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Social Anxiety Help is a founding regional clinic of the National Social Anxiety Center (NSAC): nationalsacenter.com


 

What is Cognitive-Behavioral Therapy (CBT)

Common Therapy Goals in CBT for Social Anxiety

Some CBT Strategies & Skills to Overcome Social Anxiety

Group or Individual CBT for Social Anxiety


Cognitive Restructuring & Mindfulness for Social Anxiety

(Video broadcast to the Andrew Kukes Foundation for Social Anxiety in March, 2016)


WHAT IS COGNITIVE-BEHAVIORAL THERAPY (CBT)?

Cognitive-Behavioral Therapy (also called Cognitive Behavior Therapy, or simply Cognitive Therapy) is a practical, results-oriented approach in which you learn specific skills and strategies to help you overcome personal problems and to achieve personal goals that you choose for yourself.

CBT is based on the fact that our thoughts, feelings, behaviors, biology, and life circumstance all influence each other. Therefore, if we are having problems in one area�anxiety and social interaction, for example�we can make changes in our thinking and behavior that can help us feel better and achieve our goals.

A central premise in CBT is that how we feel about a situation is affected by our thoughts about the situation--the self-talk and images that go through our mind�as well as our core beliefs about ourselves and the world.

Two different people might feel very differently in the same situation�one person very socially anxious, the other person comfortable and confident�in part because they have very different thoughts and beliefs about the situation and themselves. For example, the socially anxious person may believe s/he is socially unskilled and uninteresting, and that s/he is likely to make a bad impression when meeting new people at a social activity. The calm and confident person in the very same situation may believe s/he is a likable, interesting person, and that if someone at a social activity doesn't enjoy talking to him/her, that most other people at the social likely will.

A cognitive-behavioral therapist will help you figure out the vicious cycles you unintentionally engage in, such as cycles of distorted thoughts, upsetting feelings, unhealthy core beliefs, and self-defeating behaviors. These vicious cycles help cause your problems and make you feel stuck. Then you experiment with different way of breaking those vicious cycles by applying the skills and strategies that you learn and practice in CBT.

It'll take hard work and determination on both of our parts. But if you're really committed to doing the therapy homework regularly--homework that you choose for yourself in collaboration with your therapist--you're likely to be making significant progress toward your goals in a matter of a few months.

Many outcome studies have demonstrated CBT to be one of the most effective approaches to overcoming social anxiety. One of the key advantages to CBT is that it's an empowering form of therapy, aimed at training you to become your own personal therapist. In other words, in CBT you learn and put into practice insights, skills and strategies that you can continue using on your own to help you reach further goals and handle future problems.
 

For more information, please read:
Cognitive-Behavioral Therapy (The New York Times),
CBT is Most Effective Treatment for Social Anxiety (Medscape Medical News),
CBT for Social Anxiety (Advances in Psychiatric Treatment),
Video Lecture on CBT for Social Anxiety (Vincent Greenwood, PhD),
Highest Rating Given to CBT for Anxiety (Consumer Reports),
Effectiveness of CBT for Social Anxiety (Journal of Cognitive Psychotherapy),
Neuroscience Demonstrates Effectiveness of CBT for Social Anxiety (Stanford Report and JAMA Psychiatry),
Group CBT Alters Brain Activity of the Socially Anxious (Healthday News),

or listen to:
National Public Radio feature on CBT for social anxiety.

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COMMON THERAPY GOALS IN CBT FOR SOCIAL ANXIETY

When you do CBT to help you overcome your social anxiety, you choose specific personal goals to work on, both in therapy sessions and in your self-chosen therapy homework.  Common goals that some people choose to work on in social anxiety therapy include:

  • socializing enjoyably
  • talking to strangers
  • meeting people and making friends
  • dating and forming relationships
  • being physically intimate
  • eating, drinking, writing, walking, working, hanging out or dancing when others may be observing
  • speaking up in groups and giving presentations
  • performing on stage 
  • being assertive
  • revealing personal information about yourself
  • interviewing for jobs, networking, and advancing your career
  • using public bathrooms comfortably
  • feeling less embarrassed and upset by mistakes and social blunders
  • feeling less embarrassed and self-conscious about blushing, sweating or other visible anxiety symptoms
  • improving your mood and self-confidence

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SOME CBT STRATEGIES & SKILLS TO OVERCOME SOCIAL ANXIETY

  • Changing Perceptions (Cognitive Restructuring):  learning to identify your hot thoughts (upsetting ideas, self-talk and mental images) that contribute to your social anxiety; learning to test these thoughts against real-life evidence; and learning to come up with a constructive attitude about the situation and yourself that is more realistic, helpful and compassionate. 

Cognitive Restructuring alone is not always enough to overcome our distressing hot thoughts.  Often, cognitive restructuring is a first step in preparing for experiments (see below), where we have the opportunity to test out our hot thoughts v. our constructive attitude about a situation and ourselves.  Sometimes we do cognitive restructuring during or after an upsetting situation so we can overcome our distress and learn from the experience.

  • Mindfulness: learning to acknowledge and set aside your distracting and disturbing thoughts and feelings, and refocus your attention on the conversation and activity in the moment; learning to “get our of your head and into the moment” so that you can interact with others more comfortably and naturally.
  • Experiments (Exposures): developing a series of learning experiences to help you work on your therapy goals and overcome your social anxiety in small, manageable steps.  You choose your own experiments based on your fear and avoidance hierarchy, starting with situations that are only a little uncomfortable, and gradually working on harder things as you build self-confidence one small step at a time.  Generally you will do cognitive restructuring before the experiments, and practice mindfulness during the experiments (see above).  You will also identify safety behaviors (psychological crutches) that you want to limit using during your experiments so that you learn more and build more self-confidence.  

