SOPHIE YOUNG GROUP PROPOSAL 1

Group Rationale: Teens with Social Anxiety

Sophie J. Young

Department of Counseling, Wake Forest University

CNS 742: Group Procedures in Counseling

April 22, 2021

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Group Rationale: Teens with Social Anxiety

Struggling with social anxiety is a common experience among adolescents – one that can

lead to impaired social functioning in adulthood if left untreated (Aydin et al., 2010). One way to

provide support and symptom relief to these individuals, as suggested by research, is to offer

youth with therapeutic group opportunities. Gladding (2020) stresses the importance of groups

for adolescents by claiming that they “can be life saving and life changing” (p. 262). In this

rationale, I will evaluate peer-reviewed studies in support of therapy groups for adolescents who

meet the DSM-IV diagnostic criteria for social anxiety and/or social phobia. The extant literature

reveals the necessity for groups of this nature, provides support for their efficacy, and shares

their methodologies including details of the theoretical orientation, program length,

interventions, and group setting.

Group Necessity and Theoretical Orientation

Providing therapeutic services to youth suffering from social anxiety is crucial in order to

prevent negative outcomes associated with this disorder such as academic failure, substance

abuse, and suicidal tendencies (Albano et al., 1995). Numerous studies have confirmed the

hypothesis that therapy groups for adolescents can lead to a decrease in their reported symptoms

of social anxiety and social phobia (Aydin et al., 2010, Baer & Garland, 2005, Hayward et al.,

2000, Ilkhchi et al., 2011, Masia et al., 2001). Of the previously cited articles, each utilized a

cognitive-behavioral theoretical orientation (CBT) in their groups. All studies concluded that the

adolescents who received CBT targeted at reducing symptoms of social anxiety/social phobia

reported decreased symptoms compared to those in a control group or waitlist group. Because of

the vast support for CBT as the framework for group therapy of this kind, I propose to use the

same approach when conducting a similar group.

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Group Structures

Previously studied groups typically convened for weekly 90-minute sessions, with

treatment programs lasting from 10 weeks (Aydin et al., 2010) to 16 weeks (Hayward et al.,

2000), with a mean of about 13 weeks (Baer & Garland, 2005, Ilkhchi et al., 2011, Masia et al.,

2001). The most common setting in which groups were held was the school that the members

attended. Masia et al. (2001) states that a school environment may be a highly beneficial setting

for behavioral treatment implementations as this setting is often where members experience the

most distress with their anxiety. With this knowledge, and as shown by empirical support, I

propose that a school setting (either middle or high school depending on members age) would be

the most effective and efficient environment in which to hold my own adolescent therapy group

for social anxiety reduction.

Research Findings

Research in support of therapy groups for socially anxious youth will now be highlighted

in order to best understand the nature of these previously conducted studies. In 2010, Aydin et al.

held a CBT group for 24 socially anxious individuals between the ages of 7 and 9. During the

treatment group, the individuals received relaxation training, practiced cognitive restructuring,

and completed exposure exercises. Following the 13-week program, a significant decrease in

scores on the Social Anxiety Scale for Adolescents was seen when compared to participants’ pre-

test scores. A study by Baer and Garland (2005) found that 12 adolescents reported significant

improvements in social phobia symptoms, with four group members no longer meeting criteria

for social phobia, after 12 sessions of cognitive-behavioral group therapy. These researchers used

a combination of social skills training, individual exposure therapy, and group peer

generalization interventions during their treatment. In a similar experiment, Hayward et al.

SOPHIE YOUNG GROUP PROPOSAL 4

(2000) provided 11 subjects, ranging from 14 to 17 years old, with a 16-week CBT treatment

program. Following termination, members reported significant reduction in symptoms of social

anxiety and significant reduction in the number of members meeting the diagnostic criteria for

social phobia compared to the control group. Ilkhchi et al. (2011) focused their research on the

components of self-efficacy and assertiveness among anxious high schoolers. After their group

therapy program, the 15 individuals who received treatment reported significant decreases in

anxiety and increased self-efficacy and assertiveness compared to those in the control group.

And finally, Masia et al. (2001) helped pave the way for school-based behavioral interventions

for the treatment of adolescent social anxiety after finding that anxiety ratings decreased

significantly following a 14-week group held in the members’ school.

