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Cognitive Behavioural Therapy for Social Anxiety Disorder

Man sitting on his own in large dark room

After Depression and Generalised anxiety, Social Anxiety Disorder is the 3rd most common mental health disorder.  However, due to the very nature of the problem, treatment for Social anxiety disorder is not always sought.

The effects can be severe.  People with social anxiety disorder can experience difficulties in relationships, friendships, career and health and are at an increased risk of other mental health problems such as depression.

This article takes a deep look at social anxiety disorder (sometimes also called social phobia) and at how Cognitive Behavioural Therapy (CBT) can be used as an effective Social Anxiety Disorder treatment.

I’ve gone into a lot of depth with regards to the actual treatment for social anxiety disorder for a very specific reason:

Social Anxiety itself stops people from looking for help

Studies suggest that only around half of people with Social Anxiety Disorder ever seek help and this is often only after between 15 to 20 years of living with the problem.

My aim here is to “demystify” what CBT treatment for social anxiety disorder/social phobia actually is.  I want you to understand the key elements of the problem – all of the things that happen in your head, in your emotions and in your behaviour that serve to keep the problem going.  I then want to be really clear about how we then treat it so, when you decide to get the help, you know exactly what to expect.

We offer treatment for Social Anxiety Disorder and Social Phobia face to face from our clinic in Liverpool, Online either via secure video messaging or private messaging forum or by phone.  Often people find it easier to begin therapy by phone, secure video or messaging – I too think that this is a great way to begin working with your Social Anxiety Symptoms.

If you want to get help from us then please feel free to contact us on 07887 701 176 or enquiries@accessCBT.co.uk

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Social Anxiety Disorder & Social Phobia

Let’s start by talking about what Social Anxiety Disorder (also sometimes called Social Phobia) actually is and what it looks, and feels like, from the clinical perspective.

People with Social anxiety disorder report that they feel intense anxiety, sometimes at the level of a panic attack, when faced with a social situation.  This anxiety will often be underpinned by a belief that the individual’s ability to perform or function in the social situation will be scrutinised, criticised or otherwise viewed negatively by other people in the the situation.  They often expect to feel humiliated, shamed or ridiculed in social situations.

To deal with their anxiety or just get through the social situation, the individual will adopt a number of behavioural strategies, such as avoiding eye contact, not speaking in public or behaving in other ways to tolerate their distress.  Even when they manage to get through the situation, they may feel like it was a “near miss” or that they just managed to get through.  Often the will avoid social situations entirely.

The box below shows the different diagnostic criteria used by the diagnostic and statistical manual V (DSM-V) to diagnose social anxiety disorder.

The diagnostic and statistical manual version 5 (DSM-5)  defines Social Anxiety Disorder like this:

A.  A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.

B.  Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.

C.  The person recognizes that this fear is unreasonable or excessive.

D.  The feared situations are avoided or else are endured with intense anxiety and distress.

E.  The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F.  The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.

G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder…

Copyright 2013, The American Psychiatric Association

A Cognitive Model of Social anxiety Disorder/social phobia

This is an image of a Cognitive Model of Social anxiety Disorder originally developed by Clark and Wells in 1995.  A “Model” is simply a map of what we believe to be going on when Social Anxiety is happening and gives us a breakdown of which parts can be treated to reduce the social anxiety.

You can hover over the red dots for more information about each of the parts of the model and I’m going to take you through them in more detail here.

Firstly, we have our “Trigger social situation.”  This can be any situation which activates our social anxiety but some common examples include:

  • Speaking to someone new.
  • Giving a presentation.
  • Going on a date.
  • Speaking in front of a large group.
  • Meeting someone in authority.

Our next box is “Activates negative thoughts.”  In our CBT cognitive model, the main assumption is that for us to experience a certain emotional state, we will have had a thought pop into our mind which is evaluating an event or situation in a particular way.

