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Monday, 01 Oct 2018

The Most Effective way to Treat Social Anxiety Disorder

By Dr Becky Spelman

Social anxiety disorderSocial anxiety is a state that can affect people from all walks of life. Everyone has experienced a jangling of nerves before a big interview or date; this is normal. But when this sense of nervousness reaches such heightened levels it interferes with rational thought over a sustained period, it shifts from a being an emotional response to a disorder.

Social Anxiety Disorder can can largely be thought of as the intense scrutiny of an upcoming event, and how you anticipate you will be received by those who are present. It is the fear of judgment, rooted in a lack of self-esteem and unworthiness. Those who suffer from SAD often have difficulty with self-acceptance and lack the confidence to embrace their identity.

It is generally accepted that in most instances, the cause can be traced back to a specific event, usually in childhood, which serves as the reference point for present actions. This takes place through an occurrence often referred to as a dysfunction assumption.

Essentially, this is the manufacture of a belief, based on previous experiences, which then becomes the expectation for future interactions. For example, if a child received little to no affection from his or her parents, but were then praised for their academic achievements, this would setup the thought that unless they excelled consistently, they would be rejected.

These thoughts make up what is referred to as a person’s core beliefs, which are enacted through automatic responses, based on those foundational experiences earlier on in life. They are learnt responses, and therefore can be unlearnt.

But how?

Cognitive Behavioural Therapy

The purpose of Cognitive Behavioural Therapy is to change the way a person thinks and therefore the way they perceive the world around them. It is a very pro-active form of therapy, which relies on willingness not just while in session, but also to put the theory into practice outside of it, as well.

There are two components to the process of CBT; the first is discussion with your therapist, with the purpose of understanding the issue at hand, and breaking it down into smaller, more manageable components that can be addressed, individually.

Then, having identified the challenges preventing you from leading a functional life, you work through a process of disarming them. This is achieved through behaviour experiments, testing the outcome of negative predictions, such as ‘if I leave the house, something terrible will happen.’

A useful way to break down the process would be as follows:

Thoughts create feelings >> Feelings create behaviours >> Behaviours reinforce thoughts.


Thoughts: I can’t leave the house, people will stare at me, what if I’m mugged?

Feelings: Fear, anxiety, stress, depression.

Behaviour: Avoidance, reclusiveness, justification.

So in essence, the goal of CBT is to provide you with the tools to make positive changes in your own behaviour; it is an empowering process. You aren’t told what to do by a therapist; you work with them to become aware of your inner workings and create more capable version of self.

It is this highly structured and person-centred nature of CBT that makes it so effective in treating social anxiety disorder, and with practical approach to problem-solving that is encouraged, provides a tangible way to measure progress.

Other Forms of CBT

In choosing a therapist, you likely find that each will have their own particular approach, and draw on certain aspects more so than others to assist with your set of challenges. Below are some of the fundamentals of CBT that can also be offered as standalone therapies in their own right.

Exposure Therapy – This falls in line with the behavioural side of CBT, as the premise of exposure therapy is to introduce the source of anxiety in a controlled manner without the intention of provoking, triggering or causing any undue mental trauma. The purpose is to increase the capacity to tolerate distress that would usually see patterns of escape enacted. These challenges are increased gradually, rising to most stressful until the sense of fear and anxiety is no longer present

Social Skills Training – As the name suggests, this involves a more practical approach, and provides the platform, and skill set to help properly integrate the positive work done with the cognitive side of therapy. Similar exposure therapy, the focus is on becoming more comfortable in stressful situations. With the help of your therapist, you engage in role play-playing scenarios, designed to help you start and maintain conversations socially, leading to better relationships and an increased sense of self-worth.

Cognitive Restructuring – This area focuses more on the mental challenges that SAD presents such as poor self-image, fear of judgment and negative attribution bias, i.e., the assumption that positive outcomes are luck-based and negative outcomes are the result of personal failings. The process involves talking with your therapist to identify negative thoughts and determine whether or not they are rational and/or warranted. Once these have been established, they can then be replaced with positive thoughts that will in turn seed more constructive habits.

Some Final Words

Social Anxiety Disorder can be extremely challenging to deal with; the nature of the condition can make seeking help a huge obstacle in itself. But it’s important to remember having a strong support network around you can be of great benefit in the initial stages of treatment.


For help with the issues discussed in this article speak to one of our therapists here at Private Therapy Clinic for a free initial chat or to make an appointment.

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