Together, these findings summarize much of the extant literature regarding the efficacy

of group therapy for adolescents suffering from social anxiety and social phobias. After

reviewing the common methodologies utilized in these studies, I have gleaned a better idea of

how to effectively organize a group of this nature. Overall, the literature suggests that a

theoretical framework of CBT works exceptionally well for helping participants address their

cognitions and alter their behaviors related to their social anxiety. Some intervention strategies to

use with this framework include teaching relaxation and cognitive restructuring techniques, as

well as having the group complete exposure activities in which members confront anxiety-

provoking situations (Aydin et al., 2010). Additionally, teaching members skills to enhance self-

efficacy and assertiveness has also been shown to be helpful for participants in these groups

(Ilkhchi et al., 2011). Group size can range from 6 (Masia et al., 2001) to 15 (Ilkhchi et al., 2011)

individuals in a single group while maintaining positive outcomes. With this knowledge, I

propose to conceptualize a therapy group in a high school setting that convenes weekly for 13
SOPHIE YOUNG GROUP PROPOSAL 5

weeks in 90 minute sessions. This hypothetical group would provide a similar therapeutic

environment to that of previous studies, with strong evidence suggesting the potential efficacy

and utility to be had among anxious adolescents of today.

SOPHIE YOUNG GROUP PROPOSAL 6

References

Albano, A. M., DiBartolo, P. M., Heimberg, R. G., & Berlow, D. H. (1995). Children and

adolescents: Assessment and treatment. Cognitive Behavioral Practice, 2(1995), 271-

298.

Aydin, A., Tekinsav-Sütçü, S., & Sorias, O. (2010). Evaluation of the effectiveness of a

cognitive-behavioral therapy program for alleviating the symptoms of social anxiety in

adolescents: Turkish journal of psychiatry. Turk Psikiyatri Dergisi, 21(1), 1-36.

Baer, S., & Garland, J. (2005). Pilot study of community-based cognitive behavioral group

therapy for adolescents with social phobia. Journal of the American Academy of Child &

Adolescent Psychiatry, 44(3), 258-264. https://doi.org/10.1097/00004583-200503000-

00010

Gladding, S. T. (2020). Groups: A counseling specialty, 8th edition. New York: Pearson.

Hayward, C., Varady, S., Albano, A. M., Thienemann, M., Henderson, L., & Schatzberg, A. F.

(2000). Cognitive-behavioral group therapy for social phobia in female adolescents:

results of a pilot study. Journal of the American Academy of Child & Adolescent

Psychiatry, 39(6), 721-726. https://doi.org/10.1097/00004583-200006000-00010

Ilkhchi, S. V., Poursharifi, H., & Alilo, M. M. (2011). The effectiveness of cognitive-behavioral

group therapy on self-efficacy and assertiveness among anxious female students of high

schools. Procedia – Social and Behavioral Sciences, 30, 2586 – 2591.

https://doi.org/10.1016/j.sbspro.2011.10.506.

Masia, C. L., Klein, R. G., Storch, E. A., & Corda, B. (2001). School-based behavioral treatment

for social anxiety disorder in adolescents: Results of a pilot study. Journal of the
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American Academy of Child & Adolescent Psychiatry, 40(7), 780-786.

https://doi.org/10.1097/00004583-200107000-00012
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Group Objectives

1. Group members will learn how to participate in a group effectively and appropriately.

2. Group members will learn to identify their anxiety and understand how it impacts them.

3. Group members will explore the relationship between their thoughts, feeling, and
behaviors related to their anxiety.

4. Group members will challenge their anxiety by engaging in anxiety-provoking activities

in a safe, therapeutic environment.

5. Group members will learn to effectively utilize relaxation and mindfulness techniques
when feeling anxious.
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Informed Consent Form

Dear Parent/Guardian of __________________.

As part of our school’s comprehensive school counseling program, the counseling department is
now offering the opportunity for students to voluntarily participate in a confidential, therapy
group for those who struggle with social anxiety. The group will begin on _________________,
and will focus on social skills building, social anxiety awareness, and techniques for anxiety
reduction. Each session will include opportunities for members to engage in self-awareness,
reflection, and to contribute to the groups content and process. Group activities may include
exposure therapy, relaxation training, and mindfulness practices.

We would like for your child, __________________, to be a part of this small group. We believe
participation in the group will lead to benefits in your child’s social and academic experience at
our school. The group will be compromised of eight 9th grade students. It will meet immediately
after school on Wednesdays for 90 minutes. The group will meet for a total of 13 weeks, with the
last session taking place on _________________. Your student should report to the media center
at the end of the school day. A parent/guardian or another authorized adult can pick your child up
at the front of the school at 5:00 PM.

