It is common for people to feel nervous in some social situations. But with social anxiety disorder, also called social phobia, everyday interactions cause persistent, intense fear or anxiety about specific social situations because one believes they will be judged negatively, scrutinized or rejected by others.
To be diagnosed with social anxiety disorder, a person’s fear and anxiety consistently lead to avoidance that severely disrupts a person’s daily activities such as work, academics and/or social life. Persons with this disorder are at an increased risk for developing major depressive disorder and alcohol use disorders. Social anxiety disorder affects 15 million adults in the US and is the second most commonly diagnosed anxiety disorder.
Treatment for Social Anxiety
Social anxiety disorder is highly treatable using a combination of cognitive behavioral therapies depending on the client’s specific needs. In treatment clients learn how to do Cognitive Restructuring to identify distorted thoughts that cause distress, broaden their perspective on these thoughts and restructure them to be more rational and reasonable.
Social skills training begins with an assessment to identify what if any social skills deficits exist so those areas can be addressed in treatment, such as how to start and maintain conversations and how to use eye contact.
Mindfulness training helps clients learn how to allow and tolerate distressing thoughts and feelings about social situations that arise without judging them or engaging with them. Acceptance and Commitment therapy (ACT) reinforces the concept of allowing unhelpful distressing thoughts and feelings to be there while moving towards valued activities that are meaningful to them, rather than let their unhelpful thoughts and feelings determine their actions.
Once clients have learned and practiced effective tools to approach feared social situations and tolerate anxiety and discomfort, they are ready to begin Exposure and Response Prevention therapy (ERP). ERP is a compassionate and collaborative process whereby clients learn to gradually face their fears, eventually retraining their brains that these situations are not so important or dangerous.
The first step of ERP is identifying the mental and physical compulsions one is currently doing to reduce anxiety from social anxiety triggers. Together the therapist and client create a hierarchy of the compulsions to eliminate, from easiest to hardest. In treatment clients next learn tools to help them with this process.
They then continue to work on gradually facing fears and responding to social anxiety thoughts, feelings, sensations and urges in a new way that does not reinforce avoidance or other compulsions. Clients are in charge of the exposures that they choose to do and the pace they do them.
The remainder of therapy is doing ERP, applying what they have learned. Clients gradually begin engaging with the world with more confidence and understanding that whatever social situation arises, they can handle it.