Social Anxiety from a CBT Perspective

 There are two characteristics that identify social anxiety:

– the fear of doing or saying something foolish in public

– the fear of being judged negatively by others

The specifics can vary from person to person. One person might be comfortable around strangers but uncomfortable at family get-togethers or vice versa.

Often ‘safety behaviours’ are taken on. These coping mechanisms may include avoiding eye contact, keeping busy or self monitoring. These safety behaviours can be counter-productive, and may make the person seem less approachable. This can worsen the issue.

My previous blog post on self worth and social anxiety includes some pointers to assist people with shyness or social anxiety.

Maintenance of social anxiety

Self focus works in a way that maintains social anxiety. The social event is typically evaluated from a negative bias before and after the event: before: ‘I’m going to feel so uncomfortable at this party’, after: ‘I looked like an idiot’. This negative bias is further exacerbated during the event due to excessive self focus. e.g. ‘I must look so awkward’. The negative aspects are overemphasised and any positive aspects discounted by the individual. This in turn leads to further anxiety as well as disengagement from others.

When I am working with a person who presents with social anxiety I like to take two approaches.The first is a CBT perspective (cognitive behavioural therapy) and the second is a more humanistic approach. The CBT approach works with the here and now, and identifies cognition, physiology, emotions, and behaviour, and the interplay between them. I’ll explore CBT further in another post.

The NHS have a very helpful resource available online that address social anxiety using CBT.

This booklet outlines typical symptoms of social anxiety. It helps identify the negative self talk and assumptions we make about ourself in social situations. Negative automatic thoughts, rules and assumptions, and core beliefs play a part in maintaining social anxiety. Typical negative automatic thoughts of social anxiety might include: ‘They will think I’m boring’. ‘I hope I don’t have to speak’. Rules and assumptions might be: ‘if I go to social situations people will know I am nervous’, ‘Parties are always a disaster for me’. Deeper ‘core’ beliefs for example may be: I’m not good enough’, ‘Others are better than me’.

Cognitive Interventions

Explore why you are anxious about a meeting, and explore each thought that follows. Starting with ‘I’m afraid I will be asked a question’, you could find that leads to ‘because my voice might crack’, ‘people will notice that I am nervous’, ‘people will think less of me for being nervous or they will be surprised by my lack of confidence’. This thought process is self-defeating and maintains a state of social anxiety as you feel too anxious and self-conscious to speak up.

Once the negative automatic thought process is identified, you can counter with an alternative balanced thought. This can be facilitated by asking what you would think if someone else at the meeting spoke with an anxious sounding voice. The alternative balanced thought might become: ‘people might notice for a moment but they won’t think much of it, at worst they will be a little concerned for me’. A thought record sheet is helpful here in noting the thoughts and mood triggered by a situation and then noting the mood change when the alternative balanced thought is introduced. You can draw attention to the difference in the strength of emotion elicited by the automatic versus the balanced thought. (Whalley 2012).

Examining errors in thinking is another cognitive intervention used in the treatment of social anxiety. Identifying mind reading – ‘if I stammer people will think I am stupid’, or personalising – ‘she didn’t sit beside me because she thinks I am boring’, catastrophizing – ‘the evening was a disaster because I blushed’. Once these thinking errors are identified they can be challenged and a rational alternative brought in.

Behavioural Interventions

Once the role of self-focus in reinforcing the social anxiety cycle is understood, you can begin to plan to move outward. This involves not monitoring self, looking at others and the surroundings, really listening to what is being said, and not taking all the responsibility for keeping conversations going. Furthermore recognising that silence is acceptable, that physical symptoms of anxiety are not that noticeable and beginning to believe that people will not dislike you because you are anxious. (NHS 2006, P.12).

Safety and avoidance behaviours keep the client from disconfirming their beliefs. An example being someone might keep their head down to feel safe, and so will not discover that it is safe to make eye contact in social situations. This self-protection is counter-productive.

Behaviour experiments can be used to disprove negative beliefs about social situations. For this purpose the belief needs to be specific and testable. For example the belief might be ‘When I go to the supermarket checkout everyone will look at me’, or ‘if I go to the party without a companion no one will talk to me’. After testing and disproving a belief several times it becomes less powerful. Behaviour experiments are planned in advance, outlining the belief to be tested and the possible obstacles to the experiment. The behavioural experiment is re-evaluated and usually several behavioural experiments are necessary in order to effectively challenge the belief. (Whalley, 2012).

It is also necessary to understand that physical symptoms of anxiety are a result of a perceived threat, which sets the hormone adrenaline to produce the fight or flight response. This can facilitate putting anxiety symptoms into perspective. Practicing relaxation and breathing exercises on a regular basis can help deal with this anxiety when it occurs. Practice in gaining presence and mindfulness is important here, for example through using senses or breathing. Visualisation and distraction can also be helpful in treating social anxiety.

For some, social anxiety is an extension of generalised anxiety. In this case the specifics of social anxiety as well as exploring the general sense of unease in life require exploration.

Shame

From the humanistic approach I have found it helpful to address the issue of ‘shame’ which appears to be a common denominator for many people with social anxiety. Shame often is caused by a deep sense of ‘there is something wrong with me’ or ‘theres something different about me’. It can be helpful, though not always necessary, to identify where this originated. It may be that the person picked up a parent or parents own sense of shame or it may have been a particular scenario which the person experienced as shameful, and the person has continued to carry this shame.

Self acceptance is the antidote to shame. The following book addresses how to overcome shyness and social anxiety through compassion.

Henderson, L. (2010) Improving Social Confidence and Reducing Shyness, 1st Edition. London: Constable & Robinson.

There is also a helpful website which contains guided visualisations for self-compassion.: http://www.self-compassion.org (Neff N.Dr.,2009)

John Bradshaw’s book, ‘Homecoming’, contains very clear exercises to follow which are helpful in addressing shame as well as any other unresolved issues from childhood. I also recommend this book to anyone with a negative self image. While the book refers to childhood abuse, it can be useful in dealing with many childhood issues.

The humanistic approach is less formulaic than CBT. It is a process and can elicit strong feelings which are seeking to be resolved. Support, preferably in the form of therapy, is particularly advisable here. Developing self-compassion can be more difficult than developing balanced thoughts because balanced thinking is often reasonably accessible to many who can understand, on a logical level, that their negative self thoughts are irrational. Self-compassion would enable a gentler examination of the emotional cycle which can often evoke punitive feelings such as humiliation and shame rather than compassion towards the self.

In short, bringing relaxation, mindfulness, balanced thinking and self compassion into daily practice is important in the treatment of social anxiety.

See my previous blog on social anxiety for a list of short pointers to help with social situations.

 

 

 

 

 

 

 

 

Author: Liz Wright MIAHIP

Accredited member of the Irish Association of Humanistic and Integrative Psychotherapy I have been working as a counsellor and psychotherapist since 1999. My experience and training covers a wide range of areas, allowing me to provide the right therapy for you.

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