This is what is meant by an “Automatic Negative Thought.

In social anxiety, an Automatic negative thought might be something like, “They’ll think I’m stupid” or “I’ll start shaking and look anxious”.  These thoughts are only anxiety provoking in the context of what we expect to happen if they were true.  For instance, “They’ll think I’m stupid” is likely to create anxiety for us if we believe that “Others will reject people who come across as stupid”.  This relates to the third box in our model, the one titled “Perceived social threat.

Social anxiety disorder model

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The “social object”

If we follow the arrows down we then come to the circle entitled, “Processing of self as a Social object.”  What does this mean?

Well, we all have an image in our minds of how we think we look.  This image is constructed by a combination of memories of the times we have seen ourselves (photos, in a mirror etc), information we have got from what other people may have said about us, and from sensory information from how we feel in our bodies.  In simple terms, our minds “create” an image of what we think we look like using different sources of information.  This is our view of ourselves as a Social Object.

Now, in social anxiety disorder – what do you think this “Social Object” might look like when the social anxiety is activated?

Strong? Capable? Confident?  Probably not.

Instead, typically the image will be a negative one and one which increases our feelings of anxiety.  We are much more likely to build our Social Object upon thoughts of how anxious we think we look, memories from when we may have been anxious in the past and from the anxiety symptoms that we can feel in out body (e.g., shaky, sweaty, mumbling, blushing or mute).

Our processing of ourselves as a Social Object might make us view ourselves as observably anxious, maybe with our hands shaking uncontrollably, our voice wavering covered in a sheen of sweat and pillar box red from blushing.

But the key thing here is that this image is a construction.  It isn’t necessarily the truth.  But the problem is that the socially anxious individual is so self-conscious – that is, their attention is so focused inwards – that they are only paying attention to how anxious they themselves feel and think they look.  This inward self-focused attention upon the thought of how they look and the physical feedback they are getting from their body creates further social anxiety.

So, at risk of labouring this point, in social anxiety we create an internal model of how we believe we are coming across in a social situation that is based upon an internally focused perspective.

Now ask yourself, what is the problem with this?

There are two main problems as far as social anxiety disorder goes.  The first is that, because the individual is so self-focused, they often fail to notice any information around them that would challenge their internal idea of how they think they appear.

For example, if I’m so focused upon how anxious I think I look, believing that I’m appearing to others like a sweating, shaking, mumbling mess and my main source of input for this idea is because I’m self-focused upon how sweaty I feel, the shaking I notice in my hands as my heart is pumping and the fact that my mind appears to go blank, then I’m unlikely to notice any information from my external environment to contradict this.  I’m unlikely to notice that people around me are even aware that I’m feeling the way that I feel.

Because the individual with social anxiety disorder is so self-focused in social situations, they fail to see information from around them that would convince them that they were not appearing as anxious to other people as they believed themselves to be.  This is where the next box in our model comes into play – “Safety behaviours and avoidance.

Diagram showing how self-focused attention contributes to processing of self as a social object in social anxiety disorder

Safety behaviours and avoidance

We talk a lot about safety behaviours in CBT.  A safety behaviour is a type of behaviour that we do to alleviate our distress or help us to “get through” a particularly challenging situation.  In social anxiety and social phobia, a safety behaviour is something that we do to either cope with the physiological symptoms of our anxiety – our trembling hands, blushing or sweating – or to get us through the social situation in as least distressing a way as possible and to reduce the chances of being viewed negatively by other people.

The problem with safety behaviours however is that we never get to find out what would happen if we didn’t use them.  In fact, what we tend to find is that using safety behaviours in social situations can actually serve to keep the problem of social anxiety going.

The following example shows how…

This image is a snapshot of the lower half of the Social Anxiety model shown earlier.

What we can see here is how a socially anxious individual may do a certain set of behaviours in response to how they feel and how they think they look.  We can then also see that these particular behaviours can then keep the problem going or even make it worse.

