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Social Anxietyand Cognitive Behavioural Techniques
Social Anxietyand Cognitive Behavioural Techniques
Social Anxietyand Cognitive Behavioural Techniques
Techniques.
Compiled by Edward Griffin
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The term Social anxiety was coined by Janet (1903) to describe people who
feared being observed while speaking, playing the piano, or writing. Social
Anxiety nowadays is a term used to describe the excessive fear, nervousness
and apprehension that people experience in social interactions (Butler, 1999).
People with social anxiety fear being judged negatively by other people or
humiliated in front of them.
The physical indicators of social anxiety are similar to those of other types of
anxiety attack. When social anxiety occurs, individuals can experience all the
indicators of autonomic nervous system arousal (racing heart, sweating,
clammy hands, trembling, stomach butterflies and feeling sick), and in some
circumstances 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.
It is advisable to contact your doctor who will give you a formal diagnosis and
either refer you to a therapist or put you on medication. Therapies include
counselling, psychotherapy and cognitive behavioural therapy (CBT). The
most common and successful of these therapies seems to be CBT.
Medication is also successful in reducing social anxiety and comes in the form
of anti-depressant types (MAOIs* and SSRIs*) or tranquilizers such as valium
and Beta Blockers. Whilst medications can be effective, in some individuals
they can have unwanted side effects.
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.
Figure 1 - The cognitive behavioural model of social anxiety devised by Clark and
Wells 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 answering
the phone to someone you dont like talking to, or walking past a group of
people you know in the street who stop and talk to you. For some people the
situations might be more specific, such as the weekly meeting at work or a
formal chat with your boss. The trigger situation activates the beliefs and
assumptions the person has about them self, the specific situation, and social
situations in general.
Activates beliefs and assumptions refers to the thought patterns the person
has about themself, the specific situation and previous experiences in similar
situations. Examples of these beliefs and assumptions are: They think I am
weird, they are judging me in a negative way, Im no good in these
situations, there must be something wrong with me or people think I am
inferior.
CBT is a tried and tested method for helping to relieve the anxiety caused by
social situations. Often people are referred to a cognitive behavioural
therapist by their doctor. However getting referred to a cognitive behavioural
therapist can sometimes be quite difficult for somebody with social anxiety.
For a start it involves explaining the problem to a doctor, which some people
may find difficult, and secondly there are often long waiting lists for therapy,
and sessions can be quite sporadic. Whilst someone who is referred to a
therapist 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
properly, will give you a programme of cognitive behavioural techniques which
you can use on yourself.
Most of the following techniques either come from, or are adapted from Gillian
Butlers excellent book Overcoming Social Anxiety: A self-help guide using
Cognitive Behavioural Techniques. The book goes into far more detail and
covers a lot more then what is mentioned on this page, but some of the
aspects on this page should be quite helpful.
The first thing to do is to identify your thoughts and beliefs. Thinking plays a
big 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 socially
anxious person may believe that other people are generally hostile and will
ridicule any weaknesses observed in them, or they may believe that they have
a generally un-likable personality. These beliefs may have stemmed from bad
childhood or past experiences. Many beliefs are dispositional in that they
exist but have never previously been analysed and been questioned. Some
beliefs are also limiting in that they inhibit ones actions. It can be hard to
identify deep seated beliefs, as the belief may have formed years ago in
response to a situation which may have been forgotten. Beliefs play a big
part in behavioural responses. Someone who believes that people are
generally hostile may think that it is dangerous to tell people too much about
themself and avoid too much small talk.
Identifying Beliefs - The first step taken in CBT is to identify your beliefs in
order to analyse them. Start by thinking of a situation where you felt
particuarly socially anxious. Try to relive the situation, and write it down in as
much detail as you can. Pay attention to the thoughts, feelings and images
that 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. This
process can take a while but it is very important in order to help identify your
beliefs. When you have analysed the situation consider the following
questions:
I am
Others are..
For example:-
At the Party
Panicky Theyll think I am odd
Sweaty I cant relax and be normal
Heart Racing People dont like me
Talking to the
secretary Embarrassed She thinks Im an idiot.
rude
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 of
anything to say, he appeared nervous and he said silly things to fill in the
gaps.
Tony thought that he was judging himself in ways that he thought other people
would 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 he
was the new guy. He thought that they would pick up on his weaknesses and
judge him negatively. He imagined them talking about him behind his back
To Tony the situation meant that he appeared boring, nervous and unlikable.
He felt it proved that he was socially inferior to others and other people
thought that he was strange.
Tony thought that others seemed not to enjoy talking to him and that his
nervousness seemed to make them feel uncomfortable.
Others Are : always judging me on my downfalls and are likely to team up and
ridicule me if they see my weaknesses.
Tony analysed several other situations and discovered similar beliefs. He also
noted that when he was bullied and ridiculed at school, his anxiety made it
difficult for him to stand up for himself and answer back.
Changing beliefs.
The next step is to analyse your beliefs and to try and change them.
For example, Tony believed that:
other people would judge him on his downfalls and were likely to team
up and ridicule him if they were to see his weaknesses.
