Group Action Plan for Students with Social Anxiety Disorder
Introduction
Understanding the experiences of students who live with social anxiety disorder (SAD) is
a large concern in a society where success in academics is of utmost importance. Anxiety
disorders are the most frequently diagnosed psychological disorders, and students have been
identified as a particularly vulnerable group with the highest risk of developing such disorders.
People diagnosed with an anxiety disorder will experience symptoms and behaviors that are
similar to the diagnostic measures outlined by the DSM-IV. However, the symptoms of
individuals can vary depending on the severity of the disorder and the type of anxiety they are
experiencing. Starting a therapy group for students with social anxiety disorder will have several
benefits. First, group therapy offers comfort to group members when they know that others in
their group have similar experiences and feelings. Group therapy can instill hope in members
when they see that other people have gotten better. It can also be beneficial when one’s selfesteem increases after realizing how they can help others.
This group action plan will provide a comprehensive review of group treatments for
individuals suffering from social anxiety disorder (SAD), also known as social phobia (Neufeld
et al., 2020). This plan will also include the reasoning for a group therapy approach, and a
description of cognitive behavioral group therapy that theorizes on the future use of group
treatment for SAD. Even though the number of sessions with group therapy is relatively limited,
it would seem that anxiety disorders, including SAD, are well-suited for group treatment. This is
based on research showing that group treatments for anxiety are effective, efficient, and costeffective, leading to recommendations that group cognitive-behavioral therapy (CBT) should be
considered as the initial treatment for SAD (Emmelkamp et al., 2020, Asbrand et al., 2020).
Literature of Review
Social anxiety disorder is considered the third most common mental disorder, after
substance abuse and depression (Leigh & Clark, 2018, Emmelkamp et al., 2020). Social anxiety
has a prevalence rate of approximately 12%. It is also characterized by a persistent fear of social
situations in which the individual is exposed to unfamiliar people or possible scrutiny by others
(Leigh & Clark, 2018). The individual often fears that they will act in a way that will be
embarrassing and humiliating. This will almost always result in an avoidance of the feared
situations, where the person will endure almost any hardship to be alone and away from public
scrutiny. Social anxiety disorder (SAD) is a well-documented and researched mental health
condition. It is a chronic and debilitating disorder that leads to excessive and often irrational fear
of social situations and scrutiny. The term 'social anxiety disorder' was first introduced in the
Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), and the
condition can be more easily defined by breaking it down into its key components, “fear and
avoidance.”
According to the research done by Nicoară et al. (2023), social anxiety disorder can be
influenced by the following factors: genetic background, family history, parent’s anxiety,
learning experience, and parenting style. Social anxiety disorder is one of the most common
mental disorders associated with the well-being and everyday life of affected youth. With
prevalence rates as high as 9% in youth, effective and efficient treatment is essential. Cognitive
behavioral therapy (CBT) programs have generally proven effective for anxiety disorders in
children, adolescents, and adults. In academic settings, students suffering from social anxiety
disorder are at an increased risk for failing or dropping out of school. The impairment in quality
of life does not solely arise from fear and avoidance of situations, but the negative physical and
psychological effects of anxiety. Such effects include headaches, trembling, blushing, profuse
sweating, and difficulty talking. Social anxiety disorder is also associated with a high rate of
other psychiatric problems. Usually, more than 50% of patients with SAD also suffer from
another anxiety disorder. On the other hand, those suffering from SAD with an onset in the
specific situation of public speaking are at high risk for developing alcohol dependence.
As one would expect, SAD commonly interferes with the student's ability to effectively
participate in the school environment. The sole study focusing on the impact of SAD on
educational outcomes at the high school level found that, compared to a healthy control group,
students with SAD had significantly lower school attendance and academic performance, as
well as higher rates of dropping out. Lowered academic achievement and increased rates of
dropping out clearly indicate that there is a problem with SAD students not receiving the
assistance that they need. This supports the high importance of addressing SAD in students, to
act preventatively in stopping academic dysfunction, and to improve the prognosis for those
already experiencing dysfunction.
Session 1: Building Rapport and Psychoeducation
The first few sessions will focus on group cohesion and psychoeducation. It is very
important to stress that social anxiety disorder has a biological basis, and it is not the fault of the
parents or the child. An overprotective parenting style has been linked to the development of
SAD due to a lack of opportunity to develop social skills, but it is also reported that 80% of
youth with SAD came from families of average or above-average levels of expression of parental
warmth. A parent may feel responsible for their child's anxiety and view this as a family
problem. We want to educate parents and children to understand SAD and to recognize group
therapy as an intervention method and not a remediation for some ill behavior.
Building social skills and increasing social interactions are emphasized in group therapy
sessions. While research supports the use of these groups in the treatment of children with a
variety of disorders, validated treatment methods for SAD are scarce. Youth who are extremely
anxious in social situations were found to benefit from skills-building activities that provide
repeated practice in a social setting with feedback. Participants of interpersonal therapy groups
strongly agreed that social interactions with other group members were useful in decreasing
symptoms. Mock trials and role-playing exercises allowed them to recognize and change
negative thoughts about their interactions. These are findings that we too can apply to our
sessions with youth with SAD.
