CBT FOR SOCIAL ANXIETY
SOCIAL ANXIETY
Anxiety is the most common mental health condition. Social anxiety is one of the most common forms of anxiety.
Everybody experiences social anxiety on occasions. Indeed, it is perfectly normal to feel anxiety in situations such as a job interview, making a speech, or going to a social event.
Social anxiety disorder is different. It is defined as an excessive fear, nervousness and apprehension experienced in social interactions. It often revolves around the feeling of being judged or being seen in a negative light by others. People with social anxiety often have a fear of being humiliated in public. Quite often poor self-esteem and depression underpin social anxiety.
Social anxiety can be very painful and debilitating. The world is a social place; you cannot avoid social interaction. Many people experience severe stress in advance of social contact and again afterwards, when analysing how the situation went. Others feel compelled to cut themselves away from people, avoiding social situations altogether. Avoidance leads to feelings of isolation, loneliness and depression. Social anxiety can negatively impact all areas of a person’s life – home life, work life and leisure.
SOCIAL ANXIETY TRIGGERS
The situations that trigger social anxiety will vary from person to person. A trigger might be going into a supermarket or busy bar, or walking past acquaintances who stop and talk to you, or weekly work meetings. Regardless of the type of trigger, each situation activates beliefs and assumptions the person has about themselves, the specific situation, and social situations in general.
Examples of these thought patterns might be:
‘people see through me’
‘she thinks I’m useless’
‘they are judging me in a negative way’
'I’m dreadful in these situations’
‘there must be something wrong with me’
‘people think I am inferior'
SAFETY BEHAVIOURS AND SOCIAL ANXIETY
Some people may think they can solve social anxiety by themselves, by ‘getting out there’ and pushing themselves. However, this can actually be counterproductive. What tends to happen is that people employ safety behaviours to minimise painful feelings of anxiety. For example, someone might engage in mental rehearsal prior to social interactions, going over what to expect and how to respond. Others might hold items tightly to avoid visibly shaking. These safety behaviours typically backfire and only intensify the perception of social failure. Afterwards, the person tends to ruminate, analysing their performance and replaying the social situation. As a result, negative experiences and beliefs only get reinforced.
SOCIAL ANXIETY: CBT TREATMENT
Cognitive behavioural therapy (CBT) has specific protocols that have been shown to be highly successful in the treatment of social anxiety.
Social anxiety is associated with acute self-focus and self-consciousness. In social situations, you may be so focused on yourself that you miss what others are saying and doing. In therapy, clients can learn how to shift their attention and ‘decentre’ from this acute self-focus. Combining cognitive and behavioural strategies, people learn how to challenge their worries and overcome fears of embarrassment and shame. The safety behaviours which people engage in to minimise uncomfortable feelings of intense anxiety will be examined.
With social anxiety, it is very common to experience a heightened awareness of the physical symptoms of anxiety. Relaxation skills training is therefore very important. Relaxation and mindfulness strategies are taught. These allow you to learn to adopt an attitude of curiosity instead of avoiding social situations. Exposure exercises (gradually exposing yourself to feared situations) can be set up in the safety of the therapy room and moved slowly to real-life situations, accompanied by the therapist as necessary. In CBT, this real-life exposure is known as in-vivo exposure. It allows you to truly test out and master your fears at their own pace.
The outcome of CBT interventions for the treatment of social anxiety is very promising. The vast majority of clients make marked progress.