Imagine being in a social setting, and suddenly, a harsh inner camera flips on.
For many with social anxiety, this “inner movie” is a negative self-image, seen through the critical eyes of an imaginary observer.
It’s a key focus in therapy for non-autistic adults. But what if the lens through which social anxiety is experienced is fundamentally different for autistic adults?
A recent exploratory study involving 62 autistic adults sheds new light on the inner world of social anxiety, suggesting that current treatment models might need a significant recalibration to be effective for the autistic community
Key Points
- Social Imagery is Highly Distressing: Autistic adults reported that mental images generated during anxious social situations were significantly more upsetting, less controllable, and made them want to escape, compared to images about relaxed situations.
- The “Field” Perspective Dominates: Contrary to non-autistic adults with social anxiety, most autistic participants did not view their anxious social images from an “observer perspective” (seeing themselves as an outsider would). Instead, they reported a “field perspective” (looking out through their own eyes).
- Worry is Rooted in Somatic Feelings, Not External Judgement: The distress in the social imagery was more strongly linked to general feelings of social anxiety and discomfort, rather than a specific Fear of Negative Evaluation (FNE) from others.
- A Desire to Escape: The finding that social anxiety (but not generalized anxiety) was associated with wanting to escape the social imagery suggests the fear is more about being unable to cope with the anxious physical sensations in the social situation than with simply being judged.
The Camera that Won’t Turn Off
For decades, a leading cognitive model of social anxiety, the Clark and Wells (1995) model, has centered on the idea of a negative self-image.
In non-autistic individuals, this image is often a distorted, negative view of oneself from an outside or “observer” perspective.
This self-focused attention is believed to maintain the anxiety. In therapy, tools like video feedback are used to correct this distorted, negative image.
This new study used a structured mental imagery interview to investigate the quality and perspective of social imagery in a group of autistic adults, most of whom reported high levels of social anxiety.
The participants generated mental images for both social and relaxed scenarios.
The results were compellingly different from what the standard model predicts for non-autistic individuals.
A Different View of Anxiety
The first surprise was the visual perspective. The majority of autistic participants reported their social imagery from a field perspective.
This means they saw the scene through their own eyes, not as if they were watching themselves on a screen.
There was no significant shift to the “observer perspective” in the anxious social imagery compared to relaxed imagery.
This challenges the idea that a shift to self-focused, observer-perspective attention is a central maintenance mechanism for social anxiety in autistic adults.
The second key finding relates to the source of the distress. For non-autistic individuals, the negative image is often driven by the Fear of Negative Evaluation (FNE)—the worry about how others will judge them.
However, in autistic adults, the distressing qualities of the social imagery (like how upsetting or anxiety-provoking it was) were more strongly linked to general feelings of anxiety and social anxiety symptoms overall, rather than a specific concern about FNE.
Not a Cognitive Worry, but a Somatic Signal
The researchers suggest that for autistic adults, the social imagery might be generated by drawing on internal bodily sensations, physical discomfort, and sensory experiences associated with high anxiety.
Think of the image not as a cognitive worry about a social blunder, but as a visual, often traumatic, record of the body’s overwhelming reaction to the environment.
The core fear, therefore, might not be “they will see I am anxious and judge me,” but “I will become overwhelmingly anxious and be unable to cope, so I must escape”.
The image is less about a perceived failure to perform socially, and more about an authentic, visceral response to distress.
This view aligns with a growing body of qualitative research from autistic adults, who often describe their anxiety as “trauma-based” due to persistent negative social encounters, which can include bullying, discrimination, and a general lack of societal acceptance.
Why It Matters
This study signals that the how and why of social anxiety in autistic adults may require a unique therapeutic approach.
Since the negative social imagery is not primarily driven by an observer’s perspective or FNE, the standard therapeutic focus on correcting a perceived negative external image (like using video feedback) may be less effective.
Instead, clinicians should focus on the internal experience. Questions should be scaffolded to explore bodily sensations, sensory experiences, and physical discomfort present in the imagery.
The image should be viewed as a portal to understanding the individual’s past social trauma and their body’s current “fight or flight” response.
By validating the image as a reflection of genuine distress and past, often traumatic, experiences—rather than a disproportionate fear—therapy can shift from correcting a “distorted” belief to helping the client manage an authentic, intense internal experience.
This new understanding opens the door to more tailored, compassionate, and effective cognitive-behavioral adaptations for the autistic community.
Reference
Lei, J., Attwood, J., & Russell, A. Exploring the suitability of the Clark and Wells (1995) model of social anxiety in autistic adults: The role of mental imagery and fear of negative evaluation. Autism. https://doi.org/10.1177_13623613251379945
