Social Anxiety and Cognitive Behavioural
Techniques.
Compiled by Edward Griffin
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Introduction and Definition
The term ‘Social anxiety’ was coined by Janet (1903) to describe people who
feared being observed while speaking, playing the piano, or writing. Social
Anxiety nowadays is a term used to describe the excessive fear, nervousness
and apprehension that people experience in social interactions (Butler, 1999).
People with social anxiety fear being judged negatively by other people or
humiliated in front of them.
The physical indicators of social anxiety are similar to those of other types of
anxiety attack. When social anxiety occurs, individuals can experience all the
indicators of autonomic nervous system arousal (racing heart, sweating,
clammy hands, trembling, stomach butterflies and feeling sick), and in some
circumstances they can experience panic attacks and loss of consciousness.
This can cause considerable discomfort and embarrassment and often affect
the person’s ability to act naturally or perform a task in front of people.
Performance anxiety (better known as stage fright) is one of the most
common aspects of social phobia. The performance situation triggers intense
anxiety with the result of significantly hindering a person’s ability to perform a
task in front of people that they would normally find simple performing alone.
Cognitively, social anxiety often revolves around the feeling of being judged or
being seen in a negative light by others. People with social anxiety often have
a fear of being humiliated in public. When social anxiety arises, people’s
minds go blank; they get confused and often think that they come across in a
bad light. In many cases it is not surprising that a person with social anxiety
will often avoid many social situations. This can result in poor self-esteem
and depression.
Social phobia is often a secondary aspect to many types of neurodiversity,
especially Asperger’s and Dyspraxia where an understanding of social
situations and subtleties in communication can be difficult (helpguide.org).
People with neurodiversity may have some kind of impairment or difference
which could stand out. This could increase self consciousness to an extent
that considerable anxiety is caused.
How to overcome social anxiety
Social anxiety happens to everybody at one time or another. It is perfectly
normal to feel anxiety in situations such as a job interview, making a speech,
or going on a date. Some people however develop anxiety in most social
situations, which can seriously affect their quality of life. When social anxiety
becomes this intrusive there are several options people can take.
It is advisable to contact your doctor who will give you a formal diagnosis and
either refer you to a therapist or put you on medication. Therapies include
counselling, psychotherapy and cognitive behavioural therapy (CBT). The
most common and successful of these therapies seems to be CBT.
Medication is also successful in reducing social anxiety and comes in the form
of anti-depressant types (MAOIs* and SSRIs*) or tranquilizers such as valium
and Beta Blockers. Whilst medications can be effective, in some individuals
they can have unwanted side effects.
*[MAOIs: Monoamine Oxide Inhibitors – e.g. Phenelzine ]
*[SSRIs – Selective Serotonin Reuptake Inhibitors – e.g. Fluoxetine]
There are several things people can do to help themselves in reducing the
indicators of social anxiety and anxiety in general:
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Exercise regularly. – Helps keep the heart healthy and produces brain
chemicals which relieve anxiety.
Improve your sleeping pattern. – You are more prone to anxiety if you
are tired or if your sleeping pattern is irregular.
Give up, or cut down on drinks and foods that contain caffeine. These
speed up the heart which can cause anxiety.
Gradually expose yourself to situations that can cause anxiety.
Give up or cut down on smoking.
Cognitive Behavioural Model of Social Anxiety
One of the most popular methods used to reduce and eliminate social anxiety
is cognitive behavioural therapy (CBT). It utilises the idea that various
recurring thought patterns and behaviours are linked to physical and
emotional indicators of social anxiety. CBT is a process of identifying,
analysing and changing these thought patterns and behaviours with the result
of reducing the overall anxiety. CBT has been stringently applied to many
people with anxiety and depression, and it has proven to be more effective
then any other psychological techniques, and just as effective as medication
(without the side effects). Cognitive behavioural therapy works around the
idea that thoughts affect behaviour and vice versa. Therefore the reprogramming of both is likely to change the situation.
The cognitive behavioural solution to social anxiety is generally based around
a model (diagram) showing the thought processes, behaviours and how they
interact with one another. One of the most common and well supported
models of social anxiety was devised by Clark and Wells in 1995. The Clark
and Wells model shows the processes involved in social anxiety:
Figure 1 - The cognitive behavioural model of social anxiety devised by Clark and
Wells 1995. This version was adapted from Butler 1999.
