How CBT can help with different mental health problems

Social Anxiety Disorder or Social Phobia

What is Social Anxiety Disorder (SAD) or Social Phobia.

SAD is a condition which is characterised by significant fear and anxiety in social situations. Everyday interactions cause significant anxiety, self-consciousness and embarrassment because of their fear of being scrutinised, humiliated or judged negatively by others.

People with SAD fear situations which might lead to being judged negatively, embarrassed or humiliated by others. This leads to them experiencing excessive worries, and intense physical symptoms of anxiety when they engage in social situations and interactions.

Such intense fear and anxiety around social situations

leads to unhelpful behaviours such as avoidance that can disrupt quality of life.

Worries include::

Embarrassing or humiliating themselves

Talking/interacting with strangers

Others noticing they look anxious or are experiencing physical symptoms of anxiety such as blushing, sweating, trembling or having a shaky voice

Upcoming/future activities or events - e.g. what to say, what will happen, how they will come across, how they will cope, worst case scenarios

After a social situation- the worst possible consequences occurring following a negative experience

Physical signs and symptoms that accompany SAD include:

Fast/racing heartbeat

Blushing/face going red

Sweating

Trembling

Muscle tension

Upset stomach/nausea

Dizziness/lightheadedness

Trouble catching your breath

Feeling that your mind has gone blank

Unhelpful behaviours include::

Avoidance of situations where they might need to interact with other people- e.g. parties. social gatherings, work, using a public restroom,

Avoidance of situations where they might be the centre of attention- e.g. returning items to stores, doing presentations, eating in front of others, ordering food in a restaurant, entering a room where people are already seated, dating

Avoidance of speaking to people including starting conversations or making eye contact

Analysis of performance and identification of flaws in their interactions after a social situation

Having SAD can disrupt daily life, affecting relationships, work and overall quality of life.

NICE guidelines recommend 12-16 sessions.

How CBT helps

CBT helps people with SAD to understand the connections between their thoughts, feelings, and behaviors relating to social situations and interactions.

It helps people understand how fear of negative evaluation, self-perception, self-focused attention, post-event processing and anticipatory focus contribute to the Vicious Cycle of Social Anxiety.

CBT helps people identify, challenge and modify negative thoughts that contribute to social anxiety. It helps people to change harmful thought patterns and biases into healthier alternatives. helping reduce anxiety and improve self-esteem.

CBT for SAD helps people address unhelpful behaviour patterns such as avoidance. It helps alter behaviours that contribute to the avoidance and self-consciousness experienced by people with SAD.

CBT helps expose people to social situations in a step-by-step way, helping people face their fears in a gradual, controlled and safe way. During exposure therapy people will start with situations which are less frightening and gradually move up to the more difficult ones.

Repeated exposure helps to teach the brain that the feared situation is not as dangerous as it believes it is, leading to a reduction in anxiety levels over time. This helps people to learn that anxiety lessens on its own over time.

CBT for SAD also incorporates social skills training. This equips people to manage anxiety symptoms more effectively and better problem solve negative experiences they may face in social situations.

CBT helps people develop a sense of control over their anxiety around social situations. It helps people develop skills and techniques that enable them to feel more positive and self-confident in social situations.