To begin with, we have the top circle representing the “self as social object” and can see that the individual in this case sees themselves as blushing bright red, with uncontrollable shaking hands and covered in sweat.

Regardless of whether this image is accurate or not (and it usually isn’t!) the individual will expect to be judged negatively and as such their anxiety response will bed in further with increased physical and cognitive anxiety symptoms.  Check out fight or flight for more info on this.

So what does our socially anxious individual do to deal with all of this?  Firstly, they might avoid the situation entirely.  Unfortunately, although this strategy may give us relief in the short term, we are failing to gain opportunities to get used to being in social situations and the problem keeps on going.

Safety behaviours in Social anxiety disorder

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Secondly, the behaviours have the effect of actually making the situation worse.  If I choose to cover myself up so that people can’t see how hot and sweaty I am, what happens?  That’s right, I get more hot and sweaty.

Likewise, if I grip tightly onto a pen or bottle of water or anything else to keep my hands still from shaking, what happens?  Try it – The shaking actually gets worse.

We see here, that the safety behaviours that we use to deal with our anxiety and to get by actually maintain our social anxiety disorder – So what do we need to do to fix this?  We need to learn how to drop them – we’ll discuss this further in the Treatment section of this article.

Anticipatory and post-event processing

Anticipatory and post-event processing are two more key maintaining factors in social anxiety and social phobia.

“Anticipatory processing” refers to the process which occurs in social anxiety disorder in which the individual spends time thinking about future social interactions which may pose a perceived threat.

So, even before they are in the social situation, people with social anxiety disorder will find themselves working through potential situations in their mind – planning how it might go, what problems there might be and what to do or say so that they can “get through.”

There are some problems with this type of thinking.  Firstly, we do not know what the situation will actually be like and the chances of us being able to predict the situation are slim, particularly as we are likely to be using the sorts of negative thinking and unhelpful thinking styles that characterise anxiety.

We are very to generate a distorted, threat-heavy picture of what the situation might be like.  If we generate such a picture, with predictions of others judging us negatively whilst we stand there sweating, mumbling and stuck for words, what happens?  We begin to experience anxiety even before the event is happening – This could be the night before, the week before or even months before a given social situation.

Secondly, because anticipatory processing focuses upon what might go wrong for us in a social situation, it increased the likelihood that we are going to use safety behaviours or simply avoid a social situation entirely.

Post-event processing in social anxiety is the opposite to anticipatory processing.  After we have been in a social anxiety trigger situation, post-event processing is the process by which we then reflect upon how we think we came across.  The problem with this process however, similarly to anticipatory processing, is that the reflection on our performance is also informed by thinking biases and cognitive distortions.

In the post-event processing, we are reviewing our performance based upon a memory of how we think we came across.  Now, because we may have been excessively self-focused and not been aware of much of the non-verbal feedback that people may have given us in the social situation (e.g., smiles of encouragement, listening attentively) our post-event reflections of the event will be skewed by our limited, distorted memory of the event.  As such, it may not be a very reliable representation of what actually happened and can contribute to maintenance of the problem.

Post-event processing will often be characterised by negative thoughts such as, “they all thought I looked foolish”, “everyone saw how anxious I was” and “that was a disaster.”  Again, these are judgements based upon incomplete information, negative thinking and cognitive biases.

Negative thoughts and thinking errors

Negative thoughts play a large role in social anxiety disorder and there are lots of different ways in which they can do this.  In CBT we spend a lot of time identifying, exploring and modifying our thinking, often finding that many of the thoughts that we have can sometimes be unhelpful and/or inaccurate.  We call this activity “Thought Challenging” or “Cognitive Restructuring.”

To change our thoughts, we first need to learn what they are.  This may seem obvious – “I know what I’m thinking”, I hear you say, however we are after a very particular type of thought.  We call this thought a “Negative Automatic Thought” or NAT for short.

