CBT for Social Anxiety: A Step‑by‑Step Guide
Cognitive Behavioral Therapy (CBT) was originally developed in the 1960s by Dr. Aaron Beck to treat depression; since its inception, it has become a first line, gold standard treatment for a variety of clinical presentations, including anxiety disorders. Accordingly, it is commonly used by therapists in their work with clients who experience social anxiety. In addition to the substantial database attesting to the effectiveness of CBT in targeting the harmful thought patterns that give rise to anxieties and fears, therapists themselves oftentimes default to this line of treatment because its core tenants map on well to the clinical presentation of Social Anxiety. Social Anxiety stems from cognitive distortions about social situations and CBT aims to target and modify them.
CBT for Social Anxiety Disorder (CBT-SA) aims to identify irrational beliefs and thought patterns and adapt them to be more balanced. In doing so, feelings and behaviors will begin to follow suit and evolve to be more realistic. For example, people with social anxiety may fear being judged by their peers and ruminate over previous interactions they have appraised to be embarrassing or shameful. They may strive for perfection in their conversations and when they do not match these lofty expectations they may internalize this disappointment and develop negative beliefs about themselves and their self worth. These negative thoughts occur automatically for a lot of people and before they know it they are overwhelmed with an inundation of anxiety that oftentimes exceeds their capacity to cope with. Over time, this thought pattern becomes ingrained in the brain, making it exceedingly difficult to shake.
CBT-SA, from a cognitive perspective, narrows in on the maladaptive beliefs and works to reframe them to be more accurate. Rather than continuing to catastrophize over saying the wrong thing or overgeneralize that you always say the wrong thing, therapists and clients collaborate to widen the scope of interactions to evaluate them more fairly. For example, after giving a presentation in class, a student may feel discouraged and defeated because they mispronounced one word or had a typo. While these things may have really happened, and may leave a bit of an icky feeling, it also may be true that this student may have been able to answer every question asked at the end with facility, confidence, and adding nuance to the conversation. Cognitive restructuring is not aimed at putting a positive spin on experiences, but it is concerned with reducing all or nothing thinking and increasing perspective taking.
CBT-SA, from a behavioral standpoint, offers solutions to breaking the vicious cycle of anxious thoughts brought on by social situations. One such technique is Systematic Desensitization, a behavioral intervention used to modify socially anxious behaviors. systematic desensitization is a form of exposure that couples paced introduction to anxiety-inducing situations with relaxation strategies. This is, of course, a slow process that can be adapted to each individual according to their needs and their comfort threshold. In between sessions, clients may be tasked with imagining frightening social situations and, as their anxiety begins to build, employing the soothing skills learned in session to stave it off until it begins to dissipate. Eventually, when they feel ready, clients will immerse themselves into these feared social environments intentionally and utilize the relaxation tools they now have in their toolbox to remain present and tolerate the discomfort.
On the whole, CBT-SA is a wonderful treatment option for Social Anxiety because it targets various aspects of the fears and worries, including both cognitive distortions and unhelpful behaviors. This comprehensive approach allows CBT-SA to cast a wide net and serve as an appropriate treatment for various presentations of Social Anxiety. It can be tailored to each individual and emphasise the interventions that best align with what each client needs and would benefit from.
