Social anxiety disorder (SAD) is commonly treated with cognitive-behavioral therapy (CBT), a form of therapy that first became popular in the 1980s and 1990s for treating anxiety disorders. Research has shown that CBT is one of the few forms of therapy that reliably helps in overcoming clinical anxiety disorders.
CBT is not one set method but rather a combination of various techniques that depend on the disorder being treated. For example, CBT for treating depression will be different from CBT for treating SAD or other anxiety disorders. Because there are so many different techniques, it is important that your therapist is experienced in using CBT for treating SAD, and knows which particular techniques are most effective for this disorder.
Goals of CBT for Social Anxiety Disorder
One of the central goals of CBT is to identify irrational beliefs and thought patterns and replace them with more realistic views. As part of the therapy process, you will work on a number of problem areas including:
- misperceptions you may have about your abilities and self-worth
- guilt, embarrassment, or anger over past situations
- how to be more assertive
- tackling perfectionism and being more realistic
- dealing with procrastination related to social anxiety
Your CBT therapy sessions may feel somewhat like a student-teacher relationship. The therapist will take the role of a teacher, outlining concepts and helping you on a path of self-discovery and change. You will also be assigned homework assignments that are key to making progress.
CBT consists of a number of techniques, many of which focus on problematic thinking. Cognitive methods help lessen anxiety in interpersonal relationships and groups, and give the person with SAD a feeling of control over their anxiety in social situations. The ultimate goal of cognitive therapy is to change your underlying core beliefs (also known as your “schemas”) which influence how you interpret your environment. A change in your core beliefs will lead to long-lasting improvement of your anxiety symptoms.
One of the central problems targeted by CBT are automatic negative thoughts, also known as cognitive distortions. People with SAD have developed automatic negative ways of thinking that are misaligned with reality, increase anxiety, and lessen your ability to cope. These thoughts occur instantly when you think about an anxiety-provoking situation. For example, if you have a fear of public speaking, just thinking about the situation will elicit thoughts of embarrassment and fear of failure. The goal of CBT is to replace these cognitive distortions with more realistic views.
As a person suffering from SAD, at some point in your life someone has probably told you to just “think positive”. Unfortunately, the problem is not that simple to solve –- if it were, you likely would have overcome your anxiety long ago. Because your brain has become hardwired over time to think negatively and have anxious thoughts, it needs to be gradually trained to think in a new way. Just telling yourself “I will be less anxious next time” doesn’t work because this is an irrational statement, given your current way of thinking.
Changing negative automatic thinking in the long term requires practice and repetition, every day for several months. At first you might be asked simply to catch negative automatic thoughts and make them rationally neutral. As this becomes easier, you would work your way up to thoughts that are more realistic. Only then does it become automatic and habitual.
Over time, your memory processes will be affected and the neural pathways in your brain will be altered. You will begin to think, act and feel differently, but it will take persistence, practice, and patience for progress to be made. At first, this is a conscious process but as it is practiced and repeated it becomes automatic.
One of the most commonly used behavioral techniques to treat SAD is exposure training, also known as systematic desensitization. Exposure training involves gradually exposing yourself to anxiety-provoking situations so that over time they elicit less fear.
Exposure training for SAD has to be a very gradual process. People may have told you to “toughen up and face your fears;" unfortunately this is extremely bad advice. People with social anxiety are already forced to face what they fear on a daily basis. Exposure that is not structured in a gradual step-by-step process does more damage than good. It will make your anxiety worse, keep you locked in a vicious cycle, and eventually lead to doubt and depression.
With your therapist, you will gradually expose yourself to feared situations so that over time they no longer elicit fear. At first, you may practice “in vivo” exposure, such as imagining giving a speech or practicing a job interview through role playing. Once the practiced or imagined situation becomes easier, you would move to the situation in the real world. If exposure training moves too fast or the situations are too demanding too soon, it will backfire.
Keys for Success
Research has shown that there are several keys for success when it comes to CBT and SAD. The likelihood that CBT will help you depends largely on your expectations about success, your willingness to complete homework assignments, and your ability to confront uncomfortable thoughts. People who are willing to work hard and believe that CBT will help them are more likely to improve. Although this form of therapy is intensive and requires active participation by the person with SAD, the improvement shown tends to be long-lasting and well worth the effort invested.
Anxiety Treatment and Resource Centre, Hamilton, Ontario, Canada. Social Anxiety Disorder. 5 September 2007.
Beck, J.S. (1995). Cognitive Therapy: Basics and Beyond. Guilford Press.
Social Anxiety Institute, Phoenix, Arizona. What is Comprehensive Cognitive-Behavioral Therapy? 5 September 2007.