A NAT can be thought of as a thought that enters our consciousness automatically, makes an evaluation about an event, and then triggers a negative emotion such as sadness, anxiety, anger or shame.  Often however the NAT doesn’t necessarily get noticed by us as we are already paying attention to the negative emotions it creates.

Let’s look at an example.  Let’s say that we see a dog in the street and then notice that we are feeling the emotion of fear – why do we feel fear and not some other emotion?  Our mind has had a negative automatic thought.  The thought popped in, said something like “That dog looks dangerous, best get running” and the next thing we know is our heart is pounding and we’re running up the street in fear.  If we were able to notice the thought and evaluate it before the feeling of fear was generated, we may have stuck around to find out whether the dog was a genuine threat or whether it was just a playful puppy.

If you think about it, this example is very similar to what happens in social anxiety disorder.  We have a trigger (a social situation), we have our NAT (e.g., “They’ll think I’m boring/an idiot/anxious”), our fear kicks in and we either escape, avoid or use safety behaviours to get through the situation.

But – and this is an important “but” – what if our NAT’s are in part or even completely inaccurate?  What if our NAT’s are so inaccurate that all of the distress that we experience is based upon something close to a fabrication?   If we’re experiencing this much distress, then we at least need to check out the evidence for our NAT’s.

There are lots of strategies for doing this.

First off, we use thought records to enable us to “catch” our NAT’s.  A thought record is a really simple tool to use – you can download one of our thought records here.  Just focusing on the first three columns to begin with (Situation, Feeling and Negative Automatic Thought), you will be asked by your therapist to carry your thought record around with you between sessions and use it to catch any automatic thoughts that are present when your social anxiety is triggered.

This first exercise is important for two reasons:

      1.  Catching your negative automatic thoughts whilst they are “live” in the real situations gives us accurate content to work with – we know exactly what the NAT’s are and we can begin to develop our working social anxiety formulation around them.
      2.  By catching your NAT’s in this way you are becoming more aware of them – that is, they become less “automatic” and more available for you to respond to, and change them.

There are then lots of different ways for us to challenge our NATs.

For instance, We can evaluate the evidence for them (sometimes called the “courtroom intervention).  We can develop a behavioural experiment to enable us to test out whether our socially anxious thoughts come true in the “real world”.  We can also begin to familiarise ourselves with the long list of thinking biases that can occur in anxiety disorders and learn to label and distance ourselves from them as they arise.

CBT Treatment for Social Anxiety & Social Phobia

So, now we understand what is happening in social anxiety disorder and what processes keep it going, how exactly are we going to treat it?

Step 1 – Formulation.

First of all, we want to really test out how well the model above fits with your experience of social anxiety disorder.  At this stage, your CBT therapist will spend a lot of time sketching out the above social anxiety model with you, but will enter in all of your own experiences of what happens during a typical episode of your social anxiety.  To help with this, we will typically ask you to keep a Social Anxiety Diary to record what actually happens when you feel socially anxious.

We will want to know the trigger situation, the automatic negative thought that popped into your head at the time the episode occurred, what you thought that you looked like in the social situation, what emotions you felt and what you did to deal with the situation.

Then we take all of this information and compile a model like the one above, but with your own information.  We call this personalised model an idiosyncratic formulation.  The formulation is our snapshot of just how you do your social anxiety.

The use of the diary as described above is an important element of treatment and is something that your therapist will ask you to continue using throughout treatment.  There are a number of different types of unhelpful thoughts and thinking processes that contribute to social anxiety disorder – using the diary regularly will help you to identify and challenge this unhelpful thinking.

Step 2 – Dropping Safety behaviours and Self- focused Attention

As we saw in the model earlier, when we find ourselves in a situation in which our social anxiety is activated, our behaviours and focus of attention change.  We typically find that we become much more self-focused – so much so, that we notice every little change in our movements, our speech and our body.  And, as our model suggests, noticing these small changes through this enhanced self-focus leads us to become more anxious, leading to more self-focus – the problem gets worse.