The trigger situation refers to the situation that activates the bout of anxiety.
This can vary from person to person but often includes things like answering
the phone to someone you don’t like talking to, or walking past a group of
people you know in the street who stop and talk to you. For some people the
situations might be more specific, such as the weekly meeting at work or a
formal chat with your boss. The trigger situation activates the beliefs and
assumptions the person has about them self, the specific situation, and social
situations in general.
Activates beliefs and assumptions refers to the thought patterns the person
has about themself, the specific situation and previous experiences in similar
situations. Examples of these beliefs and assumptions are: ‘They think I am
weird’, ‘they are judging me in a negative way’, “I’m no good in these
situations’, ‘there must be something wrong with me’ or ‘people think I am
inferior.’
The situation is perceived as socially dangerous. The combination of the
trigger and the negative thoughts associated with it accumulate in the person
perceiving the situation as threatening or dangerous, which can activate three
responses:
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Safety behaviours. These are behaviours developed to minimise the
anxiety felt at the time and avoid further exposure to potentially greater
anxiety. For example - leaving the situation to avoid further
embarrassment, or changing the subject to something you feel
confident talking about.
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Self consciousness. This is when attention becomes focused upon
oneself. For example – becoming very aware of how much or how little
eye contact you are making, or being very aware of your shaking
hands.
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Signs and symptoms of anxiety include increased heart rate,
sweating, quivering voice, breathing becoming heavier and starting to
shake.
These three responses are interlinked. Self consciousness increases the
feeling of anxiety, which increase the perceived threat of the situation, which
can in turn increase the signs and symptoms of anxiety. If you feel at risk, this
activates safety behaviours which can confirm that the situation is dangerous.
Self help Cognitive Behavioural Therapy
CBT is a tried and tested method for helping to relieve the anxiety caused by
social situations. Often people are referred to a cognitive behavioural
therapist by their doctor. However getting referred to a cognitive behavioural
therapist can sometimes be quite difficult for somebody with social anxiety.
For a start it involves explaining the problem to a doctor, which some people
may find difficult, and secondly there are often long waiting lists for therapy,
and sessions can be quite sporadic. Whilst someone who is referred to a
therapist will gain the benefit of experienced one to one counselling and group
workshops, there are a couple of very useful self help books which if used
properly, will give you a programme of cognitive behavioural techniques which
you can use on yourself.
Most of the following techniques either come from, or are adapted from Gillian
Butler’s excellent book “Overcoming Social Anxiety: A self-help guide using
Cognitive Behavioural Techniques”. The book goes into far more detail and
covers a lot more then what is mentioned on this page, but some of the
aspects on this page should be quite helpful.
Use a diary or electronic organiser to record and monitor your progress.
Thoughts and Beliefs
The first thing to do is to identify your thoughts and beliefs. Thinking plays a
big part in several of the processes involved in social anxiety. If analysed
properly, thoughts can be categorised into beliefs, assumptions and attitudes.
Knowing what type of thought you are thinking is essential in changing them.
Beliefs - A belief is a thought that you make real or feel is true. A socially
anxious person may believe that other people are generally hostile and will
ridicule any weaknesses observed in them, or they may believe that they have
a generally un-likable personality. These beliefs may have stemmed from bad
childhood or past experiences. Many beliefs are dispositional in that they
exist but have never previously been analysed and been questioned. Some
beliefs are also limiting in that they inhibit one’s actions. It can be hard to
identify deep seated beliefs, as the belief may have formed years ago in
response to a situation which may have been forgotten. Beliefs play a big
part in behavioural responses. Someone who believes that people are
generally hostile may think that it is dangerous to tell people too much about
themself and avoid too much small talk.
Identifying Beliefs - The first step taken in CBT is to identify your beliefs in
order to analyse them. Start by thinking of a situation where you felt
particuarly socially anxious. Try to relive the situation, and write it down in as
much detail as you can. Pay attention to the thoughts, feelings and images
that come to your mind. You could use the following table (Word Doc) to help
you to identify the feelings and thoughts encountered in the situation. This
process can take a while but it is very important in order to help identify your
beliefs. When you have analysed the situation consider the following
questions:
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What do you feel were your short falls?
