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Social Anxiety and Cognitive Behavioural Techniques.

Compiled by Edward Griffin

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Introduction and Definition

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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.

 

 

 

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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 person’s ability to act naturally or perform a task in front of people. 

 

Performance anxiety (better known as stage fright) is one of the most common aspects of social phobia.  The performance situation triggers intense anxiety with the result of significantly hindering a person’s ability to perform a task in front of people that they would normally find simple performing alone.   

Cognitively, social anxiety often revolves around the feeling of being judged or being seen in a negative light by others.  People with social anxiety often have a fear of being humiliated in public.  When social anxiety arises, people’s minds go blank; they get confused and often think that they come across in a bad 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-esteem and depression.

Social phobia is often a secondary aspect to many types of neurodiversity, especially Asperger’s and Dyspraxia where an understanding of social situations and subtleties in communication can be difficult (helpguide.org).  People with neurodiversity may have some kind of impairment or difference which could stand out.  This could increase self consciousness to an extent that considerable anxiety is caused.

 

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How to overcome social anxiety

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Social anxiety happens to everybody at one time or another.  It is perfectly normal 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 social situations, which can seriously affect their quality of life.  When social anxiety becomes this intrusive there are several options people can take.

 

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.

 

*[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.

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Cognitive Behavioural Model of Social Anxiety

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One of the most popular methods used to reduce and eliminate social anxiety is cognitive behavioural therapy (CBT).  It utilises the idea that various recurring thought patterns and behaviours are linked to physical and emotional 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 many people with anxiety and depression, and it has proven to be more effective then any other psychological techniques, and just as effective as medication (without the side effects).  Cognitive behavioural therapy works around the idea 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 around a model (diagram) showing the thought processes, behaviours and how they interact with one another.  One of the most common and well supported models of social anxiety was devised by Clark and Wells in 1995. The Clark and Wells model shows the processes involved in social anxiety:

 

 

 

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

 

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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 don’t 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’,  “I’m no good in these situations’, ‘there must be something wrong with me’ or ‘people think I am inferior.’

 

The situation is perceived as socially dangerous. The combination of the trigger and the negative thoughts associated with it accumulate in the person perceiving the situation as threatening or dangerous, which can activate three responses:

  • Safety behaviours.  These are behaviours developed to minimise the anxiety felt at the time and avoid further exposure to potentially greater anxiety.   For example - leaving the situation to avoid further embarrassment, or changing the subject to something you feel confident talking about.
  • Self consciousness.  This is when attention becomes focused upon oneself.  For example – becoming very aware of how much or how little eye 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 to shake.

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

 

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Self help Cognitive Behavioural Therapy

 

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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 Butler’s 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.

 

Use a diary or electronic organiser to record and monitor your progress.

 

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Thoughts and Beliefs

 

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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 one’s 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. 

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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:

 

( adapted from Butler, 1999)

 

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 where social anxiety arose

Feelings (there may be more than one)

Thoughts, impressions etc

 

When asked if he wanted to come to Nigel’s leaving buffet

 

 

At the Party

 

 

 

Talking to the secretary

 

Fear

Apprehension

Worried

 

 

 

Panicky

Sweaty

Heart Racing

 

Embarrassed

rude

 

 

 

I wont know any body

I wont be able to talk if I get nervous

People wont like me

 

 

They’ll think I am odd

I can’t relax and be normal

People don’t like me

 

She thinks I’m an idiot.

 

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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 couldn’t 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.

 

I am : socially inferior to other people, and if I become anxious I become vunerable to ridicule

 

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.

 

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Changing beliefs.

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The next step is to analyse your beliefs and to try and change them.

For example, Tony believed that:

 

It is unlikely that Tony’s 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:

 

(Butler, 1999 p174)

 

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 wasn’t 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.

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Behaviours

 

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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 doesn’t - 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 don’t 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. 

 

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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.

 

Another negative aspect of safety behaviours is that they focus attention inwards and make people increasingly self aware and self conscious.  This has an effect of increasing the psychological and physiological aspects of anxiety.

 

Examples of safety behaviours are:

 

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.

 

Post-mortem – It is very common amongst socially anxious people to critically analyse a social situation which caused anxiety after the situation has occurred.  Usually these post-mortems are not based around facts but more on the person’s negative beliefs and attitudes.  A socially anxious person is likely to have negative beliefs and attitudes toward themselves in social situations.  Try to avoid the post-mortem at all costs.  It is useful to know that everybody makes mistakes and nobody is perfect in all social situations.  

 

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Self-Consciousness

 

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Self -consciousness comes from focusing your attention into yourself.  It makes you increasingly aware of uncomfortable sensations, feelings, thoughts and 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 experience and makes it very difficult to pay attention to the external world. 

 

 

 

The key to reducing self-consciousness comes with learning to focus your attention on what is happening outside yourself and stop listening to your internal worries.  Tackling self consciousness is one of the more difficult aspects in reducing social anxiety.  It usually comes with practice and exposure to situations. It is important to know that people often don’t notice the thing that you are conscious about. 

 

To help focus on external things it is a good idea to adopt the attitude of curiosity. If you have worked successfully on changing your beliefs then you will realise that in most situations a bout of self-consciousness does not present any danger whatsoever.

 

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.   

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Putting it all together

 

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As discussed previously thoughts, feelings and behaviours are intrinsically linked with social anxiety.  If you would like to use some of the ideas already discussed, 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 be addressed in order to provide a good set-up for changing behaviours.

 

 

Step 1 – Identifying Beliefs

 

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. 

 

Step 2 – Questioning Beliefs

 

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.

 

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Step 3 – Identifying Behaviours

 

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. 

 

Step 4 – Changing Behaviours

 

Armed with revised beliefs and an awareness of counter-productive behaviours, it is time to plan a method of changing behaviours and trying to do things differently.  Whilst this can be quite daunting, it is often a good idea to adopt the role of a scientist who wants to discover the effects of various behaviours upon the feelings of anxiety.  Use the following chart (word Doc) to plan an experiment in changing behaviours.  This will require you to start exposing yourself to situations that cause social anxiety.  Why not treat reducing your social anxiety as if it were a job?  It is usually best to start off small and work your way up.  It is a good idea to deliberately expose yourself to one situation a day that makes you feel uncomfortable.  Try not to use any safety behaviours or avoidance techniques.  It is important to document your experiences and learn from them.  After a week you will probably feel a little more 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 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.

 

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Other Strategies to help reduce Social Anxiety

 

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Relaxation is often noted as being very beneficial to people with anxiety-related problems.  Using relaxation techniques on a daily basis can reduce the intensity and frequency of any anxiety felt throughout the rest of the day.

 

Many people with anxiety recommend Yoga, particularly a relaxing style of yoga which incorporates meditation.  Not only does yoga help to relax the mind, 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 quite expensive, charging approximately £50 sterling per session.  There are also many hypnotism audio CDs out there. Paul McKenna has written a series of books with accompanying CDs which can really help to relax you and re-programme your mind.  One of his books is called Instant Confidence and includes a useful programme for improving confidence in all kinds of situations.

 

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.

 

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References

 

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Books and Journals

 

Butler, G., (1999) Overcoming Social Anxiety and Shyness: A self help guide using 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. 69–93). New York: Guilford.

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

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 Press

 

Websites

 

Helpguide.org., (2007). http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm . (accessed 08/03/2007)

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