Over the years, we have received this question on a regular basis: "Is blushing a symptom of social anxiety?"
Here is a typical inquiry:
Hi Dr. Richards,
Am I really wrong in believing that people think it's strange to see someone blush and act nervous in front of them for no apparent reason?
Could I have been misjudging people and their responses to me all these years? You say that ANTS (automatic negative thoughts) are always wrong - are my thoughts wrong?
If I only knew that it really wasn't that big of a deal, then I think I could overcome social anxiety for good.
Also, which handouts (i.e., therapy methods) would best address my problem directly? I'm going through the "Overcoming Social Anxiety" audio series, and I've noticed a lot of good progress, but I am still afraid of blushing and about what people think about it.
-- Jen
Dear Jen:
Blushing is an instantaneous physiological response to a situation we find potentially embarrassing, and it is a big problem for many people who have social anxiety disorder.
(Not everyone who blushes has social anxiety, and not every person with social anxiety blushes.)
Being put on the spot can trigger blushing.
An example of this might be when you feel you are made the center of attention and everyone is looking at you. Or, maybe someone has singled you out and put you on the spot by asking you a question in front of other people. Perhaps the supervisor at work comes up behind you, surprises you, and asks you a question for which you don't have the answer. All of these situations are potential triggers to people whose social anxiety symptoms include blushing.
Many times there is an element of surprise involved... you weren't expecting something to happen and when it does, you blush. The blushing then embarrasses you and you are afraid that others interpreted your blushing as being strange or weird.
The physiological response of blushing is traumatically real, but it is typically set off by circumstances that may not be rational in nature.
Let me try to explain this more clearly.
It is our perception of what is happening that makes us respond in the way we do. That is, it is the way we view the situation, combined with our instant social anxiety "fear response", that determines why and if we'll blush.
Each person has his or her own "triggers" for blushing. One person may blush when a person at work calls his name in a crowded room. Another may blush when she is made the center of attention in a college classroom.
The "fear of blushing" helps keep blushing alive
In other people the fear of blushing may be so strong that they bring the blushing on themselves, even in fairly minor public situations. If we are consumed, obsessed, and worried about blushing, then our brain is focused on blushing and, therefore, it will happen to us much more frequently.
Blushing may happen when we are put on the spot, when others say something we perceive as being embarrassing or humiliating, and even when we anticipate that we might blush. The anticipation or expectation of blushing can lead to further blushing.
It is this fear of blushing -- worrying about it, feeling that it is awful and that others will notice and not approve of us -- and the anticipatory anxiety we have about it occurring -- that feeds and fuels the act of blushing itself.
The worry and fear about blushing sets us up to blush more often. It is the fear of blushing, and how we think others view it, that "convinces" us that blushing is a dreadful thing.
However, the act of blushing itself is not an "automatic negative thought" or ANT.
If you blush, then that is just an unfortunate fact of life right now.
It is your cognitive interpretation of your blushing that can be an automatic negative thought (ANT).
By definition, an automatic negative thought (ANT) is irrational, and it is always wrong. You are right: If you feel that everyone notices you blush, is judgmental about it, and thinks less of you because of it, these are automatic negative thoughts.
Blushing is a reaction that is triggered by our potential embarrassment and humiliation, and involves social anxiety feelings, such as self-consciousness and fear of being the center of attention. These symptoms lead to low self-esteem, lack of confidence, and feelings of helplessness.
Blushing means you are reacting to an event like you have in the past. It is a hot, sharp, emotional experience.
Because blushing is such a strong, hot, sharp, and embarrassing experience our emotions are invoked immediately. It seems there is nothing we can do to stop them. It feels as if the blushing is uncontrollable and we will always have to live with it.
This is not true. But this is how a person feels before they understand how social anxiety can be overcome.
Just to make it clear: Social anxiety and all its symptoms, including blushing, CAN be overcome.
Please reason with me for a minute.
