Treating social anxiety with cognitive behavioural therapy (CBT)

According to DSM-IV, social anxiety disorder or social phobia, is defined as 'a persistent and excessive fear of social or performance situations lasting at least six months'. Exposure to the feared social situation triggers anxiety or panic attack, fearing that the individual will be humiliated or embarrassed. The individual with social anxiety is concerned about negative evaluation by others and makes predictions about the outcome of the situation.

What is social anxiety disorder?

Statistics on social anxiety

Social anxiety affects people of all ages, but it is more common in women than in men. Also, minority and socially deprived groups are predisposed to developing a mental health problem due to stresses, marginalisation etc. Research suggests that it is one of the most predominant psychological disorders in Western countries reaching 12%, compared with other anxiety disorders such as generalised anxiety disorder with 6%, panic disorder 5%, PTSD 7% and 2% for obsessive-compulsive disorder. National Institute for Health and Care Excellence Guidelines (NICE) classifies social anxiety as one of the most common mental health problems in the UK.

Causes of social anxiety

A combination of biological, psychological and environmental factors contributes to the development of social anxiety. For example, an imbalance of the neurotransmitter serotonin can lead to anxiety, a traumatic social experience (eg. loss) or a lack of mirroring and observation of others. It is mainly developed in childhood or puberty and if left untreated it is likely to have a detrimental effect on the individual’s life.

Consequences of social anxiety

Social anxiety impacts the individual’s normal functioning, his social, work and educational life, resulting in poor social impairment. Also, statistics indicate that individuals with social anxiety will experience another mental health issue in their lives such as anxiety, depression, PTSD or substance abuse.

Treatment of social anxiety

NICE recommendation for treating social anxiety is cognitive behavioural therapy (CBT). CBT is a process of identifying, processing and changing thought patterns and behaviours which are related to physical and emotional symptoms of social anxiety. The frequency of the sessions is weekly, offering if possible 90 minutes, up to 14 sessions over a course of 4 months. Therapy can be delivered face-to-face and online.

The CBT Competencies Framework for working with social anxiety recommends the use of the model devised by Clark and Wells in 1995. Clark and Wells's model theorises that social anxiety can be triggered by a situation which activates anxiety, beliefs and assumptions that the individual holds about himself. The combination of these two factors makes the individual perceive the situation as threatening. As a way of managing this situation the individual develops three interlinked responses, safety behaviours to minimize the anxiety, become self-conscious and develops some physical signs of anxiety. Thus, social anxiety is developed and maintained impacting the individual’s functioning.

In CBT for social phobias, you learn to drop maladaptive behaviours and challenge negative thoughts or core beliefs which support the problem.

If you would like to learn more about how therapy can help you overcome social anxiety please do not hesitate to contact me. 

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