Social Anxiety and Cognitive Behavioural Techniques

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Social Anxiety and Cognitive BehaviouralTechniques.

Compiled by Edward Griffin

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Introduction and Definition

The term Social anxiety was coined by Janet (1903) to describe people whofeared being observed while speaking, playing the piano, or writing. SocialAnxiety nowadays is a term used to describe the excessive fear, nervousnessand apprehension that people experience in social interactions (Butler, 1999).People with social anxiety fear being judged negatively by other people orhumiliated in front of them.

The physical indicators of social anxiety are similar to those of other types ofanxiety attack. When social anxiety occurs, individuals can experience all theindicators of autonomic nervous system arousal (racing heart, sweating,clammy hands, trembling, stomach butterflies and feeling sick), and in somecircumstances they can experience panic attacks and loss of consciousness.This can cause considerable discomfort and embarrassment and often affect

the persons ability to act naturally or perform a task in front of people.

Performance anxiety (better known as stage fright) is one of the mostcommon aspects of social phobia. The performance situation triggers intense

anxiety with the result of significantly hindering a persons ability to perform atask in front of people that they would normally find simple performing alone.


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Cognitively, social anxiety often revolves around the feeling of being judged orbeing seen in a negative light by others. People with social anxiety often havea fear of being humiliated in public. When social anxiety arises, peoplesminds go blank; they get confused and often think that they come across in abad light. In many cases it is not surprising that a person with social anxiety

will often avoid many social situations. This can result in poor self-esteemand depression.

Social phobia is often a secondary aspect to many types of neurodiversity,especially Aspergers and Dyspraxia where an understanding of socialsituations and subtleties in communication can be difficult (helpguide.org).People with neurodiversity may have some kind of impairment or differencewhich could stand out. This could increase self consciousness to an extentthat considerable anxiety is caused.How to overcome social anxiety

Social anxiety happens to everybody at one time or another. It is perfectlynormal to feel anxiety in situations such as a job interview, making a speech,or going on a date. Some people however develop anxiety in most socialsituations, which can seriously affect their quality of life. When social anxietybecomes this intrusive there are several options people can take.It is advisable to contact your doctor who will give you a formal diagnosis andeither refer you to a therapist or put you on medication. Therapies includecounselling, psychotherapy and cognitive behavioural therapy (CBT). Themost common and successful of these therapies seems to be CBT.Medication is also successful in reducing social anxiety and comes in the formof anti-depressant types (MAOIs* and SSRIs*) or tranquilizers such as valiumand Beta Blockers. Whilst medications can be effective, in some individualsthey can have unwanted side effects.*[MAOIs: Monoamine Oxide Inhibitors e.g. Phenelzine ]*[SSRIs Selective Serotonin Reuptake Inhibitors e.g. Fluoxetine]There are several things people can do to help themselves in reducing the

indicators of social anxiety and anxiety in general:

Exercise regularly. Helps keep the heart healthy and produces brain

chemicals which relieve anxiety. Improve your sleeping pattern. You are more prone to anxiety if you

are tired or if your sleeping pattern is irregular. Give up, or cut down on drinks and foods that contain caffeine. These

speed up the heart which can cause anxiety. Gradually expose yourself to situations that can cause anxiety.

Give up or cut down on smoking.

Cognitive Behavioural Model of Social Anxiety


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One of the most popular methods used to reduce and eliminate social anxietyis cognitive behavioural therapy (CBT). It utilises the idea that variousrecurring thought patterns and behaviours are linked to physical andemotional indicators of social anxiety. CBT is a process of identifying,analysing and changing these thought patterns and behaviours with the result

of reducing the overall anxiety. CBT has been stringently applied to manypeople with anxiety and depression, and it has proven to be more effectivethen any other psychological techniques, and just as effective as medication(without the side effects). Cognitive behavioural therapy works around theidea that thoughts affect behaviour and vice versa. Therefore the re-programming of both is likely to change the situation.

The cognitive behavioural solution to social anxiety is generally based arounda model (diagram) showing the thought processes, behaviours and how theyinteract with one another. One of the most common and well supported

models of social anxiety was devised by Clark and Wells in 1995. The Clarkand Wells model shows the processes involved in social anxiety:

Figure 1 - The cognitive behavioural model of social anxiety devised by Clark andWells 1995. This version was adapted from Butler 1999.