Likewise, because we don’t want people to notice how anxious we feel, we also use lots of safety behaviours to get through the situation.  Again these behaviours (e.g., avoiding eye contact, saying little, holding onto something to keep our hands still) also keep the problem going.

We never get to find out what might happen if we didn’t do them!

So this stage in the treatment is all about understanding the role that self-focused attention and safety behaviours play in the maintenance of our social anxiety symptoms.

Firstly, your therapist will talk you through the role that attention and safety behaviours play in the problem maintenance, just like we have done here.  Then they will create two situations for you to experiment with what happens when you both use your safety behaviours and self-focus and then when you drop them.

So for instance, we may agree on you having two conversations with one of my colleagues.  In the first conversation, you would use every one of your safety behaviours, really use them.  You would also deliberately focus upon yourself – How you’re coming across, how anxious you feel, etc.  We then take a rating and have a discussion about how anxious you felt, how anxious you think you looked and any other factors relevant to your particular formulation.

In the second role play we would drop all of these safety behaviours.  Maintaining appropriate eye contact, keeping hands relaxed and speaking less quickly for example.  You would also be aiming to shift self-focus by focusing more on what the other person is saying, doing and wearing.  And again, just like in the first role play, we would take a rating on how anxious you felt, how anxious you think you looked etc.

What do you think we might find in doing this exercise?

Well, people tend to find that they feel more anxious in the first role play, whilst using self-focused attention and their safety behaviours, than they do in the second.  They realise that the self-focus and behaviours actually keep the problem going and are unhelpful for them in their social anxiety.

The client is then encouraged, over the following week, to experiment with dropping and using their safety behaviours in any social situations that they come across over the next week and see the effects that this has upon their social anxiety.

Step 3 – Is that really how you look?

So, we talked earlier about how we create an inaccurate internal image of how we think we look – what the model calls, “processing of self as a social object.”  

How do we challenge this?

What we need to do is create an opportunity for you to compare the image of you that you have in your mind and how you actually look.  Using Video feedback is  fantastic way to do this.

This is what we do…

    1. Create a firm picture of how you think you look.  For instance, we might use a “redness” colour chart to predict how much you think you blush.  We will also get a firm idea of how much you believe you will shake, your voice wobble or get hot and sweaty.  It’s important for us to as closely define each of these areas as possible.
    2. Create a trigger situation for your social anxiety.  For instance we might get you to give a presentation in front of a group of people.
    3. Record the situation using a video recorder.
    4. Watch the video and compare what you predicted you would look like in a social anxiety situation with what you actually did look like.
    5. Reflect – Was your blushing as noticeable as you though it would be?  How much did your hands really shake?  What did you learn from all of this?  What does this mean for the future?

People tend to find that how they expect to see themselves doesn’t match what they actually look like in the social situation.  In fact, they’re often shocked to find out just how different they actually look compared to how they think they look.  This leads to a significant reduction in anxiety for them.

Step 4 – Behavioural Experiments

Behavioural experiments are used a lot in Social Anxiety Disorder and in CBT in general.  A behavioural experiment is a way of us testing out old, unhelpful beliefs or new more balanced beliefs in a “real-world” context.  It’s often much better for us to learn new perspectives and beliefs by actually putting them into action.  As you may have experienced, it’s one thing to “know” something in your head, but when a situation arises it can often be forgotten.

There are lots of different ways to create behavioural experiments in social anxiety so we’ll give you just one example here:

Kevin had the belief that if he didn’t pay close attention to the words coming out of his mouth when he was in a social interaction, then he would say something stupid and be laughed at.  He and the therapist agreed to create an experiment to test this belief out.

First of all they defined the negative thought as:

“I must pay close attention to saying intelligent words otherwise I will say something stupid and get laughed at.”

