Do you have an overwhelming fear of being scrutinized, judged, or embarrassed in public? If so, social anxiety disorder may be at the root of your dread. The DSM-5 criteria for a diagnosis of social anxiety disorder includes:
- A persistent, intense anxiety about specific social situations caused by fear of being judged negatively for doing something embarrassing or humiliating.
- Recognition that this fear is unreasonable or excessive.
- Avoidance of anxiety producing social situations, or enduring them with intense fear and anxiety.
- Anxious anticipation that leads to avoidance of or distress in the feared social situation, and that interferes with the person’s ability to function normally in his or her daily life.
- The experienced fear and anxiety are not due to a medical condition, drug usage, or another mental disorder.
Although social anxiety can cause many difficulties in your life, the good news is that it’s a highly treatable condition. There are several successful treatment options available that can help you gain confidence and improve your ability to interact with others.
Social Anxiety Therapy Options
One or more of these therapy options may be good choices to help you overcome social anxiety.
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy is an intensive short-term therapy option that requires persistence and active participation. It is based on the premise that what you think affects how you feel, and your feelings affect your behavior.
Therefore, if you change the way you think about the social situations that make you feel anxious, you will feel and function better as well. Research studies have shown that CBT is one of the most effective treatments for social anxiety.
The aim of cognitive behavioral therapy is to teach you how to recognize, challenge, and replace the distorted thought patterns that are at the root of your anxiety and that are having a negative impact on your behavior and emotions. Also, it equips you with coping strategies that can help increase your confidence, decrease the fear you experience in social situations, and enable you to manage the anxious feelings and physical symptoms that come up.
The ultimate goal is for you to be able to consistently apply the skills learned during your therapy sessions to your everyday life. Success is proportionate to your willingness and commitment to put forth the effort required for change to occur.
Social skills training
Social skills training is often conducted in a group setting. Under the guidance of a trained therapist, you are able to practice navigating social interactions, and receive corrective feedback.
This type of therapy involves a series of modeling, rehearsing, and role-playing exercises designed to help you learn appropriate behaviors, improve your confidence and self-esteem, and decrease your anxiety in social situations.
Group therapy provides an opportunity for people suffering from social anxiety to come together in a safe, non-threatening setting to practice the skills they are learning under the guidance of a trained counselor.
It’s a way to gain confidence and practice challenging social interactions in a safe environment, as well as help you form new relational patterns and responses to the social situations that trigger your anxious feelings.
Exposure therapy focuses on progressively confronting the fears underlying your social anxiety so as to help you slowly build up your comfort level and ease your way into situations you have been avoiding. This can be done using real life social situations, virtually simulated ones, or vividly imagined ones.
Depending on how severe your anxiety is, your therapist may start you out with imagined or virtual exposure first, and then slowly advance to real life situations when you feel ready to handle them. With each repetition, fear and avoidance behavior diminish, until eventually you reach your goal of being able to face the dreaded event without it triggering anxiety.
The premise of exposure therapy is that although avoidance may decrease feelings of anxiety short term, it actually strengthens your fear response and prevents you from learning that there are effective techniques you can learn to help you successfully cope with your social anxiety.
Cognitive restructuring focuses on identifying the mental processes that lead to your symptoms of social anxiety, such as poor self-concept, fear of being judged negatively by others, and negative attribution bias (an irrational thought process that causes you to ascribe positive outcomes to chance, and negative ones to your own shortcomings). The premise is that changing your automatic thoughts enables you to influence your emotions and behaviors.
During cognitive restructuring therapy your therapist may walk you through an imagined scenario, or one you actually experienced, to help you identify the beliefs that trigger your anxiety. He or she will then guide you through a series of exercises aimed at teaching you how to challenge these thoughts by asking yourself how true they are and what parts of them you may be distorting or misinterpreting, and then reframe them in a more rational and positive way.
Psychodynamic therapy is a longer-term, in-depth talk therapy similar to psychotherapy. Self-reflection is used to dig into the subconscious mind to uncover the roots of your negative thoughts and anxieties. The premise is that as you gain a deeper understanding and insight into why you feel and think the way you do, you become equipped to make better choices and live a more balanced life.
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy is a newer form of therapy with a different approach than that of traditional CBT, in that there is no focus on symptom reduction. You work on modifying how you perceive your emotions rather than on trying to alter them.Known as a third wave treatment, the core aim of ACT is to get you to accept your distressing feelings and emotions and deal with them in a non-judgmental fashion, rather than try to eliminate them. The premise is that struggling against distressing thoughts and personifying them as stressful will only intensify them, whereas learning to view them in a disengaged way will reduce their emotional impact and make them easier to process.
During acceptance and commitment therapy sessions you will work on detaching from painful emotions and taking action based on your values instead. Mindfulness training and goal setting exercises are used to help you achieve this dissociation from your social anxiety.
Your therapist will have you practice staying focused in the present moment so you can learn to engage in social situations and experience them to their fullest extent instead of trying to avoid them.
Dialectical behavior therapy (DBT)
Dialectical behavior therapy is a third wave therapy similar to ACT. Its approach is centered on identifying and labeling distressing thoughts and emotions and validating them rather than refuting them.
The premise is that non-judgmental acceptance reduces the intensity of these feelings and enables you to detach yourself from them and react in a more positive, rational way. One of the ways DBT differs from ACT is that it includes group therapy.
Your individual DBT sessions will involve training in coping techniques such as mindfulness, distress tolerance, and emotional regulation (an opposite action skill that enables you to act in a way opposite to how you feel). You then get to practice these skills in the structured social setting of a group, before actually testing them out in the real world.
Christian Counseling for Social Anxiety
Christian counseling involves a combination of biblical principles and clinical intervention. If you have questions or would like to set up an appointment, please contact me or one of the other faith-based counselors in our online counselor directory. We would be happy to meet with you to discuss which option might work best for you.
Arlin Cuncic (July 18, 2020). Treating Social Anxiety Disorder, Verywell Mind.
Social Anxiety Disorder: More Than Just Shyness, National Institute of Mental Health (NIMH).
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