In what way are you judging yourself?
What did the situation mean to you?
What did the situation mean about you?
What were the attitudes of others in the situation?
What does this tell you about them?
( adapted from Butler, 1999)
With the situation fully in mind complete the sentences:
I am………………
Others are………………..
For example:-
Tony used the table to analyse his thoughts and feelings
Situation where
social anxiety arose
Feelings (there may
be more than one)
When asked if he
Fear
wanted to come to
Apprehension
Nigel’s leaving buffet Worried
Thoughts, impressions etc
I wont know any body
I wont be able to talk if I get
nervous
People wont like me
At the Party
Talking to the
secretary
Panicky
Sweaty
Heart Racing
They’ll think I am odd
I can’t relax and be normal
People don’t like me
Embarrassed
rude
She thinks I’m an idiot.
He then asked the set of questions aimed at helping to identify his beliefs.
On analysis, Tony felt that his short falls were that he couldn’t think of
anything to say, he appeared nervous and he said silly things to fill in the
gaps.
Tony thought that he was judging himself in ways that he thought other people
would be judging him, and in ways that he had been judged in the past.
Tony thought that in the situation people would be judging him because he
was the new guy. He thought that they would pick up on his weaknesses and
judge him negatively. He imagined them talking about him behind his back
To Tony the situation meant that he appeared boring, nervous and unlikable.
He felt it proved that he was socially inferior to others and other people
thought that he was strange.
Tony thought that others seemed not to enjoy talking to him and that his
nervousness seemed to make them feel uncomfortable.
I am : socially inferior to other people, and if I become anxious I become
vunerable to ridicule
Others Are : always judging me on my downfalls and are likely to team up and
ridicule me if they see my weaknesses.
Tony analysed several other situations and discovered similar beliefs. He also
noted that when he was bullied and ridiculed at school, his anxiety made it
difficult for him to stand up for himself and answer back.
Changing beliefs.
The next step is to analyse your beliefs and to try and change them.
For example, Tony believed that:
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he was socially inferior to other people, and if he became anxious he
became vunerable to ridicule from others
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other people would judge him on his downfalls and were likely to team
up and ridicule him if they were to see his weaknesses.
It is unlikely that Tony’s beliefs were based around facts. Although they might
have seemed true once, he has avoided situations and not tested them since
he was bullied at school.
Here are some interesting questions that can be used to analyse your beliefs:
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How are your beliefs making you behave?
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Would you judge someone else who felt like you do in the same way?
Are you being fair to yourself?
Are you going in for character assassination rather then sticking to
what happened on one particular occasion?
Are you forgetting that everyone makes mistakes and feels socially
uncomfortable at times?
Are you ignoring your strengths and focusing on your weaknesses?
Are you falling into a biased pattern of thinking?
Are you drawing conclusions based upon your childhood or adolescent
experiences?
Are you judging yourself as you have once been judged?
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(Butler, 1999 p174)
Tony concluded that his beliefs were not as true as he had thought they
were. He noted that his beliefs made him avoid social situations, say
unecessary things to avoid silences and try to please people so that they
would like him.
He realised that it wasn’t the case that everyone was against him and that
people had grown out of the school yard bullying mentality.
He realised that his avoidance of situations meant that he was unable to test
how true these beliefs were.
He felt responsible for the long silences in conversations and often said
something to fill in the gaps. After this exercise he realised that the other
person may have felt just as awkward about the silences and that it was their
responsibility too.
Tony decided that his self consciousness was partly due to the beliefs he had
and the behaviors he adopted because of these beliefs.
Behaviours
Behaviours play a key role in the social anxiety cycle. Usually behaviours are
built around beliefs, and as demonstrated previously, many beliefs held by
socially anxious people are not as true as they may seem. Below are a
number of unhelpful behaviours that socially anxious people often adopt:
Avoiding the situation - This is one of the things that socially anxious people
often do. After one bad experience with a particular social situation, people
may avoid similar situations thereafter. This can lead to social isolation and
cause depression and low self-esteem. Whilst avoidance has the benefit of
keeping anxiety at bay, it has a negative overall effect. It helps to maintain
the difficulty rather than to resolve it. By avoiding the situation, the person will
never know if the situation warrants this kind of self protection (in most
situations it doesn’t - see beliefs). Experiments in anxiety show that the more
people are exposed to situations which make them feel anxious, the less
anxious they eventually come to feel about the situations. This however does
require giving up safety behaviours.