Kevin rated his belief in this thought at 90%, a belief so strong that it meant that he always put a lot of effort into finding the right words to say in a conversation so that he didn’t appear stupid or incompetent.  The problem with this was that he then often stumbled in getting his words out (it’s hard work always trying to sound clever!) which contributed to him appearing to be more anxious and less comfortable in social situations.

In developing the behavioural experiment, Kevin and the therapist considered two options.  One option they considered was testing out Kevin’s assumptions around how people respond when others say something stupid, or at least incorrect.  Is it always the case that people get laughed at when they say something stupid?  And even if they do, what would be the worst thing about that?  Does saying something stupid lead to social rejection or something else?  Hint:  Donald Trump was mentioned in this conversation.

The second experiment that was discussed was around the effects of Kevin paying close attention to his words.  It was already highlighted in his formulation that paying close attention to his words was having the adverse effect of making him stumble, increasing his self-focused attention and possibly contributing to his overall appearance of being anxious.  Given that this experiment was at the level of Kevin’s specific thoughts, rather than at the deeper level of his assumptions around how people may judge him, Kevin and the therapist agreed to set up an experiment around testing out what happens when he stops trying to choose the right words and lets them come out naturally.  The other experiment was saved for later.

Here’s what the experiment looked like:

Behavioural Experiment

Thought:  I must pay close attention to saying intelligent words otherwise I will say something stupid and get laughed at.

Belief rating:  90%

Alternative Thought:  Paying close attention to my thoughts makes it more difficult to find the right words and leads me to stumble in getting my words out.

Belief in alternative thought:  40%

Experiment:  I’m (Kevin) going to have 3 conversations this week with different people at work.  In each conversation, I’m not going to focus upon the words that come out and instead listen to what the other person says and then respond spontaneously with whatever comes into my mind.  Conversation needs to last for 5 minutes.

Safety behaviours to drop:  Trying to find “intelligent” words, self-focused attention, trying to hold my hands still, avoiding eye contact, avoidance, speaking quickly.  Pre and post event processing.

What happened?:  I spoke to 5 people over the week.  At first I found it difficult to speak spontaneously but this passed quickly once I had been speaking for a while.  I found that I was able to hold a reasonable conversation and make a point without obsessing over saying the “right” thing.  The words seemed to come out a little easier too.

What does this mean?:  I can probably stop trying so hard!  The words will come out anyway and thinking about saying the right thing stops the flow – it’s counterproductive.

Re-rate your belief in the initial thought:  50%

Re-rate your belief in the alternative thought:  80%

So we can see here how we are actually testing out Kevin’s ideas about himself and what he needs to do to get by in social situations. 

Often, when we are caught up in the cycle of an anxiety disorder, we struggle to actually test out the beliefs that are keeping the problem going.  We believe them as though they are true.  By becoming our own “Thought Scientist” and actually testing these beliefs we are able to get real-life evidence to support our thoughts, weaken them or refute them entirely.  Behavioural experiments are a fantastic tool in Social Anxiety Treatment.

Step 5 – Broadening the bandwidth

A key theme in social anxiety disorder and social phobia is the idea that other people create some degree of social threat – If we do something wrong, then we will be ridiculed, shamed, rejected or criticised by others.  Indeed, there may have been times in our lives when this has been the case – in fact these previous events are very likely to have contributed to the development of social anxiety disorder.

However, whilst these events may have occurred in the past, this doesn’t necessarily mean that they are going to happen today.  We are “hard-wired” with a tendency to over-estimate threat.  What this means is that we are likely to expect to find threat more often that we will actually find it.  From the perspective of evolution this makes sense.  Our ancestors that paid more attention to potential threat were generally more likely to survive than ones who didn’t.

Over-estimating threat gave our ancestors an advantage in the dangerous age of hunter-gatherers – they were less likely to end up as food.  