The trigger situation refers to the situation that activates the bout of anxiety.This can vary from person to person but often includes things like answeringthe phone to someone you dont like talking to, or walking past a group ofpeople you know in the street who stop and talk to you. For some people the


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situations might be more specific, such as the weekly meeting at work or aformal chat with your boss. The trigger situation activates the beliefs andassumptions the person has about them self, the specific situation, and socialsituations in general.

Activates beliefs and assumptions refers to the thought patterns the personhas about themself, the specific situation and previous experiences in similarsituations. Examples of these beliefs and assumptions are: They think I amweird, they are judging me in a negative way, Im no good in thesesituations, there must be something wrong with me or people think I aminferior.The situation is perceived as socially dangerous. The combination of thetrigger and the negative thoughts associated with it accumulate in the personperceiving the situation as threatening or dangerous, which can activate threeresponses:

Safety behaviours. These are behaviours developed to minimise the

anxiety felt at the time and avoid further exposure to potentially greateranxiety. For example - leaving the situation to avoid furtherembarrassment, or changing the subject to something you feelconfident talking about.

Self consciousness. This is when attention becomes focused upononeself. For example becoming very aware of how much or how littleeye contact you are making, or being very aware of your shaking

hands.

Signs and symptoms of anxiety include increased heart rate,

sweating, quivering voice, breathing becoming heavier and starting toshake.

These three responses are interlinked. Self consciousness increases thefeeling of anxiety, which increase the perceived threat of the situation, whichcan in turn increase the signs and symptoms of anxiety. If you feel at risk, thisactivates safety behaviours which can confirm that the situation is dangerous.

Self help Cognitive Behavioural Therapy

CBT is a tried and tested method for helping to relieve the anxiety caused bysocial situations. Often people are referred to a cognitive behaviouraltherapist by their doctor. However getting referred to a cognitive behaviouraltherapist can sometimes be quite difficult for somebody with social anxiety.For a start it involves explaining the problem to a doctor, which some peoplemay find difficult, and secondly there are often long waiting lists for therapy,and sessions can be quite sporadic. Whilst someone who is referred to atherapist will gain the benefit of experienced one to one counselling and group

workshops, there are a couple of very useful self help books which if used


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properly, will give you a programme of cognitive behavioural techniques whichyou can use on yourself.Most of the following techniques either come from, or are adapted from GillianButlers excellent book Overcoming Social Anxiety: A self-help guide using

Cognitive Behavioural Techniques. The book goes into far more detail andcovers a lot more then what is mentioned on this page, but some of theaspects on this page should be quite helpful.Use a diary or electronic organiser to record and monitor your progress.

Thoughts and Beliefs

The first thing to do is to identify your thoughts and beliefs. Thinking plays abig part in several of the processes involved in social anxiety. If analysed

properly, thoughts can be categorised into beliefs, assumptions and attitudes.Knowing what type of thought you are thinking is essential in changing them.Beliefs - A belief is a thought that you make real or feel is true. A sociallyanxious person may believe that other people are generally hostile and willridicule any weaknesses observed in them, or they may believe that they havea generally un-likable personality. These beliefs may have stemmed from badchildhood or past experiences. Many beliefs are dispositional in that theyexist but have never previously been analysed and been questioned. Somebeliefs are also limiting in that they inhibit ones actions. It can be hard toidentify deep seated beliefs, as the belief may have formed years ago inresponse to a situation which may have been forgotten. Beliefs play a bigpart in behavioural responses. Someone who believes that people aregenerally hostile may think that it is dangerous to tell people too much aboutthemself and avoid too much small talk.

Identifying Beliefs - The first step taken in CBT is to identify your beliefs inorder to analyse them. Start by thinking of a situation where you feltparticuarly socially anxious. Try to relive the situation, and write it down in asmuch detail as you can. Pay attention to the thoughts, feelings and imagesthat come to your mind. You could use the following table (Word Doc) to help

you to identify the feelings and thoughts encountered in the situation. Thisprocess can take a while but it is very important in order to help identify yourbeliefs. When you have analysed the situation consider the followingquestions:

What do you feel were your short falls?