Safety Behaviours - People who have had social anxiety for some time often
become quite skilled at behaving in ways which reduce the perceived threat.
Safety behaviours are essentially a way of minimising or avoiding the
embarrassment and anxiety felt in social situations. For example if you are at
a party, you may hang around on the periphery so as not to attract too much
attention. You realise that having little to say at a party might look a little odd,
so you only talk to the people that you feel most comfortable with. You may
drink your alcoholic beverage quickly to give you a bit more confidence. You
may regularly visit the toilet, even when you don’t need to go, just to avoid
chatting to someone you feel poses a threat. You probably say the same old
things in the same way to different people just because you have rehearsed
them and feel a little more comfortable saying them. You may get up and
make an excuse and leave when the anxiety gets too much.
Whilst safety behaviours may seem helpful at the time, in the long run they
are counter-productive. They confirm that the situation is dangerous by
reinforcing the belief that you have got to keep safe or something bad will
happen (Butler, 1999). Safety behaviours often become habitual responses
to situations which are mostly harmless. Using safety behaviours has the
effect of not testing how dangerous the situation really is.
Another negative aspect of safety behaviours is that they focus attention
inwards and make people increasingly self aware and self conscious. This
has an effect of increasing the psychological and physiological aspects of
anxiety.
Examples of safety behaviours are:
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Rehearsing what you are about to say and mentally checking that you
have got the words right.
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Holding things tight or locking your knees together to avoid shaking.
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Keeping an eye on the escape route (a way out of the situation) and
never getting fully involved.
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Sticking with a ‘safe person’ or staying in a ‘safe place’ – never taking
any chances.
To identify behaviours you will need to take a specific situation where social
anxiety arose and write it down. Try to remember how you behaved when
you felt anxious. Write these behaviours down.
Post-mortem – It is very common amongst socially anxious people to
critically analyse a social situation which caused anxiety after the situation has
occurred. Usually these post-mortems are not based around facts but more
on the person’s negative beliefs and attitudes. A socially anxious person is
likely to have negative beliefs and attitudes toward themselves in social
situations. Try to avoid the post-mortem at all costs. It is useful to know that
everybody makes mistakes and nobody is perfect in all social situations.
Self-Consciousness
Self -consciousness comes from focusing your attention into yourself. It
makes you increasingly aware of uncomfortable sensations, feelings, thoughts
and behaviours. An episode of self-consciousness can arise in any social
situation, regardless of how well you know the people you are with (Butler,
1999). It makes you focus your attention on your inner present experience
and makes it very difficult to pay attention to the external world.
The key to reducing self-consciousness comes with learning to focus your
attention on what is happening outside yourself and stop listening to your
internal worries. Tackling self consciousness is one of the more difficult
aspects in reducing social anxiety. It usually comes with practice and
exposure to situations. It is important to know that people often don’t notice
the thing that you are conscious about.
To help focus on external things it is a good idea to adopt the attitude of
curiosity. If you have worked successfully on changing your beliefs then you
will realise that in most situations a bout of self-consciousness does not
present any danger whatsoever.
Next time that you are talking to someone, why not see what happens if you
consciously observe everything about them, including what they are saying to
you – the colour of their hair, the style, their eyes, their clothes etc? Count
things: the windows in the room, the number of books on the book shelf, etc.
At first you may find this slightly distracting, but it is often insignificant in
comparison to how distracting self-consciousness can be.
Putting it all together
As discussed previously thoughts, feelings and behaviours are intrinsically
linked with social anxiety. If you would like to use some of the ideas already
discussed, then you are going to need to know how to put them all together.
Please remember that while some of these methods may seem a little simple,
they are based around a sophisticated understanding of the problem.
Generally in CBT, thoughts and beliefs are the primary aspects to be
addressed in order to provide a good set-up for changing behaviours.
