As promised, today’s post is on how Cognitive Behavioural Therapy (CBT) specifically treats social anxiety. If you haven’t already, check out my post on “Social Anxiety Explained”, available here:
The Cognitive Model of Social Anxiety
Social anxiety consists of five components, these components are like symptoms of social anxiety and they keep us in the cycle of anxiety.
- Anticipatory processing and assumptions about oneself and the social world. This is making negative predictions about an upcoming social event and what the experience will be like. Usually it is thinking of the worst thing that could happen (catastrophizing)
- Self-focused attention while constructing an impression of oneself as a social object. Entering into social situations and become internally focused (focused attention on yourself), while developing a negative image of yourself. By focusing internally this increases your anxiety symptoms.
- Safety Behaviours: these are things you do to try and control your anxiety. For example you may avoid getting up and walking to the toilet if you need to, you may clench your fists to stop your hands shaking or you may leave the social situation early. Safety Behaviours can keep us in the cycle of anxiety.
- Anxiety-induced skills deficits: These are like our social skills, these can become low in social anxiety due to our thoughts and safety behaviours.
- Post-event processing. This is when the social event is over but we go over the event and our performance over and over again.
Types of thoughts during Anticipatory Processing
These are the types of thoughts most common in social anxiety during the anticipatory processing (predictions about upcoming events). They tend to fall into 6 categories:
- Predictions about their upcoming performance— for example: I won’t have anything to say at the party.
- Consequences of the poor performance— for example: I’ll look foolish.
- Other people— for example: Others will see how anxious I am.
- Disapproval— for example: Others will evaluate me negatively.
- Anxiety— for example: I won’t be able to tolerate how anxious I am.
- High-performance Standards— for example: I must impress people.
Tailoring CBT for Social Anxiety
Here is a step by step guide of what would be thought to you in a CBT session:
1. Psychoeducation work on social anxiety (explaining all of the above in the session)
2. Cognitive restructuring of anticipatory anxiety. Here you would be given techniques and thought how to rationalise your thinking by evaluating your thoughts.
3. Focus of attention training, giving techniques to stop internal focused attention
4. Post event processing strategies. Helping you to reduce how you analysis the social situation after it has happened, getting you to see how unhelpful this is and how inaccurate it can be. While also teaching you some thought stopping techniques to help you take control of your thinking again.
5. Exposure work both in sessions and outside – this is only done when you have built up a good skill set in using all of the above techniques. This is also done in a gradual process.
(Image Credits: Google Images)
CBT can be a highly effective treatment approach in helping to reduce the symptoms of social anxiety. Its very much techniques orientated and helps to equipped you with the techniques for the future, while having the goal of teaching you to be your own therapist.