In what way are you judging yourself? What did the situation mean to you?

What did the situation mean about you? What were the attitudes of others in the situation?

What does this tell you about them?

( adapted from Butler, 1999)
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With the situation fully in mind complete the sentences:I am

Others are..For example:-

Tony used the table to analyse his thoughts and feelings
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Situation wheresocial anxiety arose

Feelings (there maybe more than one)

Thoughts, impressions etc

When asked if he

wanted to come toNigels leaving buffet

At the Party

Talking to thesecretary

Fear

ApprehensionWorried

PanickySweatyHeart RacingEmbarrassedrude

I wont know any body

I wont be able to talk if I getnervousPeople wont like me

Theyll think I am oddI cant relax and be normalPeople dont like meShe thinks Im an idiot.

He then asked the set of questions aimed at helping to identify his beliefs.On analysis, Tony felt that his short falls were that he couldnt think ofanything to say, he appeared nervous and he said silly things to fill in thegaps.

Tony thought that he was judging himself in ways that he thought other peoplewould be judging him, and in ways that he had been judged in the past.

Tony thought that in the situation people would be judging him because hewas the new guy. He thought that they would pick up on his weaknesses andjudge him negatively. He imagined them talking about him behind his backTo Tony the situation meant that he appeared boring, nervous and unlikable.He felt it proved that he was socially inferior to others and other peoplethought that he was strange.

Tony thought that others seemed not to enjoy talking to him and that hisnervousness seemed to make them feel uncomfortable.I am : socially inferior to other people, and if I become anxious I becomevunerable to ridiculeOthers Are : always judging me on my downfalls and are likely to team up andridicule me if they see my weaknesses.

Tony analysed several other situations and discovered similar beliefs. He alsonoted that when he was bullied and ridiculed at school, his anxiety made it

difficult for him to stand up for himself and answer back.


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Changing beliefs.

The next step is to analyse your beliefs and to try and change them.For example, Tony believed that:

he was socially inferior to other people, and if he became anxious hebecame vunerable to ridicule from others

other people would judge him on his downfalls and were likely to teamup and ridicule him if they were to see his weaknesses.

It is unlikely that Tonys beliefs were based around facts. Although they mighthave seemed true once, he has avoided situations and not tested them sincehe was bullied at school.

Here are some interesting questions that can be used to analyse your beliefs:

How are your beliefs making you behave?

Would you judge someone else who felt like you do in the same way?

Are you being fair to yourself? Are you going in for character assassination rather then sticking to

what happened on one particular occasion? Are you forgetting that everyone makes mistakes and feels socially

uncomfortable at times? Are you ignoring your strengths and focusing on your weaknesses?

Are you falling into a biased pattern of thinking? Are you drawing conclusions based upon your childhood or adolescent

experiences? Are you judging yourself as you have once been judged?

(Butler, 1999 p174)Tony concluded that his beliefs were not as true as he had thought theywere. He noted that his beliefs made him avoid social situations, sayunecessary things to avoid silences and try to please people so that theywould like him.

He realised that it wasnt the case that everyone was against him and thatpeople had grown out of the school yard bullying mentality.He realised that his avoidance of situations meant that he was unable to testhow true these beliefs were.He felt responsible for the long silences in conversations and often saidsomething to fill in the gaps. After this exercise he realised that the otherperson may have felt just as awkward about the silences and that it was theirresponsibility too.Tony decided that his self consciousness was partly due to the beliefs he had

and the behaviors he adopted because of these beliefs.


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Behaviours

Behaviours play a key role in the social anxiety cycle. Usually behaviours arebuilt around beliefs, and as demonstrated previously, many beliefs held bysocially anxious people are not as true as they may seem. Below are a

number of unhelpful behaviours that socially anxious people often adopt:

Avoiding the situation - This is one of the things that socially anxious peopleoften do. After one bad experience with a particular social situation, peoplemay avoid similar situations thereafter. This can lead to social isolation andcause depression and low self-esteem. Whilst avoidance has the benefit ofkeeping anxiety at bay, it has a negative overall effect. It helps to maintainthe difficulty rather than to resolve it. By avoiding the situation, the person willnever know if the situation warrants this kind of self protection (in mostsituations it doesnt - see beliefs). Experiments in anxiety show that the morepeople are exposed to situations which make them feel anxious, the less

anxious they eventually come to feel about the situations. This however doesrequire giving up safety behaviours.

