Nowhere to Hide: Treatment For The Cycle of Involuntary Blushing

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Everyone blushes, but for some people their lives can be dominated with trying to prevent it. The fear of involuntary blushing impacts the daily life of more people than you would think. It is a very common characteristic of social anxiety. It is rarely spoken about by those who struggle with it because attention to it could lead to it. Biologically, it is a result of the activity of the sympathetic nervous system (activates bodies response to danger). Blood vessels near the skin dilate and the increase in blood flow reddens the face. Typically fear redirects blood flow from the skin and extremities to skeletal muscles but the opposite seems to happen with blushing. Why this happens is not clear.

Everyone blushes and typically this is a result of embarrassment, surprise, modesty, or shame. However, for some people there is no clear reason for it to happen. This painfully unpredictable disorder is called Idiopathic Craniofacial Erythema (ICE). The phobia of blushing is called Erythrophobia. Because reddening of the face can be quite visible (depending on natural skin coloration), someone who is socially anxious might connect blushing with the possibility of embarrassing attention and so it becomes part of their anxiety.

It may be for others that the biological tendency to blush easily is first and then anxiety about it follows. When anxiety associates with blushing then the anxiety activates the sympathetic nervous system and that causes blushing and so a self-reinforcing cycle forms. This can be debilitating as people avoid any circumstance that might lead to blushing. This is often social because it is one of those things that people seem to feel free to comment upon, “Wow, your face is so red! Why is your face red?” Research shows that verbal feedback like this increases blushing. Fearing or expecting to blush can be a self-fulfilling prophecy. Often the anxiety starts in childhood because kids are more likely to comment about it.

Here is a working list of suggestions for treatment that I have found in various places.

  1. Task concentration training (TCT) appears to be most effective treatment based on research I found. The theory is that anxiety and blushing cause an inward focus thus increasing subjective awareness of feelings, thoughts and symptoms. This increases the blush response as well as anxiety. Training in outward focus (a similar treatment is effective with athletes) has been proven to be the most effective approach even after a year. This article has a good summary of the process although it is a bit technical.
  2. Cognitive-Behavioral Therapy. More specifically that would mean examining and revising beliefs (cognitive) about blushing. Also, it would involve behaving differently. Rather than avoiding it could mean voluntarily exposing yourself to a fearful situation. A number of suggestions I found fall under this treatment:

    • Activate the counterbalancing part of your nervous system (parasympathetic) by relaxing and breathing differently. This has to be practiced at some length before it will be effective.
    • Draw attention to it rather than hiding it. This paradox, as hard as it seems, works with anxiety. Many people with social anxiety mistakenly think that disclosing anxiety is worse than hiding it.
    • Accept it rather than resist it. Accept that at this point you are a person who blushes easily and that is simply the way it is. You may wish it was different but it is what it is.
    • Revise what you imagine other people are thinking. Collect some data. Ask some people what they think. What would a friend tell you about it? Explain it to people. Research suggests that blushing-fearful people inflate the both the probability it will happen and the social cost of blushing. In other words, they think it is way worse than it is and that others are thinking more critically than they are.
    • Practice the symptom. Try to make yourself blush by creating the circumstances. Do that over and over on purpose. You can do this gradually or all at once. This process is called systematic desensitization or exposure.
    • Reframe the meaning of blushing. Historical evidence demonstrates that redness of cheeks is a sign of beauty and youth as well as markers of modesty and charm. As an expression of shame or embarrassment that can be very positive depending on the context.
  3. Some sites suggest hypnosis. I couldn’t find any research support but there are a number of personal stories or single cases that showed improvement on the web.
  4. Medication. Some people experience relief with medications that treat anxiety. Typically these are medication like Celexa, Prozac, Zoloft and other similar medications. Medications like Xanax, Klonopin and other benzodiazepines are sometimes prescribed. Sometime blood pressure medications such as beta blockers can be effective. A few sites suggest that botox may be helpful. Consult your physician for more information about this treatment.
  5. There is a surgical operation available for severe cases. It is called Endoscopic thoracic sympathectomy. Frequently this is used to treat severe sweating but there appear to be cases that have been effective for blushing.
  6. A dermatologist should be consulted if this problem exists to rule out any underlying disorders.

It seems that there has been an increase in research and treatment options in the last 10 years. This is hopeful for those struggling with this.

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