillan KA, Asmundson G, Sareen J. Comorbid PTSD and social anxiety disorder: associations with quality of life and suicide attempts. The Journal of nervous and mental disease. 2017;205(9):732-737.

Kvedaraite M, Zelviene P, Elklit A, Kazlauskas E. The role of traumatic experiences and posttraumatic stress on social anxiety in a youth sample in Lithuania. Psychiatric Quarterly, 2020;91(1):103-112. doi:10.1007/s11126-019-09684-7

Gren-Landell M, Aho N, Carlsson E, Jones A, Svedin CG. Posttraumatic stress symptoms and mental health services utilization in adolescents with social anxiety disorder and experiences of victimization. European child & adolescent psychiatry. 2013;22(3):177-184.

Rabinak CA, Mori S, Lyons M, Milad MR, Phan KL. Acquisition of CS-US contingencies during Pavlovian fear conditioning and extinction in social anxiety disorder and posttraumatic stress disorder. Journal of affective disorders. 2017;207:76-85.

Bandelow B, Charimo Torrente A, Wedekind D, Broocks A, Hajak G, Rüther E. Early traumatic life events, parental rearing styles, family history of mental disorders, and birth risk factors in patients with social anxiety disorder. Eur Arch Psychiatry Clin Neurosci. 2004;254(6):397-405. doi:10.1007/ s00406-004-0521-2

Carleton RN, Peluso DL, Collimore KC, Asmundson GJ. Social anxiety and posttraumatic stress symptoms: The impact of distressing social events. Journal of anxiety disorders, 2011;25(1):49-57. doi:10.1016/j. janxdis.2010.08.002

Erwin BA, Heimberg RG, Marx BP, Franklin ME. Traumatic and socially stressful life events among persons with social anxiety disorder. Journal of anxiety disorders. 2006;20(7):96-914. https://doi. org/10.1016/j.janxdis.2005.05.006

Bjornsson AS, Hardarson JP, Valdimarsdottir AG, Gudmundsdottir K, Tryggvadottir A, Thorarinsdottir K, Wessman I, Sigurjonsdottir Ó, Davidsdottir S, Thorisdottir AS. Social trauma and its association with posttraumatic stress disorder and social anxiety disorder. Journal of anxiety disorders. 2020;72:102228.

Gray E, Beierl ET, Clark DM. Sub-types of safety behaviours and their effects on social anxiety disorder. PloS one. 2019;14(10):e0223165.

Cheng Q, Shi C, Yan C, Ren Z, Chan SH, Xiong S, Zhang T, Zheng H. Sequential multiple mediation of cognitive fusion and experiential avoidance in the relationship between rumination and social anxiety among Chinese adolescents. Anxiety, stress, and coping. 2021: 1-11. Advance online publication.

Im S, Kahler J. Evaluating the empirical evidence for three transdiagnostic mechanisms in anxiety and mood disorders. The Journal of general psychology. 2020:1-26. Advance online publication. https://doi. org/10.1080/00221309.2020.1828252

Mahaffey BL, Wheaton MG, Fabricant LE, Berman NC, Abramowitz JS. The contribution of experiential avoidance and social cognitions in the prediction of social anxiety. Behavioural and cognitive psychotherapy. 2013;41(1):52-65.

Spinhoven P, Drost J, de Rooij M, van Hemert AM, Penninx BW. A longitudinal study of experiential avoidance in emotional disorders. Behavior therapy. 2014;45(6):840-850. beth.2014.07.001

Asher M, Hofmann SG, Aderka IM. I'm Not Feeling It: Momentary Experiential Avoidance and Social Anxiety Among Individuals With Social Anxiety Disorder. Behavior therapy. 2021;52(1):183-194.

Kashdan TB, Goodman FR, Machell KA, Kleiman EM, Monfort SS, Ciarrochi J, Nezlek JB. A contextual approach to experiential avoidance and social anxiety: evidence from an experimental interaction and daily interactions of people with social anxiety disorder. Emotion (Washington, D.C.), 2014;14(4):769- 781.

Sarfan LD, Cody MW, Clerkin EM. The mediating role of state maladaptive emotion regulation in the relation between social anxiety symptoms and self-evaluation bias. Cognition & emotion. 2019;33(2):361-369.

