What to Expect in CBT Treatment Series: Social Anxiety Disorder

What to Expect in CBT Treatment Series: Social Anxiety Disorder

Written by: Dr. Hillary Gorin, PhD, LCP

This blog series will help you understand what to expect in Cognitive Behavioral Treatment (CBT) for a variety of different anxiety disorders, OCD, and PTSD. No matter what you are seeking help for, it can be very scary to start treatment. I assume most of my patients enter their first appointment with me with anxiety. I assume this for several reasons. 1. You are taking a big first step in your life to change something that may feel impossible to change; 2. Most of my patients experience an abundance of anxiety on a daily basis and new experiences make us all feel anxiety.

My hope is that this blog series helps you to have a better sense of what to expect in your treatment if you choose exposure-based CBT interventions. First and foremost, the first appointment will be a lot of data collection. In order to determine how I can be helpful, I must determine what your problem looks like. You can plan on me asking you a ton of questions. My goal is to determine what diagnoses you meet criteria for (to ensure I can treat those diagnoses) and to instill some hope in you that I can help you. Just like we would hope our doctors would evaluate what is broken before treating a broken bone and then tell us how they can be helpful, I want to use a scientific approach in my practice and give you some hope that the science works. Although a one size fits all approach does not work for everyone, I apply all evidence-based techniques or techniques that have been supported by ongoing research. In this series, you will find the general what’s and why’s of treatment with me. Also, if you are struggling with the motivation to get started, I include some information on why it may be worth it to take a chance on this treatment.

Social Anxiety Treatment

What is Social Anxiety Disorder? 

Social anxiety disorder often appears as anxiety in social situations where one could be evaluated by others (American Psychiatric Association, 2013). This could involve meeting new people, being observed by others, or even having to perform in front of others. Fear of negative evaluation is a big part of social anxiety. My patients often ask “will I embarrass myself? will I be rejected or humiliated? will I offend someone?” Individuals with social anxiety disorder want to stay away from social situations that could involve evaluation or will do so with a ton of anxiety. 

What will we work on? 

• Cognitive Restructuring: Our thoughts are very powerful, particularly during and after social interactions (Hope et al., 2019). We all have had moments of anxiety during or following a social encounter. For instance, it is fairly normative to reflect on our performance following an interview. However, for individuals with social anxiety disorder, their anxiety extends beyond a bit of doubt and appears more as automatic, extreme thoughts, such as “They didn’t like me” or “Because I didn’t answer perfectly, I will never answer perfectly, therefore, I will never get a job” or “I looked anxious and stupid” (Hope et al., 2019). I will ask you to become a scientist. I will ask you to dispute these assumptions using questions like “do you know these things for certain?” and “what evidence do you have that such assumptions are true?” (Hope et al., 2019). 

• Exposure Therapy: To overcome a fear, we must face it (Hope et al., 2019). To overcome social anxiety, I will ask you to do things that make you socially anxious or uncomfortable. Why? Because you can tolerate it. Social anxiety will not harm you. In fact, the opposite is true. Avoiding important social situations will likely cause some detriment in your life. Saying the wrong thing and being embarrassed is just a part of life. We will practice easier tasks, such as having conversations, and then harder tasks, such as doing things that make you feel embarrassed. You will learn that you can cope with these feelings and find ways to move into social situations with bravery and acceptance of uncertainty. 

Why Engage in this Treatment?

Outside of meeting our basic needs, our relationships and our ability to engage with others is likely the next most important aspect of human functioning. Is it painful for you to enter new situations or to make new friends (Grayson, 2014)? Does your fear of negative evaluation keep you from pursuing your goals? Do you avoid important social events because you just can’t tolerate the anxiety? Are you lonely because you avoid social situations? Has this pandemic led to even more isolation and exacerbated your social anxiety? If so, you may want to give treatment a try. 

Why this treatment works?

Right now, your threat brain is signaling danger during social encounters. However, for the most part, social encounters do not pose danger (as long as you are following proper COVID-19 precautions). If you repeatedly examine the thoughts during social encounters and repeatedly place yourself in uncomfortable spaces, your comfort will grow with time. You can tolerate anxiety. You do not need to run from it anymore. During the COVID-19 pandemic, we will modify the social exposures to abide by CDC guidelines. However, even now, there is a way to become more present focused in your relationships and life. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Hope, D. A., Heimberg, R. G., & Turk, C. L. (2019). Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach: Therapist Guide (3rd ed.). Oxford University Press.

Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.