Participation in this group is voluntary and your child may discontinue counseling at any time for
any reason without negative consequences. Regular attendance is very important for the
effectiveness of the group. Please consider any potential conflicts that might impact attendance
before confirming your child’s spot in the group. Student confidentiality will be addressed and
respected. I am responsible to break confidentiality if I learn of an individual intending to do
harm to self or others, or if I learn that someone is harming the individual.

If you have questions or want more information about the group, you can call me at
_________________. I look forward to working with your child. Please read, sign, and return the
slip below to confirm your child’s participation in the group.

Sincerely,

My child, ___________________________, has my permission to participate in the social

anxiety group.

_______________________________________________ ______________________________
Parent/Guardian Signature Date

_______________________________________________ ______________________________
Student Signature Date
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Group Session 1 Plan (90 minutes)

Materials
 Quiet, confidential meeting space with enough chairs for each member. Chairs should
be arranged in a circle formation.
 Group Guidelines and Objectives
 Anxiety Checklist (included on the next page)
Ice breaker/opener (40 minutes)
Welcome and  Welcome group members and introduce yourself.
Introductions.  Ask members to introduce themselves and share their name,
favorite school subject, and favorite movie or book. Also ask
(15 minutes)
them to share how they feel about being in the group today.
Review Group  Review the group guidelines and objectives. Ask if there are any
Guidelines and questions anyone has.
Objectives.
(10 minutes)
Dyad Activity  Have members break into groups of two. Have them take turns
discussing how they are currently feelings, what their fears of
(15 minutes)
being in this group are, and what their expectations of being in
this group are.
Awareness Activity (30 minutes)
Anxiety Checklist  Have members fill out an Anxiety Checklist. Then, have them
Activity pair up in groups of two (with someone different from the dyad
activity) and ask them to review their checklists together
identifying similarities and differences.
 Next, have everyone reconvene as a group and share what they
discovered. What did members learn about themselves? What did
they learn about their partner?
Concluding activity (20 minutes)
Wrap up  Ask members to go around and describe what they enjoyed about
today’s meeting, what they found to be difficult, and one thing
they will be taking away from this session.

Activities based on materials from Mazur-Elmer & McBride (2009).

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Anxiety Checklist

Feeling anxious can impact our thoughts, feelings, and behaviors. Place a check mark next to the
anxiety symptoms that you experience regularly.

(Thoughts) When I am anxious…

I constantly worry
I can’t concentrate
My thoughts race
My mind jumps from one thing to another
I imagine the worst thing that could happen
(Feelings) When I am anxious…
My heat races
My chest feels tight or painful
My fingers/toes feel tingly or numb
I feel restless
I feel sweaty
My breathing changes
I feel nauseous
I feel dizzy or light-headed
(Behaviors) When I am anxious…
I pace up and down
I talk quickly or more than usual
I become quiet
I become irritable
I eat more or less than normal
I avoid the feared situation
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Group Session 2 Plan (90 minutes)

 Quiet, confidential meeting space with enough chairs for each member. Chairs should
be arranged in a circle formation.
 Relaxation exercise script (on the next page).
 Facilitator Notes
Ice breaker/opener (20 minutes)
Check-in  Begin by asking members to go around and describe how their
week was. Did they notice any thoughts, feelings, and behaviors
related to their anxiety? Are they experiencing any symptoms
right now?
Skill Building Activity (50 minutes)
Introduce  Discuss the benefits and risks of relaxation training. Ask
Relaxation participants what they think risks and benefits could be. (See
Training facilitator notes)
(10 minutes)
Relaxation  Guide the group through the relaxation exercise by reading the
exercise script.
 Encourage participants to practice this technique over the next
(10 minutes)
week.
Process exercise  Have participants share their experiences of the relaxation
exercise with the group.
(30 minutes)
Concluding activity (20 minutes)
Wrap up  Ask members what they enjoyed and what they struggled with
during the session. Also ask members how and when they plan to
practice this relaxation exercise between now and the next
meeting.

Facilitator Notes:
Benefits of Relaxation
 Reduces anxiety and panic attacks. Regular practices of relaxation can help you to feel
more relaxed in all aspects of your life.
 Increased energy
 Decreased muscle tension
 Decreased heart rate and blood pressure
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Relaxation Exercise Script

Take a moment to make sure that you are seated comfortably. Rest your hands loosely in your lap. Now close your
eyes.

Take a long slow, deep breath in...hold it for a moment, and then slowly exhale. Just allow any tension to melt away
as you gradually relax more and more deeply with each breath.

Take another long slow, deep breath in...hold it, and then exhale. Empty your lungs completely with your out-breath.