People who are not blushers do not feel that blushing is terrible, awful, or embarrassing. Most often, they don't even notice it. If they do notice it, it is because you pay attention to it, point it out, make a comment about it, or look embarrassed, humiliated, and defeated by it.
Conversely, if you continue right on with what you are doing or saying when you blush and, if you put no effort into concentrating on the symptoms, others will not usually even notice it. Even if they do, you will have learned not to care.
So, if I was to be rational and answer the first part of your question: "Could I be misjudging people and their responses to me?" the answer would be a big "yes". Blushing occurs because we feel it is so awful and so embarrassing that others will judge us negatively.
Because we fear other's evaluation or judgment, we blow the situation out of proportion and make it in to something catastrophic. I don't know how many times I've heard people say they felt like crawling into a hole and disappearing simply because they blushed and someone else noticed it.
We not only over exaggerate our blushing, we also over exaggerate the effect our blushing has on other people.
What's the Solution?
What can we do about it? A lot. 
First, cognitive therapy for social anxiety directly address all the "germs", catalysts, or triggers involved in the cycle of blushing maintenance. Since blushing is maintained by our anxiety, in cognitive therapy we learn to think, believe, and feel differently than we have in the past about our anxiety.
Sometimes people want "blushing only" therapy. We learned very quickly that this does not work, because the root cause of blushing is social anxiety. For blushing to be eradicated, then social anxiety must be eradicated, too. Cognitive therapy to overcome social anxiety and its symptoms, whether it be blushing, excessive sweating, hands that shake, or neck twitching, is always necessary.
In addition, there are specific behavioral exercises to help in reducing blushing, and should be practiced and put into place as the cognitive, rational material is taking root in the brain.
There are a combination of cognitive methods and strategies that will lead you to change the way you think, perceive, and feel about blushing. It is these changes that will allow you to control and "be in charge" of your blushing.
Although this takes time and patience, it does work. Rational therapy HAS to work, because it changes the brain literally (i.e., physiologically).
Some people MAY react negatively to blushing; however, more people react by being kind or by ignoring it. It is even more true that MOST people do not notice the blushing is going on.
What is an ANT is your interpretation of your blushing and how it affects you and the people around you.
Take the pressure off yourself.
So, adopting a "so what, who cares" attitude and taking the pressure off yourself is the best solution. This is very hard to do on your own, and happens much more frequently in the context of an active, structured social anxiety therapy group.
Overcoming social anxiety (and blushing) is a paradox. It is only when we learn to stop fighting, struggling and trying to force the anxiety away that we can start to recover from social anxiety. This requires persistence, patience and a willingness to be kind to yourself.
Please keep up with the cognitive reading (at least 30 minutes a day) and begin putting the behavioral steps into place little by little in your daily life.
The cognitive practicing is so you will begin to remember it automatically during the day when necessary.
Until then, just take it as easy as you can, find a distraction or grab onto a rational statement when you are afraid of blushing. Don't focus or dwell on it.
If you blush, do not try to hide it or look down, but just continue on with your interaction or conversation with the other person. The more you realize it's no big deal... the more you can just go on... and simply focus externally on what you or they are talking about and let the blush go away on its own.
Afterward, pat yourself on the back for getting through the conversation....do NOT beat yourself up... because your brain will read this encounter as a negative one and then it will fear the next conversation.
Slow it down and take the pressure off yourself. It's OK to blush... the more you believe it's OK ... the less you will blush.
Many handouts will be beneficial to you such as:
The Social Anxiety "Automatic" Cycle, The Fighting Paradox, Attitudes, Focusing - And how it keeps us away from anxiety, and Accepting Myself As I Am Right Now are among them.
Other handouts or themes that are helpful to change your thinking include:
The Deserving Statements, Moving in a Positive Direction, Power Statements (Rational Questions to Ask Yourself) and Stay Away from Perfectionism and Pressure.
*If you are seeking treatment for social anxiety, start here*
--Thomas A. Richards, Ph.D.
Psychologist/Director, Social Anxiety Institute