Safety Behaviours - People who have had social anxiety for some time oftenbecome quite skilled at behaving in ways which reduce the perceived threat.Safety behaviours are essentially a way of minimising or avoiding theembarrassment and anxiety felt in social situations. For example if you are ata party, you may hang around on the periphery so as not to attract too muchattention. You realise that having little to say at a party might look a little odd,so you only talk to the people that you feel most comfortable with. You maydrink your alcoholic beverage quickly to give you a bit more confidence. Youmay regularly visit the toilet, even when you dont need to go, just to avoidchatting to someone you feel poses a threat. You probably say the same oldthings in the same way to different people just because you have rehearsedthem and feel a little more comfortable saying them. You may get up andmake an excuse and leave when the anxiety gets too much.

Whilst safety behaviours may seem helpful at the time, in the long run theyare counter-productive. They confirm that the situation is dangerous byreinforcing the belief that you have got to keep safe or something bad will

happen (Butler, 1999). Safety behaviours often become habitual responsesto situations which are mostly harmless. Using safety behaviours has theeffect of not testing how dangerous the situation really is.

Another negative aspect of safety behaviours is that they focus attentioninwards and make people increasingly self aware and self conscious. Thishas an effect of increasing the psychological and physiological aspects ofanxiety.Examples of safety behaviours are:

Rehearsing what you are about to say and mentally checking that youhave got the words right.


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Holding things tight or locking your knees together to avoid shaking.

Keeping an eye on the escape route (a way out of the situation) and

never getting fully involved.

Sticking with a safe person or staying in a safe place never takingany chances.

To identify behaviours you will need to take a specific situation where socialanxiety arose and write it down. Try to remember how you behaved whenyou felt anxious. Write these behaviours down.Post-mortem It is very common amongst socially anxious people tocritically analyse a social situation which caused anxiety after the situation hasoccurred. Usually these post-mortems are not based around facts but moreon the persons negative beliefs and attitudes. A socially anxious person islikely to have negative beliefs and attitudes toward themselves in socialsituations. Try to avoid the post-mortem at all costs. It is useful to know thateverybody makes mistakes and nobody is perfect in all social situations.

Self-Consciousness

Self -consciousness comes from focusing your attention into yourself. Itmakes you increasingly aware of uncomfortable sensations, feelings, thoughtsand behaviours. An episode of self-consciousness can arise in any social

situation, regardless of how well you know the people you are with (Butler,1999). It makes you focus your attention on your inner present experienceand makes it very difficult to pay attention to the external world.

The key to reducing self-consciousness comes with learning to focus yourattention on what is happening outside yourself and stop listening to yourinternal worries. Tackling self consciousness is one of the more difficult

aspects in reducing social anxiety. It usually comes with practice and


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exposure to situations. It is important to know that people often dont noticethe thing that you are conscious about.

To help focus on external things it is a good idea to adopt the attitude ofcuriosity. If you have worked successfully on changing your beliefs then you

will realise that in most situations a bout of self-consciousness does notpresent any danger whatsoever.

Next time that you are talking to someone, why not see what happens if youconsciously observe everything about them, including what they are saying toyou the colour of their hair, the style, their eyes, their clothes etc? Countthings: the windows in the room, the number of books on the book shelf, etc.At first you may find this slightly distracting, but it is often insignificant incomparison to how distracting self-consciousness can be.

Putting it all together

As discussed previously thoughts, feelings and behaviours are intrinsicallylinked with social anxiety. If you would like to use some of the ideas alreadydiscussed, then you are going to need to know how to put them all together.Please remember that while some of these methods may seem a little simple,they are based around a sophisticated understanding of the problem.Generally in CBT, thoughts and beliefs are the primary aspects to beaddressed in order to provide a good set-up for changing behaviours.

