Integrating CBT for Social Anxiety Management

Katy Morin

I don’t know when it started or why. I just wanted to be like everyone else, to fit in. Have friends, be happy. Not worry about every little detail in every interaction. Not worry about what others think of me. Being paralyzed by the judgment of others. Feeling trapped in my own mind. Wanting to scream but not making a sound. Thinking I was the only one feeling this way. Feeling exhausted every day from fighting my own thoughts. Wanting to ask for help but not knowing how. Thinking there was no way out of this agony. Searching for a cure, something that would make me normal. It took me years to know what I was suffering from. Social Anxiety Disorder.

What is social anxiety?

Social anxiety disorder is one of the most common anxiety disorders. The defining feature of social anxiety disorder, also called social phobia, is intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation. People with social anxiety disorder may worry about acting or appearing visibly anxious (e.g., blushing, stumbling over words), or being viewed as stupid, awkward, or boring. As a result, they often avoid social or performance situations, and when a situation cannot be avoided, they experience significant anxiety and distress. Many people with social anxiety disorder also experience strong physical symptoms, such as a rapid heart rate, nausea, and sweating, and may experience full-blown attacks when confronting a feared situation. Although they recognize that their fear is excessive and unreasonable, people with social anxiety disorder often feel powerless against their anxiety.

One of the most effective treatments for Social anxiety disorder is Cognitive Behavioural Therapy. The idea of having to talk to someone I didn’t know made me feel even more anxious. I felt like the vicious circle would never end until I found a CBT program that I could take online without having to talk to someone.

What is Cognitive Behavioural Therapy?

Cognitive Behavioural Therapy focuses on how you think about a problem (cognitive) and what you do about it (behaviour). CBT can teach you how to recognize and change faulty thinking patterns. This doesn’t mean that you will always think positive thoughts. It is a way to gain control over racing repetitive thoughts, which feed anxiety and depression. CBT can help you make sense of overwhelming problems by breaking them down into achievable parts.

The idea of CBT is to help change your thinking, by challenging and changing your automatic negative thoughts. In supportive environments, social phobics can learn to address their fears and can steadily overcome them. With the help of a therapist, they can develop strategies for coping and find a more constructive way of viewing their fears. The advantage of group therapy is that they can meet and interact with fellow sufferers, which will help them to realize that they are not facing their problems alone.

Cognitive Behavior Therapy (CBT), was pioneered by Dr. Aaron T. Beck in the 1960s, while he was a psychiatrist at the University of Pennsylvania. Having studied and practiced psychoanalysis, Dr. Beck designed and carried out several experiments to test psychoanalytic concepts of depression. Fully expecting the research would validate these fundamental concepts, he was surprised to find the opposite.

I just finished a course on CBT for Anxiety with the Beck Institute which was founded by Aaron Beck.

One thing I learned in this course is the cognitive formulation of anxiety. It involves overestimating the risk of threat and underestimating your ability to cope with the threat.

For example, If you are doing a presentation at work and you think that if you don’t do well you are going to get fired. That’s an overestimation. You are not thinking about the fact that you are prepared for the presentation and that you really know your subject.

When I first started speaking in public in Toastmasters I would always think about a negative outcome. ‘What if I forget what I want to say, I am going to look stupid.’ Once I was able to realize that my anxiety came only from my own negative thoughts and not from an external threat, I was able to use CBT techniques to overcome these negative thoughts.

In order to change your negative thoughts, you need to be able to identify them.

What are automatic thoughts?

Automatic thoughts are images or mental activity that occur as a response to a trigger (like an action or event). They are automatic and ‘pop up’ or ‘flash’ in your mind without conscious thought. Automatic thoughts can be beneficial. For example, you are driving and it starts raining very heavily. Automatically you think ‘I need to be careful!’ which leads to feelings of anxiety that cause you to drive more cautiously. Automatic thoughts can also have negative effects for people who have trouble with depression or anxiety.

For example, a person with anxiety sees an acquaintance frowning in their direction. They immediately think ‘That person hates me!’ which leads to feelings of anxiety, worry, and sadness. Thoughts like this can be damaging and unnecessary- the person who was frowning just had a pain in their leg! Cognitive behavioral therapy focuses on negative thought patterns and automatic thoughts that make people depressed or anxious. By changing these patterns and discerning how they occur can help treat emotional problems.

Here are a few examples of Negative automatic thoughts:

‘I’m not good enough’

‘I’m a failure.’

‘I’ll never make it.’

Here are a few positive thoughts to replace the negative one.

“I’m proud of myself.”

“I feel fine.”

“No matter what happens, I know I’ll make it.”

A few questions you can ask yourself to help you identify your automatic thoughts:

What was going through my mind just before I started to feel this way?

What am I afraid might happen?

The best way to identify and challenge those automatic thoughts is to use an Automatic Thoughts Record Sheet.

Click here to download the word version to use it.

The Cost Benefits Analysis, helps you identify the consequences of either using a coping strategy or holding to a particular belief.

For example, a coping strategy might be avoiding social situations because it brings you anxiety. And a belief may be that if you do talk to people you will embarrass yourself.

With the Cost Benefits Analysis, you look at the advantages and disadvantages of holding into that belief then we can figure out an alternative belief.

Choose the behavior that you want to change the most, one that is not useful to you. Perhaps you want to stop avoiding social situations. It can lessen your anxiety in the moment but in the long run, it does not help you overcome your social anxiety.

Find the benefits of continuing doing your bad habit.

Step Three: Cost of Engaging in Problematic Behavior

Write down every negative consequence that results from you doing the bad habit. Start with what is already obvious to you, and then try to extend your list to all the cons that you can think of. In the beginning you might not be used to thinking about your habit in this way, but gradually you will come up with pros and cons more easily.

Step Four: Benefits of Engaging in an Alternative Behavior

List the benefits of the alternative behavior. Try to visualize the possibilities.

Step Five: Costs of Engaging in an Alternative Behavior

Think of all the negative sides of changing your behavior. Changing behaviors requires effort and energy, paying close attention to what you choose to do. It is usually a stretch out of our comfort zone and it may take a while until you become comfortable with this new alternative behavior. Think of all the costs of making the change.

For every cost or benefit, think about the importance that each of these reasons has for you. Write it down a percentage for the problematic behavior.

You’ll find that even if you can immediately list a lot of benefits to engaging in the problematic behavior, they will probably not be as important as the costs of doing the bad habit. Then compare the points of importance. You will probably notice that the costs of engaging in the problematic behavior and the benefits of doing the alternative action are much more important.

Now you can look at all the consequences of keeping or releasing the behavior/belief. Then you can make an informed choice. The information can also help increase your motivation.

Click here to download the word version of the Cost Benefits Analysis to use it.

Step 1: Choose a goal you want to accomplish

You can use the bad habit that you used in the Cost Benefits Analysis to choose your goal.

Step 2: Identify the action steps to reach your goal

Start by making a separate list of things you avoid because of your anxiety or coping strategies you use.

Step 3: Rate each action step

On a scale of 1 to 10 rate each action.

Step 3: Add each step in order in your fear ladder.

Add the first step at the bottom of the fear ladder. This should be the situation that you fear the least and the one you fear the most will be at the top.

Step 3: Take Action

Start with the first stepuse your automatic thoughts record sheet the evaluate how you felt and when you are ready, go to the next step.

Click here to download the word version to use it.

I hope these tools help you with your social anxiety as they did for me. If you want more help, join my community where I will be sharing more tips and techniques to overcome social anxiety by showing you how to communicate better in your interpersonal and professional relationships, to have the social life and the career you want.

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