CBT for Social Anxiety
We all have an inner critic inside of us. It (not so helpfully) provides a running commentary of our lives, honing in on any flaws and spinning “what if” scenarios. In the case of social anxiety disorder (SAD), that voice becomes especially loud and convincing before, during, and after social situations. We are told in no uncertain terms that others are judging us. The man looking at his watch during your conversation finds you boring and that woman glancing in your direction was just talking about you to her friends. Your heart begins to beat faster and you start to sweat. You worry that others can tell you’re anxious. You reach for your phone to have something to do with your hands and appear engaged. You notice your hands are shaking. Finally, you make a beeline for the exit. As you feel the outside air, you are flooded with relief. You send a quick text to your friends that you ate some bad shrimp and needed to leave. You think that next time, you will skip the party in favor of your sofa and pajamas. Later, you feel guilty for lying and leaving early. You think that you really are boring and wonder whether you will ever feel comfortable with other people.
If this is you, know that you are among 12% of adults and 9% of adolescents with SAD in this country and that there are effective and evidence-based treatments. Specifically, Cognitive Behavior Therapy (CBT) for SAD teaches skills that help you challenge your anxious mind and take the catastrophic element out of anxious thoughts (cognitive restructuring). With the support of your therapist, you gradually approach anxiety-provoking situations to test out your anxious predictions (exposure). With repetition, confidence in yourself and your capabilities grows and the “threat” associated with social activities lessens.
SAD over-estimates the likelihood of being perceived negatively by others as well as over-estimates the social costs of that perception. It probably didn’t occur to you that the man checked the time because his car is in a 2-hour parking spot and the woman only coincidentally looked at you at the same time you looked at her. Such expectations of “the worst case” increase feelings and sensations of anxiousness that we are motivated to avoid. Understandably, we are driven to alleviate discomfort. In the short term, this can work wonderfully. In the long term, other unpleasant emotions seep in. Over time, avoidant behaviors narrow our lives and the inner critic is elevated to an inner dictator, telling us what we can and can’t do.
One of the first clients I saw early in my career struggled with social anxiety. In the exposure phase of CBT, he agreed to visit a busy coffee shop and interact with the barista. He was anxious, predicting all the possible ways he would embarrass himself. At the next session, he excitedly shared that he engaged the barista in conversation …and then promptly spilled his latte all over the floor. After an initial moment of horror, he burst out laughing. “This is what I have been afraid of?!” His anxiety had estimated such a high social cost of just this type of gaffe and yet, he was fine. Another barista came out from behind the counter and they chatted amiably while cleaning up the mess. This experience, though unplanned, offered an opportunity his anxiety had long deprived him of: learning that he has the capability to handle socially challenging situations and the horrible, long-lasting negative outcomes anticipated do not occur. Through CBT for social anxiety this client, like many others, came to live a fuller life shaped by his choices rather than by his anxieties.
-Meara Weitzman, Ph.D.