Cognitive Behavioral Therapy, or CBT, is a research based, short term treatment approach for many anxiety disorders, including social anxiety disorder. CBT is one of the most practical and results oriented therapeutic approaches used for treating social anxiety.1 Those who use this method to treat social anxiety have a remarkably high success rate.
Social Anxiety Disorder is characterized by intense fear or anxiety related to social situations in which the individual fears they may be judged by others. CBT for social anxiety usually consists of weekly, one-hour sessions, and lasts approximately 4-6 months.
Central Concepts of Cognitive Behavioral Therapy
Cognitive Behavioral Therapy focuses on the relationship between one’s thoughts, emotions, and behaviors. CBT attempts to help the individual understand the ways in which our behaviors are influenced by our thoughts and emotions relating to situations, as well as recognize and refute irrational thoughts that contribute to a decrease in healthy behaviors.
The overall goal of a CBT therapist is to help the individual learn to utilize the skills learned in therapy outside of the therapeutic session. Empowering the individual is a key part of CBT practice. Therapy is designed to be short term because the individual is learning to use practical skills that can be generalized and applied throughout their life.
How Can CBT Help With Social Anxiety?
Studies conducted on the efficacy of Cognitive Behavioral Therapy for treating social anxiety reveals that, not only is CBT an effective approach for the disorder, it is also considered at the top of the list of therapeutic methodologies that successfully treat anxiety disorders.2 CBT utilizes coping skills and exposure therapy to aid in the reduction of anxiety symptoms, including those associated with social anxiety disorder.
CBT aims to both help the individual understand what their irrational thoughts are and provide skills and techniques for debunking the irrational thoughts. Relaxation and mindfulness training are also key components to CBT that can help reduce anxiety.
CBT uses homework assignments in conjunction with in-office skills training to help the individual develop confidence, applying CBT techniques to real life situations. A large part of predicting success in therapy comes from the willingness of the individual to put forth the effort required for change to occur.
Common CBT Techniques & Tools for Social Anxiety Disorder
Cognitive Behavioral Therapy uses many different models, exercises, and practices to elicit change. When working with anxiety disorders, specifically social anxiety disorder, there are certain aspects of CBT that tend to provide the most relief for the individual.
While there are many, some of the more common techniques include:
The ABC model is designed to aid in evaluating situations and outcomes, often used to help predict likely outcomes based on beliefs and past behaviors.
- A – Antecedent: The situation or activating event.
- B – Beliefs: Your beliefs about the event, both conscious and subconscious.
- C – Consequence: Your behavior or emotional response to the event.
When we break down past situations into these categories, we can begin to understand how our beliefs, whether rational or irrational, determine the outcome of the situation. We can then begin to make changes to both our beliefs and behaviors to create more desirable outcomes.
S.M.A.R.T. goals are set by the individual with the aid of their CBT therapist.
- S.M.A.R.T. goals are specific, or clearly defined: The individual should know exactly what it is that they are to accomplish.
- They are measurable: The individual must be able to monitor their progress to know when they have reached their goal.
- They are attainable: The individual must possess the skill and resources required to reach their goal.
- They are realistic: The individual must be willing to devote their time and energy into accomplishing the goal.
- And they must be time-specific: The individual needs to set a clear and specific end date to complete their goal.
While S.M.A.R.T. goals are set by the individual, it is done so under the supervision of the CBT therapist. The therapist’s role is to ensure that the parameters for a S.M.A.R.T. goal are met to ensure the likelihood of success.
Often, the cause of many anxiety problems is our faulty thinking about ourselves and our environments. For this reason, cognitive restructuring is a key component of a CBT therapist’s technical approaches. Cognitive restructuring involves discovering, challenging, and replacing negative or irrational thoughts with positive, rational ones.
Since people with social anxiety disorder tend to avoid situations that cause their anxiety, the use of exposure therapy as part of their treatment is highly effective. Exposure therapy involves exposing the individual to the stressful stimulus until their level of anxiety decreases. With continued practice they begin to become desensitized to the stimulus.
There are several variations of exposure therapy:
- In vivo exposure:Involves directly facing the anxiety-provoking stimulus in real life. With social anxiety, this would involve exposing the individual to a social situation known to elicit fear.
- Imaginal exposure: Involves intensely visualizing or imagining the stimulus. When using this type of exposure with social anxiety, the individual would be asked to describe a social situation that would trigger their anxious response.
- Virtual reality exposure: Uses technology to aid in exposure. This could be used to create a virtual social situation, such as giving a speech in front of a large crowd, where the individual would be virtually exposed to the stimulus.
There are also different paces of exposure therapy:
- Graded exposure: This involves ranking an individual’s fears in a fear hierarchy, and exposure begins with the lowest ranking, or least provoking fear and working up toward higher ranking fears.
- Flooding: Also involves fear hierarchy ranking, but starts by exposing the individual to the fear that is the most anxiety provoking first and working down the list.
