How to Overcome Social Anxiety with Cognitive-Behavioral Therapy

What Social Anxiety Is

Social anxiety is a general or specific fear regarding social situations. Almost everyone experiences some kind of social anxiety throughout their life. Perhaps some only get anxious before giving a big public speech or performing in front of an audience, while others may get anxious over little social interactions, like going to school everyday or shopping for groceries.

Recent cross-cultural research has shown that between 5-7% of the population experiences some kind of social anxiety disorder (SAD). SAD is a clinical condition that includes excessive social anxiety, often defined as causing distress and/or impaired ability to function in at least some parts of daily life.

The SAD is clinically defined using the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). The main criterion for being diagnosed includes:

A. Persistent fear of social or performance situations in which embarrassment may occur.

B. Exposure to the social or performance situation provokes an immediate anxiety response.

C. The individual recognizes his or her fear as excessive or unreasonable.

D. The social or performance situation is often avoided or endured with dread.

E. The avoidance, fear, or anxious anticipation of encountering the social or performance situation interferes significantly with the person’s daily routine, occupational functioning, or social life, or if the person is markedly distressed about having the phobia.

F. In individuals younger than age 18 years, symptoms must have persisted for at least 6 months before Social Phobia is diagnosed.

G. The fear or avoidance can’t be attributed to direct physiological effects of substance abuse.

If you think these symptoms may apply to you then you may have a type of SAD.

However, if you really want to get properly diagnosed, you have to see a licensed psychologist. You cannot diagnose yourself with a psychiatric disorder.

Other signs of social anxiety include biological responses such as:

• Rapid breathing
• Palpitations
• Tremors
• Sweating
• Muscle tension
• Blushing
• Gastrointestinal discomfort
• Diarrhea
• Cold clammy hands

as well as other behavioral characteristics:

• Shaky voice
• Poor eye contact
• Poor body posture
• Fidgeting
• Repetitive behaviors such as rapid tapping of feet or fingers.

As you can see, social anxiety is a complex psycho-physiological state that can manifest itself in a number of ways. When we find this anxiety inhibiting our well-being and performance at work, school, home, or in our social life, then it may be time to start looking for ways to manage it better.

The Role of Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy (CBT) is one of the most common talk therapies in modern clinical psychology, and it has been effective in the treatment of various mood and anxiety disorders. As the name suggests, this therapy includes use of both cognitive and behavioral strategies.

Cognitive strategies are based on discovering thought patterns that may attribute to our emotions and behavior. Often we may discover that we operate on irrational beliefs or assumptions that don’t hold any bearing to the real world. When we realize our mental state is based on these irrational assumptions, we can try to replace them with more helpful beliefs that motivate us to think, feel, and act more effectively.

One of the most common cognitive strategies is cognitive restructuring. This can be done during 1-on-1 counseling, group therapy, or self-talk.

The goal is to ask questions about our social anxiety and fears in order to become more aware of the thought patterns that underlie them. Once we discover these patterns, we can determine whether or not they elicit the thoughts, feelings, and behaviors we want, or if we should try to replace them with more life-enhancing thought patterns. By doing this we can actively change our beliefs (our so-called “map of the world”) and even restructure our brains through a process known as neuroplasticity.

The other aspect of CBT is the behavioral component, often including therapies like exposure therapy and operant conditioning. This component of CBT distinguishes itself from cognitive therapies because instead of focusing on internal thoughts and beliefs, it shifts its focus outward toward habit-building.

The truth is that we can think about being better in social situations all we want. We can develop the right thoughts, beliefs, and attitudes, but if we never practice actually go outside of our homes and interacting with others then it is unlikely that we will learn ALL of the tools needed to improve our social lives.

CBT therapists recognize that experience is sometimes our best teacher. And in order to overcome our social anxiety it is sometimes necessary to “put ourselves out there” by engaging in more public speaking, job interviews, parties, bars, family reunions, and other kinds of social get together.

But of course exposure therapy doesn’t mean we just jump right into difficult situations. Exposure therapy usually goes as follows:

• Identify social activities that elicit anxiety.
• Rank the level of anxiety elicited from each social activity.
For example:
• Talking to a family member. (Low = 2)
• Talking to a friend. (Low = 10)
• Talking to a teacher. (Medium Low =20)
• Talking to a boss. (Medium = 40)
• Talking to a girl/boy you like. (Medium = 55)
• Talking with an employer during a job interview. (Medium High= 70)
• Giving a public speech. (High = 80)
• Start with activities that elicit low anxiety and expose yourself to more of these types of interactions. Once you have developed a sense of comfort, move on to other activities that elicit higher anxiety. Systematically do this until you have trained yourself to better manage anxiety at each level.

Keep in mind: The above is just an example of how someone might categorize their social anxiety. It may differ for you depending on if what kind of social anxiety you have (and whether it is more generalized or focused on a specific situation).

The key point here is to first exposure yourself to social situations that elicit small amounts of anxiety and then work your way up to more difficult levels of anxiety. By doing this you can gradually condition yourself to better manage anxiety in these different situations.

Finding a therapist

By seeing a professional psychologist you can determine whether or not you have social anxiety disorder and how you should go about receiving treatment.

Here is a worldwide database of Cognitive-Behavioral therapists that may be in your area. CBT is currently one of the most widely practiced psychotherapies today and it is widely regarded as a common solution to issues involving mood and anxiety disorders.

The role of psychopharmaceuticals

Please keep in mind that social anxiety can be dependent on many different biopsychosocial factors. It is not guaranteed that cognitive-behavioral therapies will work for everyone. In fact, for some individuals (especially those who have more biological causes for their anxiety) it may be more appropriate to get prescribed medicine from a psychiatrist. Or, it may be necessary to get a combination of both CBT and prescribed medicine (combining both talk therapy and medication has typically shown to be more effective than just having one or the other – though this isn’t necessarily the case for everyone).

Self-help applications

For one reason or another you may not want to see a professional psychologist or psychiatrist. Maybe your anxiety is too strong to even see a psychologist in person. Maybe you don’t have the money. Or maybe you think your social anxiety isn’t that bad and you can fix it yourself. Whatever your reason may be, there are some self-help applications that can help you overcome social anxiety by studying and practicing these techniques on your own.

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