CBT for Social Anxiety

Social Anxiety Disorder (SAD), also known as Social Phobia, is a fear of public or social situations, typically with worries around embarrassment or humiliation.

Social anxiety can be assessed using a number of instruments including Social Phobia Inventory (SPIN), Social Phobia and Anxiety Inventory-Brief form (SPAI-B), Liebowitz Social Anxiety Scale (LSAS) and Social Interaction Anxiety Scale (SIAS).

Cognitive Behavioural Therapy (CBT) is a type of talking psychotherapy that looks at our thoughts, feelings and behaviours. It helps us set goals and develop new ways of thinking and behaving to solve our problems.

Cognitive Behavioural Therapy (CBT) is one of the most popular forms of psychotherapy. However, CBT does not work for everyone and in this lesson, we will discuss the advantages and disadvantages of using CBT.

The body's stress response often referred to as fight, flight or freeze is a natural response to potential threats. it is controlled by the sympathetic nervous system (SNS) which triggers somatic symptoms such as a racing heart, sweating and butterflies in the stomach.

The Transactional Model of Stress looks at how we respond to potential threats. In the Lazarus and Folkman model, this is a two-step process.

The ABC model suggests that our reactions to situations are caused not by the event itself, but by our beliefs and interpretations of those events. Therefore, if we can challenge or change these beliefs, we can change our reactions to situations.

The Cognitive Behavioural Model Of Social Phobia, is a model of social anxiety created by Clark and Wells.

Anxiety is often underpinned by three core beliefs: the world is dangerous, I am not strong enough to cope, and worrying keeps me safe.

Shame typically plays a key role in social anxiety because it is as the root of our fear of embarrassment or humiliation. In this lesson, we'll define shame.

Emotions do not happen by accident: they are functional, that is, they are trying to tell us something. Shame has a protective function, helping regulate our behaviour to ensure we do not get ostracized. However, some times our shame detector can be too sensitive or go off when there is no social threat.

Why might someone have social anxiety? In this lesson, we'll explore predisposing factors including genetics, family history, physical health, childhood, bully, and self-esteem.

Avoidance often plays a key role in maintaining social anxiety.

We often respond to ourselves with an overly critical voice. In this lesson, we'll explore how to respond with compassion instead.

We've talked a lot about shame in a course on social anxiety. In this lesson, we'll summarise the role of shame in social anxiety.

Negative automatic thoughts (NATs), also known as automatic negative thoughts (ANTs) are the first thoughts we have when entering a situation. These happen with very little processing of the conscious mind.

We often make thinking errors or fall into traps. These include all-or-nothing thinking, persistent doubting, catastrophising, jumping to conclusions, mind reading, living by fixed rules, negative focus and intolerance of uncertainty.

A key part of using cognitive strategies in CBT is to explore the root of a thought so that we can challenge it.

"Why's that bad?" is a game you can play to help access the root of a worry.

Once we spot a thinking error, we can challenge it in several ways. In this lesson, we'll explore the three main ways to challenge faulty thinking.

Once we challenge a thought, we can then rewrite it so a more realistic and less negative version.

Exposure is a technique used in CBT to confront the feared situation in a controlled and manageable way.

Graded exposure is the idea that we start off with a situation that is the least scary and work out way up to more feared situations.

An exposure hierarchy is a list of feared situations with an associated score for how fearful the situation is.

In this lesson, we'll discuss how to get the most benefit from exposure therapy.

Exposure therapy can be daunting. In this lesson, we'll explore some tools that we can use to help us through it.

Mindfulness is the concept of paying attention to the present with judgement. When working with exposure tasks, we want to utilise mindful awareness to help us process the experience.

After completing an exposure task, we should debrief to review whether the task matched our initial expectations. Often, we find that the task is less scary than we imagined. But sometimes it is just as scary as we predicted and that is useful information, too.

Sometimes we get stuck on our exposure hierarchy. In this lesson, we'll explore some strategies for resolving feelings of stuckness in CBT.

Paradoxical intent is the concept that if we run towards our fear, we will take away its power.

Safety behaviours are things we do to make ourselves feel better. Although they have short-term benefits, in the long term they detract from exposure therapy because they shield us from fully experiencing the situation.

What does it look like to sit down with a client and do CBT for Social Anxiety?

This workbook can be used to help clients track their automatic negative thoughts.

This workbook can be used both in and out of sessions to help clients challenge their negative thoughts.

This workbook can be used both in and out of sessions to help clients rewrite their negative thoughts.

This workbook can be used to build a task hierarchy for exposure therapy.

This workbook should be used after an exposure therapy talk to review what happened.

Skills training can be used to help clients with social skill deficits or to help them build confidence.

Skills training is a four-step process. We'll explore each step in this lesson.

Communication skills include verbal (managing silence, listening and asking questions, modulating voice volume and expressing feelings appropriately) and non-verbal (eye contact, facial expressions, body language).

Assertiveness is the ability to request our needs are met without resorting to aggression or anger. In this lesson, we'll explore the process of being assertive and myths around assertiveness.

Public speaking is one of the most difficult things to do for people with Social Anxiety Disorder. In this lesson, we'll briefly review what good public speaking looks like and where clients can develop their public speaking skills.

Role-play can allow a client to practice using their skills in the safety of the therapy room.

Mindfulness is the practice of paying attention to the present moment without judgement. It has been integrated into Cognitive Behavioural Therapy  in a number of technical integrations including Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT).

Metacognitive Therapy is a type of Cognitive Behavioural Therapy that looks at our beliefs about worry. For example, the idea that worrying may keep us safe or that we we may not be able to control our worries.

Mental imagery, also known as visualisation, can be used to try out feared situations in the safety of the therapy room or client's home.