Session 2: Cognitive Restructuring Techniques
Session 2—Cognitive Restructuring Techniques" explains techniques to recognize and
challenge the student's negative thoughts about social situations. During a brainstorming session
between authors, it was noted that students with SAD would find it difficult to directly challenge
and confront a thought that they believe is true due to the strength of their conviction in that
thought. To immediately challenge such thoughts does present great difficulty and has been
previously avoided by therapists through use of distraction techniques. However, a new therapy
developed by Bayne and Hays creates an intermediate stage for cognitive restructuring which is
done indirectly through the use of humor to "soften the blow" of a self-attack and dislodge the
clients from their entrenched beliefs about themselves".
The use of humor is vital to this approach and is adopted from a study by Kazdin who
investigated the verbal content of therapeutic sessions and found that sessions containing humor
involved less negative affect and greater self-referent change on the part of the client. This is
consistent with a study by Heiby and Becker who found that mental juxtaposition of a client's
belief system and a more adaptive belief system led to increases in flexibility towards the new
belief system. Cognitive restructuring can be done in a standard format at group with the
modeling by a group of students who volunteer to be a "case study" in this situation it would be
best to use a student with more minor social fears. This can be seen as a testing phase for the
technique.
Session 3: Exposure Therapy
Exposure therapy in this context seeks to eliminate avoidance behavior and decrease feelings of
anxiety by having the students confront their fears in a safe and supportive environment. It also
seeks to enhance self-efficacy and provide a successful learning and performance experience.
Unfortunately, many FE students with social anxiety disorder have developed maladaptive
coping strategies to avoid anxiety-provoking social situations. By avoiding or escaping feared
social situations, students may feel relief in the short term as anxiety decreases, but in the long
term, the social isolation and lack of opportunity to disprove negative predictions may worsen
social anxiety. It is important that cognitive restructuring (sessions 4-6) occurs before exposure,
as it is imperative that the students hold a different view of what they are doing before they
engage in the activities. If not, they will not persist with the exposure tasks. These students differ
from those with specific phobias in that social situations are often encountered daily, and
avoidant behavior may be more disabling. In the long run, exposure to the feared social
situations is the most effective way to overcome social anxiety. However, careful consideration
needs to be given with the timing of when to use exposure therapy, considering the differing
severity levels for the social anxiety sufferers. High severity sufferers may be overwhelmed and
too discouraged if pushed into exposure too quickly when they are not ready for it. Low severity
sufferers, however, may make significant improvement with just a few exposure sessions.
Session 4: Social Skills Training
It is predicted that social anxiety sufferers will have many negative thoughts and often avoid
situations where they will have to spend time with another person. They will then miss out on
many potential friendships. To increase the chances of these people socializing, they are
encouraged to plan rewarding activities that involve other people. They can then use the social
skills they learn in this module to assess how the situation went and whether they want to do it
again. People with more severe social anxiety may need to do this with a therapist pretending to
be an acquaintance at first.
Stage one: It is explained to the group that the key to making friends with someone is to spend
pleasant time with them. This is because it is how the person feels when with you that will affect
whether they want to do it again. Pleasant feelings come when both people find that being with
the other is rewarding and cost-free, i.e. they are having a good time and not feeling
uncomfortable because they are feeling accepted (rewarding) and not feeling the person is being
pushy or acting in a way that they are not comfortable with.
This module takes the group through the process of making friends and having pleasant
conversations with others. This is done in five stages:
Session 5: Relapse Prevention and Graduation
Notifying group members that treatment is coming to an end may cause some anxiety.
Termination itself is a common problem area for socially anxious clients. By identifying this as a
possible difficulty, it can become another opportunity to utilize cognitive restructuring
techniques. Then, in the final session, time should be set aside for a discussion on what problems
the group predicts and how they can use their knowledge of cognitive therapy to overcome them.
Further role plays can be set up to simulate real-life situations. The scenarios portrayed should be
taken from the personal examples given in session two and should aim to gradually increase in
difficulty, causing minimum anxiety for the group member. Again, this will help to test out new
cognitions and provide evidence for the effectiveness of their cognitive techniques. As this will
be during the final week of university examinations, it may prove to be a highly stressful period
for the group. To prevent a relapse of problems during this time, it may be necessary for some
group members to set up emergency one-to-one sessions with the therapist.
To enhance confidence and the generalization of cognitive techniques, it is essential to
reinforce the learning that has taken place in previous sessions. This can be achieved by group
members identifying specific situations where they have used cognitive restructuring techniques
to change unhelpful thoughts. Tasks can then be set for home practice: in anxiety-provoking
situations, they are to try out the new self-help thoughts and report back on the outcome. The
goal of this session is twofold. Firstly, it is to maintain and enhance the confidence and abilities
of the group members using cognitive restructuring techniques and to generalize the use of these
techniques in real-life situations. This will help to prevent a deterioration of their presenting
problems after therapy has finished. A second goal is to bring the therapy to a close in a
systematic manner, ensuring that key issues are addressed and that the ending is a positive
experience for the group.