Social Anxiety Disorder and the effectiveness of CBT

Social Anxiety Disorder can develop during adolescence, and if not treated the condition can last long term. Individuals who have been diagnosed with Social Anxiety Disorder will often experience feelings of nervousness and dread surrounding social situations, which often stems from shyness and a lack of confidence. This condition can be very debilitating for the sufferer, who can experience enduring insecurity around relationships with family, friends and others; they can be extremely sensitive to criticism, and often fear they will be rejected. The sufferer will develop irrational thought patterns, worrying constantly how people may perceive them, often internalising views of others to be true about themselves. These thoughts will then magnify and become distorted. The sufferer may start to avoid these fearful situations due to the physical symptoms such as fast heart rate, shaking, sweating, and often blushing, which then makes the individual feel even more panicky that people will only look at them. These feelings often leave a range of emotions, with the sufferer feeling self-loathing, hating the way that they feel "different" or "stupid", leading to the individual to hate themselves. When the sufferer is in a social environment they become very quiet i.e. avoiding conversation, and making themselves appear invisible in a room. They may stop going to the shops, avoid speaking on the telephone, and inevitably going out of the house; this ultimately often leads to depression and loneliness. When the individual pushes themselves to go to a social event they will have often developed a range of safety behaviors as a coping strategy; these can include making sure that they know where the exits are; standing away from the crowd; avoidance behaviors; and ultimately, trying to escape from the situation.

People with Social Anxiety Disorder have developed a negative way of thinking that is twisted with reality; these thoughts then increase the person’s anxiety levels, and lessen the ability to cope. These thoughts occur instantly when they think about an anxiety-provoking situation. For example, if they have a fear of public speaking, just thinking about the situation will elicit thoughts of embarrassment and fear of failure. Cognitive-behavioral therapy has proved to be an effective form of treatment for Social Anxiety Disorder. With a directive/goal orientated approach, the therapist will often set homework for the client which helps to identify the irrational thoughts and beliefs (known as "cognitive distortions") that have been learnt over a period of time. CBT allows tools to be introduced in therapy which help the individual to replace negative thoughts and beliefs with a more rational thought pattern; this then will lead to improvement of anxiety symptoms. The individual has to be committed every day for several months to use the tools learnt in CBT to change their negative automatic thinking. Firstly, you might be asked simply to catch negative automatic thoughts and write them down, and then rationalize the thought. This over time becomes easier; with the help of the therapist you would work your way up to thoughts that are more realistic. Only then does it become automatic and habitual. The benefit of this approach is that you can help direct the client into a more positive way of thinking.

The therapist will usually use a behavioral technique known as exposure training. The therapist will work with the individual on providing exposure training which will gradually expose the client to their feared situations, with the future result being that, over time, less fear will be present. This can often involve role plays and imagining the situation, so that when in the real world the situation will become easier. These variations of technique help enable an individual to move forward. The success rate of CBT and Social Anxiety Disorder shows positive results; however, these will depend mainly on your positive outlook and enthusiasm to complete homework which is set by your therapist, and relies greatly on the person to confront their uncomfortable thoughts. Individuals that work hard on changing their thoughts and beliefs and believe that CBT will help them are more likely to improve. CBT is an intensive form of therapy which requires active participation; if the homework is done regularly, results can be long-lasting and well worth the effort invested.