Step 1 Identifying BeliefsThe first method should be to try and identify your thoughts and beliefs. Thisinvolves vividly remembering situations which have caused you considerableanxiety. Use the methods described in the beliefs section which includes achart for identifying thoughts and feelings. Take some time to do this andmake sure that you write them all down. When you have done this you shouldbe able to identify some of the beliefs that cause social anxiety.

Step 2 Questioning Beliefs

The next process is to question your beliefs using the questions highlighted inthe beliefs section. Decide how true you think these beliefs are and try tomodify them into more productive ones. When you realise that some of yournegative beliefs may be false, it becomes easier to change your behaviour insimilar situations.

Step 3 Identifying BehavioursThe next thing should be to write down your behaviours when anxiety arises.

Think of specific situations and look for the negative behaviours highlighted inthe Behaviours section. A lot of your behaviours will be a response to your


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incorrect beliefs or to lessen the feeling of anxiety. When you have identifiedyour thoughts and behaviours you will be more aware of how they affect youranxiety, and aware of their fallibility.

Step 4 Changing Behaviours

Armed with revised beliefs and an awareness of counter-productivebehaviours, it is time to plan a method of changing behaviours and trying todo things differently. Whilst this can be quite daunting, it is often a good ideato adopt the role of a scientist who wants to discover the effects of variousbehaviours upon the feelings of anxiety. Use the following chart (word Doc) toplan an experiment in changing behaviours. This will require you to startexposing yourself to situations that cause social anxiety. Why not treatreducing your social anxiety as if it were a job? It is usually best to start offsmall and work your way up. It is a good idea to deliberately expose yourselfto one situation a day that makes you feel uncomfortable. Try not to use any

safety behaviours or avoidance techniques. It is important to document yourexperiences and learn from them. After a week you will probably feel a littlemore confident and be able to move on to two situations a day.

Remember to try and avoid the post-mortem and apply the tactics of reducingself consciousness. You should find that self consciousness will reduce intime. It is important to keep going and not to give up. After a while yourconfidence should grow and social anxiety should reduce.Other Strategies to help reduce Social Anxiety

Relaxation is often noted as being very beneficial to people with anxiety-related problems. Using relaxation techniques on a daily basis can reducethe intensity and frequency of any anxiety felt throughout the rest of the day.Many people with anxiety recommend Yoga, particularly a relaxing style ofyoga which incorporates meditation. Not only does yoga help to relax themind, but it also revitalises and soothes the body.Hypnotism is an excellent way to relax. There are many private

hypnotherapists who may be able to help you, but they can be quiteexpensive, charging approximately 50 sterling per session. There are alsomany hypnotism audio CDs out there. Paul McKenna has written a series ofbooks with accompanying CDs which can really help to relax you and re-programme your mind. One of his books is called Instant Confidence andincludes a useful programme for improving confidence in all kinds ofsituations.Join a drama club. People with social anxiety may be a little out of practicewith their social techniques. The benefits of an amateur dramatics club arethat it would build up your confidence in your voice and body language, and

expose you to some forms of anxiety.
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References

Books and Journals

Butler, G., (1999) Overcoming Social Anxiety and Shyness: A self help guideusing Cognitive Behavioral Techniques. London: Robinson

Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. In R. G.Heimberg, M. Liebowitz, D. Hope and F. Scheier (Eds.), Social Phobia:diagnosis, assessment, and treatment (pp. 6993). New York: Guilford.

Heimberg, R.G., Liebowitz, M.R., Hope, D.A., Schneier, F.R., (1995) SocialPhobia: Diagnosis, Assessment, and Treatment. The Guildford Press/ NewYork

Howlin, P., (2004) Autism and Asperger Syndrome: preparing for adulthood2nd ed. USA & Canada: Routledge

Jackson, L., (2002) freaks Geeks and Asperger Syndrome: A User Guide toAdolescence. London:Jessica Kingsley

Janet, P. (1903). Les obsessions et la psychasthenie (2 volumes). Paris:Felix Alcan. Reprint: Arno Press, New York, 1976.

McKenna, P. (2006). Instant Confidence: The Power to go for anything you

want. Bantam PressWebsitesHelpguide.org., (2007).http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm . (accessed08/03/2007)
http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htmhttp://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm

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Social Anxiety and Cognitive Behavioural Techniques