Take a third deep breath in. Take your time. Hold it for a moment, and then let it go. You can already feel yourself
drifting into a state of deep relaxation.

Continue to breathe slowly and gently as you bring your awareness to the top of your head. Just sense or imagine a
feeling of relaxation beginning to spread down from the top of your scalp.... feel the muscles in your forehead and
temples relax.

Allow your eye muscles to release. Let your cheeks and jaw soften and let go of all tension.

Now let this peaceful feeling flow down into your neck. Feel it loosening every muscle and every fiber.

With each breath you take, this relaxing feeling becomes deeper and warmer. It works its way deep into the muscles
in your shoulders…soothing them…releasing them.

This peaceful feeling flows down from your shoulders and into your arms. It loosens the muscles in your upper
arms…your forearms…your hands...relaxing and soothing...all the way to the tips of your fingers.

As your body relaxes, your mind relaxes, and your thoughts seem to become lighter. You are slipping further and
further into a dreamlike state of stillness and relaxation.

Now, bring your awareness to your chest and your stomach. Feel how this area of your body gently rises and falls as
you breathe. The peaceful sensation flows throughout this area of your body, soothing every muscle and relaxing
every organ. You can feel it releasing every last molecule of tension.

Turn your attention to your upper back, and feel this relaxing sensation flow all the way down your spine. As it
gradually works its way down your body, feel every muscle in your back relax and unwind.

Feel that your entire upper body has become loose, limp and relaxed.

Sink into this serene sensation. Relax more and more deeply with each breath.

Now feel your hips relax as the peaceful feeling starts to work its way through your lower body. Relax the backs of
your thighs...the front of your thighs. Feel all these muscle groups becoming looser and more relaxed with each
passing moment.

Soothing feelings of relaxation flow down through your knees, and into your calves. Your ankles relax. Now your
feet relax. Allow your entire lower body to relax completely and allow any remaining tension from anywhere in
your body to flow out through the tips of your toes.

You are comfortable, peaceful and relaxed. 

Script Adapted from https://www.the-guided-meditation-site.com/passive-relaxation-script.html

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Outcome Evaluation Questionnaire

Please circle the line that you feel best answers the following questions.

1. I enjoyed participating in this group:

Strongly Somewhat Neutral Somewhat Strongly

agree agree disagree disagree

2. This program provided relevant and valuable information:

Strongly Somewhat Neutral Somewhat Strongly

agree agree disagree disagree

3. The group facilitators were effective and appropriate:

Strongly Somewhat Neutral Somewhat Strongly

agree agree disagree disagree

4. What did you like best or find the most valuable about this group?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

5. What did you dislike or find the least valuable about this group?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

6. How could we improve this group?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
SOPHIE YOUNG GROUP PROPOSAL 15

Please write any other comments you have here:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Materials adapted from Mazur-Elmer & McBride (2009) and information from Rowa & Antony

(2005).
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Resources for Participants, Parents/Guardians

 Insight Timer App. This is a free app (available for iOS, Android, and web) which
contains a large library of guided meditations on a variety of topics such as stress, sleep,
and anxiety. This is an excellent way for group members to practice the skills learned in
session.
 The American Academy of Child & Adolescent Psychiatry Website. This is an
informative website for parents/guardians that shares more about adolescent anxiety
disorder and how to respond to your child’s signs and symptoms.
o https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/
Anxiety_Disorder_Resource_Center/
Your_Adolescent_Anxiety_and_Avoidant_Disorders.aspx
 Helping Your Anxious Teen: Positive Parenting Strategies to Help Your Teen Beat
Anxiety, Stress, and Worry by Sheila Achar Josephs.
 My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic by Katherine A.
Martinez and Michael A. Tompkins.
 National Social Anxiety Center Website (more information for parents/guardians of
socially anxious teens)
o https://nationalsocialanxietycenter.com/2018/06/18/guidance-parents-teenagers-
shy-teen-social-anxiety-disorder/

Resources for Group Leaders

 https://socialanxietyinstitute.org/successful-social-anxiety-groups
 https://socalmentalwellness.com/group-therapy/group-therapy-for-social-anxiety-works/
 https://mindremakeproject.org/2020/05/25/group-therapy-resource-guide/
 https://www.apa.org/monitor/2019/04/group-therapy
 Yalom, I. D. & Leszcz, M. (2005). The theory and practice of group psychotherapy, 5th
edition. Basic Books.
SOPHIE YOUNG GROUP PROPOSAL 17

Potential Issues in Application

Conducting a small therapy group of this nature in a highschool would likely be a

practical and feasible task. Because of the high rates of social anxiety experienced by this

population, I believe there would be a sufficient number of participants showing interest in this

group. However, with anxious members, especially of this demographic, having pre-group

contact with the individual and their parent would be a necessary step in orienting them to the

group, initiating the working alliance, and building trust with the adolescent (Malekoff, 2004).