It is unlikely that Tonys beliefs were based around facts. Although they might
have seemed true once, he has avoided situations and not tested them since
he was bullied at school.
Here are some interesting questions that can be used to analyse your beliefs:
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?
Tony concluded that his beliefs were not as true as he had thought they were.
He noted that his beliefs made him avoid social situations, say unecessary
things to avoid silences and try to please people so that they would like him.
He realised that it wasnt the case that everyone was against him and that
people had grown out of the school yard bullying mentality.
He realised that his avoidance of situations meant that he was unable to test
how true these beliefs were.
He felt responsible for the long silences in conversations and often said
something to fill in the gaps. After this exercise he realised that the other
person may have felt just as awkward about the silences and that it was their
responsibility too.
Tony decided that his self consciousness was partly due to the beliefs he had
and the behaviors he adopted because of these beliefs.
Behaviours
Behaviours play a key role in the social anxiety cycle. Usually behaviours are
built around beliefs, and as demonstrated previously, many beliefs held by
socially 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 people
often do. After one bad experience with a particular social situation, people
may avoid similar situations thereafter. This can lead to social isolation and
cause depression and low self-esteem. Whilst avoidance has the benefit of
keeping anxiety at bay, it has a negative overall effect. It helps to maintain the
difficulty rather than to resolve it. By avoiding the situation, the person will
never know if the situation warrants this kind of self protection (in most
situations it doesnt - see beliefs). Experiments in anxiety show that the more
people are exposed to situations which make them feel anxious, the less
anxious they eventually come to feel about the situations. This however does
require giving up safety behaviours.
Safety Behaviours - People who have had social anxiety for some time often
become quite skilled at behaving in ways which reduce the perceived threat.
Safety behaviours are essentially a way of minimising or avoiding the
embarrassment and anxiety felt in social situations. For example if you are at
a party, you may hang around on the periphery so as not to attract too much
attention. 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 may
drink your alcoholic beverage quickly to give you a bit more confidence. You
may regularly visit the toilet, even when you dont need to go, just to avoid
chatting to someone you feel poses a threat. You probably say the same old
things in the same way to different people just because you have rehearsed
them and feel a little more comfortable saying them. You may get up and
make an excuse and leave when the anxiety gets too much.
Whilst safety behaviours may seem helpful at the time, in the long run they
are counter-productive. They confirm that the situation is dangerous by
reinforcing the belief that you have got to keep safe or something bad will
happen (Butler, 1999). Safety behaviours often become habitual responses to
situations which are mostly harmless. Using safety behaviours has the effect
of not testing how dangerous the situation really is.
Rehearsing what you are about to say and mentally checking that you
have got the words right.
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.
To identify behaviours you will need to take a specific situation where social
anxiety arose and write it down. Try to remember how you behaved when you
felt anxious. Write these behaviours down.
Self-Consciousness
Next time that you are talking to someone, why not see what happens if you
consciously observe everything about them, including what they are saying to
you the colour of their hair, the style, their eyes, their clothes etc? Count
things: 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 in
comparison to how distracting self-consciousness can be.
The first method should be to try and identify your thoughts and beliefs. This
involves vividly remembering situations which have caused you considerable
anxiety. Use the methods described in the beliefs section which includes a
chart for identifying thoughts and feelings. Take some time to do this and
make sure that you write them all down. When you have done this you should
be able to identify some of the beliefs that cause social anxiety.
The next process is to question your beliefs using the questions highlighted in
the beliefs section. Decide how true you think these beliefs are and try to
modify them into more productive ones. When you realise that some of your
negative beliefs may be false, it becomes easier to change your behaviour in
similar situations.
The next thing should be to write down your behaviours when anxiety arises.
Think of specific situations and look for the negative behaviours highlighted in
the Behaviours section. A lot of your behaviours will be a response to your
incorrect beliefs or to lessen the feeling of anxiety. When you have identified
your thoughts and behaviours you will be more aware of how they affect your
anxiety, and aware of their fallibility.
Remember to try and avoid the post-mortem and apply the tactics of reducing
self consciousness. You should find that self consciousness will reduce in
time. It is important to keep going and not to give up. After a while your
confidence should grow and social anxiety should reduce.
Join a drama club. People with social anxiety may be a little out of practice
with their social techniques. The benefits of an amateur dramatics club are
that it would build up your confidence in your voice and body language, and
expose you to some forms of anxiety.
References
Butler, G., (1999) Overcoming Social Anxiety and Shyness: A self help guide
using Cognitive Behavioral Techniques. London: Robinson
Heimberg, R.G., Liebowitz, M.R., Hope, D.A., Schneier, F.R., (1995) Social
Phobia: Diagnosis, Assessment, and Treatment. The Guildford Press/ New
York
Howlin, P., (2004) Autism and Asperger Syndrome: preparing for adulthood
2nd ed. USA & Canada: Routledge
Jackson, L., (2002) freaks Geeks and Asperger Syndrome: A User Guide to
Adolescence. London:Jessica Kingsley
Websites
Helpguide.org., (2007).
http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm . (accessed
08/03/2007)