Step 1 – Identifying Beliefs
The first method should be to try and identify your thoughts and beliefs. This
involves vividly remembering situations which have caused you considerable
anxiety. Use the methods described in the beliefs section which includes a
chart for identifying thoughts and feelings. Take some time to do this and
make sure that you write them all down. When you have done this you should
be able to identify some of the beliefs that cause social anxiety.
Step 2 – Questioning Beliefs
The next process is to question your beliefs using the questions highlighted in
the beliefs section. Decide how true you think these beliefs are and try to
modify them into more productive ones. When you realise that some of your
negative beliefs may be false, it becomes easier to change your behaviour in
similar situations.
Step 3 – Identifying Behaviours
The next thing should be to write down your behaviours when anxiety arises.
Think of specific situations and look for the negative behaviours highlighted in
the Behaviours section. A lot of your behaviours will be a response to your
incorrect beliefs or to lessen the feeling of anxiety. When you have identified
your thoughts and behaviours you will be more aware of how they affect your
anxiety, and aware of their fallibility.
Step 4 – Changing Behaviours
Armed with revised beliefs and an awareness of counter-productive
behaviours, it is time to plan a method of changing behaviours and trying to
do things differently. Whilst this can be quite daunting, it is often a good idea
to adopt the role of a scientist who wants to discover the effects of various
behaviours upon the feelings of anxiety. Use the following chart (word Doc) to
plan an experiment in changing behaviours. This will require you to start
exposing yourself to situations that cause social anxiety. Why not treat
reducing your social anxiety as if it were a job? It is usually best to start off
small and work your way up. It is a good idea to deliberately expose yourself
to one situation a day that makes you feel uncomfortable. Try not to use any
safety behaviours or avoidance techniques. It is important to document your
experiences and learn from them. After a week you will probably feel a little
more confident and be able to move on to two situations a day.
Remember to try and avoid the post-mortem and apply the tactics of reducing
self consciousness. You should find that self consciousness will reduce in
time. It is important to keep going and not to give up. After a while your
confidence should grow and social anxiety should reduce.
Other Strategies to help reduce Social Anxiety
Relaxation is often noted as being very beneficial to people with anxietyrelated problems. Using relaxation techniques on a daily basis can reduce
the intensity and frequency of any anxiety felt throughout the rest of the day.
Many people with anxiety recommend Yoga, particularly a relaxing style of
yoga which incorporates meditation. Not only does yoga help to relax the
mind, but it also revitalises and soothes the body.
Hypnotism is an excellent way to relax. There are many private
hypnotherapists who may be able to help you, but they can be quite
expensive, charging approximately £50 sterling per session. There are also
many hypnotism audio CDs out there. Paul McKenna has written a series of
books with accompanying CDs which can really help to relax you and reprogramme your mind. One of his books is called Instant Confidence and
includes a useful programme for improving confidence in all kinds of
situations.
Join a drama club. People with social anxiety may be a little out of practice
with their social techniques. The benefits of an amateur dramatics club are
that it would build up your confidence in your voice and body language, and
expose you to some forms of anxiety.
References
Books and Journals
Butler, G., (1999) Overcoming Social Anxiety and Shyness: A self help guide
using Cognitive Behavioral Techniques. London: Robinson
Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. In R. G.
Heimberg, M. Liebowitz, D. Hope and F. Scheier (Eds.), Social Phobia:
diagnosis, assessment, and treatment (pp. 69–93). New York: Guilford.
Heimberg, R.G., Liebowitz, M.R., Hope, D.A., Schneier, F.R., (1995) Social
Phobia: Diagnosis, Assessment, and Treatment. The Guildford Press/ New
York
Howlin, P., (2004) Autism and Asperger Syndrome: preparing for adulthood
2nd ed. USA & Canada: Routledge
Jackson, L., (2002) freaks Geeks and Asperger Syndrome: A User Guide to
Adolescence. London:Jessica Kingsley
Janet, P. (1903). Les obsessions et la psychasthenie (2 volumes). Paris:
Felix Alcan. Reprint: Arno Press, New York, 1976.
McKenna, P. (2006). Instant Confidence: The Power to go for anything you
want. Bantam Press
Websites
Helpguide.org., (2007).
http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm
08/03/2007)
. (accessed