However, in our much, much safer modern times, the tendency for us to over-estimate threat can often create a problem for us, particularly in social anxiety disorder.  We expect to find threat – i.e., people that will make us feel ridicule, shame, rejection or criticism – in more situations than they actually will.

This is where bandwidth experiments come into play.  The idea of a bandwidth experiment is to reduce our tendency to over-estimate social threat, by broadening the range (bandwidth) of socially acceptable behaviours.

Here is an example:

Kevin had the belief that other people would notice whenever he made a mistake and would be ready to ridicule him.  This belief led to him avoiding a wide variety of social situations and make him use safety behaviours (e.g., being very careful in his movements, walking slowly, avoiding eye contact) to avoid ridicule.

Kevin and the therapist agreed to engage in a bandwidth experiment to see if people were always truly ready to notice Kevin’s mistakes.  They agreed to go to the local supermarket and fill up a basket with small, unbreakable, goods such as toilet rolls, fruit and a few tin cans.  Kevin then found a place in the supermarket where he could observe the therapist “model” the experiment.

The therapist (lucky me!) walked with the basket of goods down a fairly busy aisle.  He then pretended to fall to the floor, sending toilet rolls, grapefruits and tins of beans spinning down the aisles.  What do you think Kevin got to observe?

He found that two people, a man in his twenties and a lady in her sixties, both rushed to help the therapist up.  A couple of teens in school uniform also helped to catch the rolling groceries and return them to the therapist.  The older lady even did a bit of brushing down of the therapists elbows whilst checking that he was OK before everyone continued to go about their business.

Kevin and the therapist discussed their findings.  Kevin was a little surprised that the teens had been as helpful as they had been and he thought that the other people who helped were nice and friendly however he was quite unsure about whether same thing would happen to him.  He felt that the people behaved how they did because they somehow knew that the people helped the therapist because of who he was (they had know way of knowing that he was a therapist!) and that people wouldn’t treat him in the same helpful way.

So they agreed to find out.

Kevin filled his basket of groceries and walked down the same aisle about 20 minutes after the therapist had.  It was still as busy.  Kevin struggled at first and even avoided falling down at first.  Eventually on his 4th passing through the aisle he did it.  He fell to the floor sending his groceries down the aisle, his wire basket clashing with the tiling on the deck.

What happened?

A young mum in her twenties who had a toddler and a baby in a pram rushed to help Kevin back to his feet.  A big, burly. body-builder type man rushed to save the groceries.  He made a jokey but friendly comment, “I’ve dusted your grapefruit off for you”, when he handed them back.  Both people gave a few more moments of their time to make sure that Kevin was OK before everyone got back to their shopping.  It seemed to have gone well.

The therapist and Kevin again reflected upon the experience.  What had Kevin learned?  “No one’s really bothered about the fact that I fell – they seemed to be more interested in making sure I was OK.”  What does this mean for the future? “I probably can be a bit less concerned about making mistakes in front of people, in some situations at least.”

The above example shows how we literally broadened the bandwidth of what Kevin felt was reasonable in social situations.  He could relax a little more in public which meant that he would feel less anxious.  There was also a little bit of a re-evaluation of his beliefs about people being ready to criticise him.

Bandwidth experiments such as this are anxiety provoking to begin with – of course they are, you are doing something which really takes you out of that comfort zone.  But just like with behavioural experiments, they can bring about the greatest therapeutic benefit in that you are really testing out your assumptions in the real world.  

Take the next steps…

So there we have a basic overview of what to expect from CBT treatment for Social Anxiety Disorder.  It’s not easy, if it was we wouldn’t have a problem.  But we do have a plan of treatment that has been shown to work and is recommended as a first line treatment for social anxiety disorder.  

So, now you know what to expect from the treatment, you can decide when to take the next steps, when you’re ready.

If you want to get help from us then please feel free to contact us on 07887 701 176 or enquiries@accessCBT.co.uk