    Some of these experiments take place during therapy sessions: doing various moderately challenging role plays and other activities with the therapist, as well as going out in public with your therapist to do experiments with strangers.  If you are in a social anxiety therapy group, you will do many of these in-session experiments together with other member of your group, and occasionally with former members of past groups.  If you wish, you will have the option of making private video recordings of some of your in-session experiments so you can test out your hot thoughts about how you come across v. how you actually do appear. 

    You will also do many other experiments as self-chosen homework between sessions, either on your own, with therapy group co-members, or with personal friends. 

    Most importantly, you will also learn how to benefit from both your in-session and homework experiments, no matter how they turn out.  You will learn how to identify ways you helped yourself, ways you unintentionally hurt yourself, and evidence you can gather from the experiments that refutes or supports your hot thoughts.  You will also learn how to treat yourself compassionately about the experiments you do, like a good parent or friend would do, so that you build self-confidence and make progress toward your goals more rapidly.
  • Assertion and Problem-Solving:  Sometimes our social anxiety fears do come true.  Sometimes we do embarrass ourselves.  Sometimes others do judge or reject us, and may even say critical or mean things.  Sometimes we create a bad impression.  These bad things don’t happen as often as we tend to think they do.  Nor do they usually have as negative or lasting an impact on our lives as we believe they will.  Still, our fears do sometimes come true.

One important CBT strategy in overcoming social anxiety is learning to figure out what to do in the event our fears come true.  Sometimes that involves asserting yourself with a critical person in a calm and confident tone.  We practice such assertions in session, using role plays and imagery, and we also practice it in various ways as homework.  Other times we use problem-solving strategies to develop good ways of coping with a situation turning out badly, which we also practice in session and in homework.  The more confident we feel about being able to cope with a fear coming true with our heads held high, the less socially anxious we feel about the situation.

  • Changing Attitudes (Core Beliefs and Personal Rules):  Why do some people experience troubling hot thoughts and much anxiety about a situation in which many other people experience positive thoughts and feelings?  Some of this has to do with different attitudes (core beliefs and personal rules) that people have learned about themselves and the world as they grew up.  Our attitudes act like glasses we wear: we don’t usually think of them, but nonetheless they profoundly affect the way we see the world and the situations we experience.   Change your glasses (attitudes), and the world looks very different to you. 

CBT helps you identify the unhealthy core beliefs and rigid personal rules that contribute to your social anxiety.  You then learn various skills and strategies to test and weaken your unhealthy attitudes, and to develop and strengthen alternative, healthy attitudes.

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GROUP OR INDIVIDUAL CBT FOR SOCIAL ANXIETY

Depending on your need, preferences and resources, you have the option of doing cognitive-behavioral therapy to help you overcome your social anxiety in one-on-one individual work or in specialized social anxiety CBT groups.  Both individual and group CBT are, on average, equally effective, according to outcome studies.  But depending on the person, group and individual each offer different advantages:

Advantages of individual CBT for social anxiety:    

  • Much more flexible in scheduling of sessions, and in the frequency and duration of therapy
  • Much more individualized attention and assistance from therapist, which is especially helpful for persons who have difficulty doing therapy homework their own, or who have multiple problems
  • Can work on other problems in addition to social anxiety
  • You will probably feel less anxious in session

Advantages of social anxiety CBT groups:

  • Less expensive
  • Opportunity to identify with others who share similar experiences and problems, and feel less alone or odd
  • Opportunity to support others and be supported by others, which tends to feel good and help one another make more rapid progress
  • Opportunity to do many in-session and homework experiments with other group members
  • Opportunity to make friends with people who share a common therapy experience, which is a good way to keep making progress after group is over
  • You will probably will feel more anxious in group sessions, which is a great opportunity to learn how to overcome your anxiety in a safe setting.
  • Groups serve as a safe "laboratory" to explore how we relate to others, and to experiment here-and-now with new ways of relating in a safe setting.
  • Many (but not all) group members make more rapid progress because they tend to do their self-chosen therapy homework more regularly than they do in individual CBT, perhaps because of the requirement to report on the homework they did each week to the whole group.

You may be thinking that a group is the last place you'd want to do therapy! After all, many people are more likely to experience their social anxiety in group settings than one-on-one. Perhaps you may already have been in a therapy or support group before, and perhaps you have felt lost, unable to participate or dominated by more outgoing group members. 

But imagine how different things are in a group made up of people who are socially anxious, and with a structured format designed to help members feel more comfortable participating. Sure, you may be likely to experience more social anxiety in a group setting, but I help you turn that to your advantage. I help make the group a safe place for each member to explore what is causing their social anxiety here-and-now, and experiment with healthy ways of overcoming that anxiety in the group itself.

However, many people prefer individual CBT to group CBT to help them overcome their social anxiety and other problems. Individual cognitive-behavioral psychotherapy and counseling provides you with much more personalized attention than does group, which is especially helpful for those wanting to work on overcoming other problems in addition to their social anxiety, or who have difficulty doing therapy homework on their own. Furthermore, individual CBT allows for much greater flexibility as to the scheduling of sessions and the length of treatment. The basic therapeutic approach is the same in individual and group CBT, and you can make great progress in either modality.

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    If you have any questions or comments,
    please email Larry Cohen, LICSW,
    with offices in Washington, DC.


     
     


[Larry Cohen, LICSW, does not endorse any of the products or services advertised by others on this website.]


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