Relaxation exercises are another important component of CBT used for treating anxiety disorders like social anxiety disorder. Relaxation exercises include grounding exercises, breathing techniques, and muscle relaxation. Relaxation training can be combined with other therapeutic approaches like exposure therapy. The combination of these two techniques is used in systematic desensitization, which works by learning to associate feared social situations with relaxation.
Examples of CBT for Social Anxiety
Social Anxiety Disorder can present in different ways for individuals depending on their specific social fears. Treatment often involves taking a close look at the types of environments that are causing anxiety.
Example 1: Steve
Steve is a 46-year-old male who was recently promoted at work. One of his new responsibilities is conducting weekly staff meetings. In these meetings, Steve must stand in front of coworkers and present information related to company functioning. Steve had never been comfortable with public speaking, always fearing he would make a mistake or say the wrong thing and appear incompetent.
Before the first staff meeting that Steve was to present, he experienced symptoms of rapid heart rate, heavy breathing, nausea, and difficulty concentrating. Steve immediately went to the emergency room thinking he was ill. After being evaluated by a doctor, Steve was informed that what he had experienced was a panic attack. The doctor referred him to a CBT therapist to help him understand what had led to the panic attack.
Steve had a panic attack, but the underlying condition is social anxiety. While Steve may also need to work on coping strategies to combat future panic attacks, such as relaxation exercises, he may also find exposure therapy beneficial in helping him overcome his fear of public speaking.
Example 2: Sara
Sara, an 18-year-old college freshman, is adjusting to starting her first semester of college. She had moved out of state and away from her friends and family, and she is having trouble making new friends because of her shy personality. When in social situations, like working on group projects for class, she becomes extremely uncomfortable and has a difficult time interacting with her classmates. She always feels like the others are judging her or talking about her behind her back.
She became so preoccupied with their scrutiny that she began missing classes, which led to poor academic performance. She called her mom crying after weeks of feeling anxious and isolated. Her mother convinced her to make an appointment at the university’s counseling center.
Sara’s social anxiety makes it difficult for her to engage with others as she fears that they may be secretly judging her. Sara could benefit from a skilled cognitive behavioral therapist working with her to challenge her irrational thoughts about being judged by her peers.
Example 3: Abby
Abby is 7 years old and in first grade. At her parent-teacher conference her teacher informs her parents that Abby is very bright and does well academically. She then addresses concerns for her social development. Abby’s teacher says she does not like to read aloud in class or share stories during story time, and she even tried to hide when it was her turn for show and tell. She also said Abby prefers to play alone at recess instead of engaging with the other children. The teacher advised Abby’s parents to seek therapy for Abby to work on social skills.
Abby may find help from a CBT Therapist who specializes in working with children, who can help her understand the ABC model and how her thoughts and emotions help her make decisions. She can also learn how to use relaxation techniques during exposure therapy conducted in anxious social interactions, and begin replacing her anxious feelings with these new feelings of relaxation.
Treatment goals and timeframes can vary depending on symptoms and whether there are dual diagnoses present. But the average timeframe for CBT is generally between 4 to 6 months with one-hour, weekly sessions.
Is CBT Effective for Social Anxiety Disorder?
Cognitive Behavioral Therapy is one of the most empirically researched treatment methodologies, and the research supports CBT as a highly effective treatment for anxiety disorders, including Social Anxiety Disorder.
The National Institutes of Health, the Mayo Clinic, and the American Medical Associate are among the many accredited organizations to provide research-based evidence of the efficacy of CBT for treating anxiety disorders.7
How to Find a CBT Therapist
Because of its high success rate, many providers use Cognitive Behavioral Therapy to treat a vast number of mental health issues. Finding a provider in your area can be done with an internet search. Using online directories can help, as they allow you to narrow your search by location and type of therapy, as well as a list of other factors you may want to consider.
When searching for a CBT provider, you may want to ask about their CBT training as well as how long they have been practicing using this type of therapy. All CBT providers should hold appropriate licensure.
At-Home CBT Exercises for Social Anxiety
If you are experiencing social anxiety, it is best to seek professional help. However, there are some CBT exercises you can do on your own which may alleviate some symptoms. Like any other new skill, they may feel uncomfortable at first. But the more they are practiced, the more effective they wIll be in reducing anxiety.
Deep Breathing Exercise
There are an abundance of simple deep breathing exercises that can be performed at home.
To do one of these exercise at home:
- Breath in through your nose for 5 seconds.
- Hold the breath in your lungs for 5 seconds.
- Breath out through your mouth for 5 seconds.
You can practice this technique for 5-10 minutes at a time and can be used to calm your breathing and slow your heart rate when you are feeling anxious in social situations without drawing attention to yourself.
Use a grounding exercise to keep your focus on the here and now in social situations by seeking out sensory stimuli in your current environment.
To do a simple grounding exercise, focus on finding:
- five things you can see
- four things you can touch
- three things you can hear
- two things you can smell
- one thing you can taste
These are just a couple of CBT techniques that you can try for yourself. Of course, other aspects of CBT, like exposure therapy, should be done with the help of an experienced cognitive behavioral therapist.