In a newsletter published by the International Association for Cognitive Psychotherapy, anxiety expert Dr. Christine Padesky described a unique treatment approach to social anxiety disorder (SAD). Padesky argued that the traditional focus of cognitive therapy only takes care of half of the problem for people who suffer with SAD.
One of the main causes of anxiety is the overestimation of danger. For example, people with panic disorder are fearful of physical symptoms because they might be the onset of a heart attack. People with social anxiety disorder (SAD) are afraid that they will be judged negatively because of their anxiety in social situations. Cognitive therapy shows you how your fears may be unfounded -- that people are not as judgmental as you think.
What is the problem with this approach? The problem is that sometimes people will be judgmental. If you are not prepared to cope with judgement and rejection, then the fear of social and performance situations will always persist.
Padesky presents a way to increase coping skills by exposing the person with SAD to harsh judgement during role playing in therapy sessions. Through this process, you are able to increase your self-confidence and learn how to better cope with criticism and rejection.
Padesky describes the typical steps that would be taken during therapy to increase confidence. Although this process is best enacted with a therapist, it is also possible to work on these steps on your own. Below is a description of how to work on this as a self-help project.
Step 1. Identify your automatic thoughts about the critical things that other people might say about you. Make a list of all of the possible things that you might hear.
Step 2. Create a list of responses. This step, called the "assertive defense of the self," involves coming up with a confident and assertive reaction to each of the possible criticisms.
Below is an example of how this might look:
Critical Thought: "You are shaking. Is there something wrong with you?
Assertive Response: "My hands are shaking because I am anxious. Some people are afraid of heights; I get anxious when I am around people. It doesn't make me any different than anybody else. In fact, a lot of people have this fear. It's just that nobody talks about it."
During therapy, Padesky would role play with the client. As the therapist, she would play the critical role, and ask her client to come back with assertive responses. She argues that this in-therapy practice is important because in real life, actual overt criticism is few and far between.
In the article, she describes what the final session of role-playing might look like:
"Therapist: You're shaking. Is something wrong?
Client: Not really. I'm just anxious, that's all.
Therapist: Why are you anxious?
Client: I get anxious in social situations.
Therapist: YOU DO? What's wrong? Are you crazy or something?
Client: No, I'm not crazy. I have social anxiety.
Therapist: Social anxiety? Sounds crazy to me!
Client: Maybe you aren't familiar with it. But it's quite common. It doesn't mean I'm crazy.
Therapist: You may not think so. But I think you're pretty weird if you shake like this.
Client: I can understand how it might seem weird if you're not familiar with it. But I'm not crazy.
Therapist: I don't know. I think you must be nuts.
Client: I'm sorry you don't understand. But I'm not nuts."
By the time of this conversation, the person with social anxiety usually reports feeling irritated by the critical voice rather than shamed by it.
One way to practice this process on your own is to argue against the critical voice that is already in your head. Do this first at home when you are not in social or performance situations, until you are able to easily defend yourself against your criticisms. Then, once you feel in control, try practicing in real-life situations, imagining the critical voice of others.
You might even try exaggerating your symptoms or seeking out rejection, just so that you can practice your coping skills. Padesky suggests displaying shaking hands while looking someone in the eye, or deliberately asking a neighbor over for coffee who is obviously too busy to talk with you.
The goal of this process is to develop a more confident and assertive way of coping with potential rejection and negative judgment. By exposing yourself to criticism and rejection, you will learn that you can cope.
Source:
Padesky CA. A more effective treatment focus for social phobia? International Cognitive Therapy Newsletter. 1997;11(1):1-3.