An initial hurdle to overcome would be selecting and communicating with a school who

views this group proposal as useful and greatly beneficial to their student body. Because of the

extensive body of literature supporting the efficacy of such a group in this setting, it is

anticipated that a school would be accepting of the proposal. After securing a school site, it

should be feasible to locate an empty, quiet meeting space, such as an empty classroom, in which

to conduct the group sessions. Further, the proposed timeframe should accommodate for

parent/guardian pick-up as the group is planned to end at the same time as a typical workday.

Due to the timeframe in which this group would be held (i.e. after school hours), any issues of

confidentiality should not arise as all other students would have left school property.

The only foreseeable obstacle in this group deals with member attendance. If a participant

is absent from a session due to a sickness or scheduling conflict, this individual would miss out

on valuable learning and thus may experience less of the group’s anticipated therapeutic benefits.

Additionally, because many of the potential activities in this group can be done in dyads, being

short one member could cause another student to be without a partner for the day.

As mentioned previously, there are no foreseeable ethical concerns as long as group

members agree to keep group material confidential. Additional measures can be set in place such
SOPHIE YOUNG GROUP PROPOSAL 18

as locking the door to our meeting space and/or placing a “do not disturb” sign and sound

machine outside the meeting space to ensure that no one disrupts or listens in on the group.

Potential cultural concerns pertain to the willingness of the child and parent to utilize counseling

services for anxiety. If one’s cultural beliefs do not support their participation in therapy, then an

anxious child could miss out on this opportunity. Overall, conducting a CBT based therapy group

for socially anxious teens in a school setting appears to have few obstacles and vast empirical

support for its potential efficacy.

SOPHIE YOUNG GROUP PROPOSAL 19

References

Albano, A. M., DiBartolo, P. M., Heimberg, R. G., & Berlow, D. H. (1995). Children and

adolescents: Assessment and treatment. Cognitive Behavioral Practice, 2(1995), 271-

298.

Aydin, A., Tekinsav-Sütçü, S., & Sorias, O. (2010). Evaluation of the effectiveness of a

cognitive-behavioral therapy program for alleviating the symptoms of social anxiety in

adolescents: Turkish journal of psychiatry. Turk Psikiyatri Dergisi, 21(1), 1-36.

Baer, S., & Garland, J. (2005). Pilot study of community-based cognitive behavioral group

therapy for adolescents with social phobia. Journal of the American Academy of Child &

Adolescent Psychiatry, 44(3), 258-264. https://doi.org/10.1097/00004583-200503000-

00010

Gladding, S. T. (2020). Groups: A counseling specialty, 8th edition. New York: Pearson.

Hayward, C., Varady, S., Albano, A. M., Thienemann, M., Henderson, L., & Schatzberg, A. F.

(2000). Cognitive-behavioral group therapy for social phobia in female adolescents:

results of a pilot study. Journal of the American Academy of Child & Adolescent

Psychiatry, 39(6), 721-726. https://doi.org/10.1097/00004583-200006000-00010

Ilkhchi, S. V., Poursharifi, H., & Alilo, M. M. (2011). The effectiveness of cognitive-behavioral

group therapy on self-efficacy and assertiveness among anxious female students of high

schools. Procedia – Social and Behavioral Sciences, 30, 2586 – 2591.

https://doi.org/10.1016/j.sbspro.2011.10.506.

Malekoff, A. (2004). Group work with adolescents: Principles and practice. New York, NY:

Guilford Press.
SOPHIE YOUNG GROUP PROPOSAL 20

Masia, C. L., Klein, R. G., Storch, E. A., & Corda, B. (2001). School-based behavioral treatment

for social anxiety disorder in adolescents: Results of a pilot study. Journal of the

American Academy of Child & Adolescent Psychiatry, 40(7), 780-786.

https://doi.org/10.1097/00004583-200107000-00012

Mazur-Elmer, A. & McBride, D. L. (2009). Treating social anxiety in adolescents: Ten group

therapy lesson plans. University of Lethbridge, Faculty of Education.

Rowa, K. & Antony, M. (2005). Psychological treatments for social phobia. Canadian Journal

of Psychiatry, 50, 308-315. https://doi.org/10.1177/0706743705000603