Henschel AV, Williams JL, Hardt MM. The Role of Experiential Avoidance and Emotion Regulation in DSM- 5 Posttraumatic Stress Symptomatology, Journal of Loss and Trauma. 2020;26(6):527-539. https://doi. org/10.1080/15325024.2020.1841506

Plumb JC, Orsillo SM, Luterek JA. A preliminary test of the role of experiential avoidance in post-event functioning. Journal of Behavior Therapy and Experimental Psychiatry.2004;35:245-257. https://doi. org/10.1016/j.jbtep.2004.04.011

Reddy MK, Pickett SM, Orcutt H. Experiential Avoidance as a Mediator in the Relationship Between Childhood Psychological Abuse and Current Mental Health Symptoms in College Students. Journal of Emotional Abuse. 2006;6:67-85.

Kelly MM, DeBeer BB, Meyer EC, Kimbrel NA, Gulliver SB, Morissette SB. Experiential avoidance as a mediator of the association between posttraumatic stress disorder symptoms and social support: A longitudinal analysis. Psychological Trauma: Theory, Research, Practice, and Policy. 2019;11(3):353- 359.

Leonard KA, Ellis RA, Orcutt HK. Experiential avoidance as a mediator in the relationship between shame and posttraumatic stress disorder: The effect of gender. Psychological Trauma: Theory, Research, Practice, and Policy.2020;12(6):651-658.

Krans J, Peeters M, Näring G, Brown AD, de Bree J, van Minnen A. Examining temporal alterations in Social Anxiety Disorder and Posttraumatic Stress Disorder: The relation between autobiographical memory, future goals, and current self-views. J Anxiety Disord. 2017;52:34-42. janxdis.2017.09.007

Zayfert C, DeViva JC, Hofmann SG. Comorbid PTSD and social phobia in a treatment-seeking population: an exploratory study. J Nerv Ment Dis 2005;193:93-101. nmd.0000152795.47479.d9

Tang W, Hu T, Hu B, et al. Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese university students. J Affect Disord. 2020;274:1-7. doi:10.1016/j.jad.2020.05.009

Magson NR, Freeman J, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and Protective Factors for Prospective Changes in Adolescent Mental Health during the COVID-19 Pandemic. Journal of youth and adolescence. 2021;50(1):44-57.

Hawes MT, Szenczy AK, Klein DN, Hajcak G, Nelson BD. Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic [published online ahead of print, 2021 Jan 13]. Psychol Med. 2021;1-9.

Arad G, Shamai-Leshem D, Bar-Haim Y. Social Distancing During A COVID-19 Lockdown Contributes to The Maintenance of Social Anxiety: A Natural Experiment. Cognit Ther Res. 2021;45(4):708-714.

Zheng L, Miao M, Lim J, Li M, Nie S, Zhang X. Is Lockdown Bad for Social Anxiety in COVID-19 Regions?: A National Study in The SOR Perspective. Int J Environ Res Public Health. 2020;17(12):4561. https://

Olivera-La Rosa A, Chuquichambi EG, Ingram GPD. Keep your (social) distance: Pathogen concerns and social perception in the time of COVID-19. Pers Individ Dif. 2020;166:110200. paid.2020.110200

Ferreira MJ, Sofia R, Carreno DF, Eisenbeck N, Jongenelen I, Cruz JFA. Dealing With the Pandemic of COVID-19 in Portugal: On the Important Role of Positivity, Experiential Avoidance, and Coping Strategies. Front Psychol. 2021;12:647984.

Niles AN, Burklund LJ, Arch JJ, Lieberman MD, Saxbe D, Craske MG. Cognitive mediators of treatment for social anxiety disorder: Comparing acceptance and commitment therapy and cognitive-behavioral therapy. Behavior Therapy. 2014;45(5):664-677. J.BETH.2014.04.006

Herbert JD, Forman EM, Kaye JL, Gershkovich M, Goetter E, Yuen EK, Glassman L, Goldstein S, Hitchcock P, Tronieri JS, Berkowitz S, Marando-Blanck S. Randomized controlled trial of acceptance and commitment therapy versus traditional cognitive behavior therapy for social anxiety disorder: Symptomatic and behavioral outcomes, Journal of Contextual Behavioral Science. 2018;9:88-96.

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Avramchuk O, Plevachuk O, Suvalo O. SOCIAL AVOIDANCE AS A PATHOGENETIC LINK BETWEEN SOCIAL ANXIETY DISORDER AND POST- TRAUMATIC EXPERIENCE: THE REVIEW. Proc Shevchenko Sci Soc Med Sci [Internet]. 2022Jun.27 [cited 2022Oct.7];66(1). Available from: