Areas of Specialization - Adults
Overcoming Social Anxiety and Shyness Treatment What is cognitive behavioral therapy for Social Anxiety Disorder?
The primary goal of cognitive behavioral therapy for social anxiety is to break the connection between social situations and the anxiety/panic response and to stop the repetition of ineffective avoidance behaviors and the temporary relief of anxiety. In other words, a person's cognitions (thoughts) have to be changed in a rational direction, and a person's behavior needs to gradually move away from avoidance and toward engagement and participation in life. Cognitive behavioral therapy trains anxious people to overcome their fears by practicing a variety of exercises and coping techniques.
Cognitive behavioral therapy begins with education about anxiety to help the client understand the difference between healthy, adaptive anxiety and excessive, maladaptive social anxiety. The client then examines the specific situations that provoke anxiety and learns the connection between theses situations and their thoughts and physical symptoms of anxiety. This educational process establishes a foundation to understand the training in skills to alleviate and eventually conquer social anxiety. These skills include relaxation techniques, diaphragmatic breathing, the cognitive restructuring of distorted and negative thinking that contribute to social anxiety, and a programmatic hierarchical exposure to situations that precipitate anxiety.
Specifically, cognitive behavioral therapy combines cognitive restructuring ("cognitive" component) with exposure ("behavioral" component). Socially anxious individuals consistently overestimate the threat or risk in the social situation and/or underestimate their ability to cope with the stress and demands of the situation. Cognitive restructuring is a strategy employed to correct this faulty appraisal style through:
- Identifying the erroneous beliefs and perceptions of threat which generate the client's negative thoughts which in turn create anxiety and distress, and
- Challenging and modifying the fearful thoughts by guiding the client to access information incompatible with an anxious response (corrective information) and compatible with an adaptive coping response to potentially stressful situations.
Exposure helps the client gradually become more comfortable with frightening situations as it involves actual confrontation of feared circumstances and events both in and out of therapy sessions. The client is helped to identify their feared situations and rank them according to increasing levels of anxiety. For example, exposures are gradually increased in difficulty such that initial exposures may involve introducing the client to the feared situation- e.g., presentation at work in front of supervisors. The next step is to increase the risk for disapproval in that situation so the client can build confidence that they can handle rejection or criticism- e.g., talking spontaneously without solely relying upon written speech. The client is taught techniques to cope with disapproval as they are asked to imagine their worst fear and are guided to develop constructive responses to their fear and perceived disapproval- e.g., worst fear- "I will not remember everything, Everyone will think I am stupid." Constructive response- "I do not have to be perfect to do a good job. Even if I do not remember everything the first time through I can add information later. My boss told me I did a nice job on my last presentation. If someone looks bored it may be that they are tired and have nothing to do with my speech. I have learned new techniques to manage my anxiety that I did not have during my last presentation."
Cognitive behavioral therapy is perhaps the most effective and most thoroughly researched therapy for social anxiety disorder. Cognitive behavioral therapy can be done initially on an individual basis, but an active, behavioral therapy group, consisting of other people with social anxiety can be extremely beneficial to successfully conquering one's social fears and worries.
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