Therapy for Social Anxiety Disorder

Cognitive Behavioral Therapy for Social Anxiety Disorder | Society of Clinical Psychology

Therapy for Social Anxiety Disorder

2015 Criteria
(Tolin et al. Recommendation) Treatment pending re-evaluation 1998 Criteria
(Chambless et al.

EST)

  • Basic premise: thoughts, feelings and behaviors are inter-related, so altering one can help to alleviate problems in another
  • Essence of therapy: Cognitive therapy techniques focus on modifying the catastrophic thinking patterns and beliefs that social failure and rejection are ly; exposure therapies are designed to gradually encourage the individual to enter feared social situations and try to remain in those situations.
  • Length: approx. 12 sessions

Editors: Evan Forman, PhD; Joanna Kaye, BA

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Outlines

  • CBT for Social Anxiety Disorder Outline (Hofmann & Otto)

Self-help Books

Important Note: The books listed above are empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment.

We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Smartphone Apps

  • iCBT (Bonfire Development Advisors)
  • AnxietyCoach (Mayo Clinic)

Important Note: The apps listed above are empirically-supported in-person treatments.

They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment.

We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Video Demonstrations

Group CBT for SAD (Hofmann et al)

  • Introducing group members (Hofmann et al.)
  • Overview of group treatment (Hofmann et al.)
  • Establishing ground rules (Hofmann et al.)
  • Presenting social anxiety model (Hofmann et al.)
  • Assigning homework (Hofmann et al.)
  • Exposure rationale (Hofmann et al.)
  • Setting up speech exposure (Hofmann et al.)
  • Speech exposure (Hofmann et al.)
  • Post-processing speech exposure (Hofmann et al.)
  • Rationale for social cost exposures (Hofmann et al.)
  • Setting up in vivo exposure (Hofmann et al.)
  • In vivo exposure (Hofmann et al.)
  • Post-processing after in vivo exposure (Hofmann et al.)

Clinical Trials

  • Cognitive therapy versus fluoxetine in generalized social phobia (Clark et al., 2003)
  • Cognitive—behavioral therapy versus supportive therapy in social phobia (Cottraux et al., 2000)
  • Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia (Davidson et al., 2004)
  • Cognitive—behavioral group treatment for social phobia: Effectiveness at five-year followup (Heimberg et al., 1993)
  • Treatment of social phobia in cognitive-behavioral groups (Heimberg et al., 1994)
  • Cognitive behavioral group therapy versus phenelzine therapy for social phobia (Heimberg et al., 1998)
  • Cognitive mediation of treatment change in social phobia (Hofmann, 2004)
  • Cognitive therapy for social phobia: individual versus group treatment (Stangier et al., 2003)

Meta-analyses and Systematic Reviews

  • Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis (Mayo-Wilson et al., 2014)
  • Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis (Gould et al., 1997)
  • Psychological treatment of social anxiety disorder: A meta-analysis (Acarturk et al., 2009)
  • Meta-analysis of cognitive-behavioral treatments for social phobia (Taylor, 1996)
  • Cognitive and behavioral treatments for anxiety disorders: A review of meta-analytic findings (Deacon & Abramowitz, 2005)
  • The treatment of social anxiety disorder (Rodebaugh, Holaway, & Heimberg, 2004)
  • Cognitive-behavioral therapy for social anxiety disorder: Current status and future directions (Heimberg, 2002)
  • Cognitive-behavioral therapy for social anxiety disorder: The state of the science (Gordon, Wong, & Heimberg)

Other Treatment Resources

Источник: https://div12.org/treatment/cognitive-behavioral-therapy-for-social-anxiety-disorder/

Treatment for Social Anxiety

Therapy for Social Anxiety Disorder

Social anxiety causes fear or panic in social situations. It is a treatable condition. Therapy is often helpful for people with social anxiety. If you experience social anxiety, you may benefit from exploring treatment options with a mental health professional. A therapist can help you understand your anxiety and develop coping methods.

How Therapy for Social Anxiety Works

Cognitive restructuring is a technique used to treat social anxiety. The treatment works by identifying negative beliefs and combating them. It is often a helpful way for a person to examine the inner self and notice beliefs that worsen their social anxiety.

Two kinds of exposure may help people overcome social anxiety:

  • In vivo exposure. This type of exposure puts people in situations they tend to avoid.
  • Interoceptive exposure. This exposes people to disd sensations. These sensations occur as a result of one's anxiety.

Both types of exposure seek to reduce feelings of anxiety. These feelings are reduced when a person is exposed to the thing they do not without negative results. This method can help people get over social anxiety in certain situations.

Overcoming Obstacles to Getting Help

Sometimes social anxiety can make it hard to get treatment. Reaching out to a therapist may difficult if you experience severe social anxiety.

But this fear does not have to stop you from getting help. Some methods can help you overcome anxiety caused by reaching out to others. These can help you start addressing social anxiety on your own.

They may also enable you to reach out for more support.

People who feel social anxiety is keeping them from getting help can:

  • Ask a supportive family member or friend to contact the therapist first. They could even set up the first appointment.
  • Write a letter or email to a therapist you want to meet with. This may be easier for some than making a phone call.
  • Meet with a therapist who practices therapy online or over the phone.
  • Practice some social anxiety self-care to reduce anxiety about seeking help.

Types of Therapy for Social Anxiety

Many types of therapy make for effective social anxiety treatments. They often work by helping people address their thoughts and beliefs.

These thoughts and beliefs may be about oneself or society. Treatments meet the person where they are. A good therapist will help someone with social anxiety slowly build up their comfort level.

This may take time for someone with severe social anxiety.

  • Cognitive behavioral therapy (CBT). In CBT, the therapist and the person in treatment work together. They develop strategies to overcome anxiety and establish new skills. These skills will help the person continue to address the condition on their own.
  • Social skills training. This can give people in treatment stronger conversation and listening skills. It can also help them practice their assertiveness. Training may be done by role-playing scenarios with the therapist.
  • Group therapy. People with social anxiety may find group therapy sessions helpful. Group therapy can be a space for people to practice and build social skills. This is done in a safe and teamwork-oriented setting.  
  • Psychodynamic therapy (PDT). PDT is being researched as an option for treating social anxiety. This type of therapy requires self-reflection and more sessions than CBT.

The therapeutic relationship is also helpful in social anxiety treatment. It can reinforce positive beliefs about interacting with others. The person with social anxiety may then feel emboldened to interact with others.

Self-Care for Social Anxiety

There are many self-help approaches for social anxiety. Some research was done on how random acts of kindness affect social anxiety.

The study shows people who performed random acts of kindness for others reduced their levels of social anxiety. Kindness often generates a positive result.

The positive responses people with social anxiety got lessened some of their symptoms. This made them more ly to engage socially again.

There are other ways to practice self-care for social anxiety. You might:

  • Join a social anxiety support group
  • Take time to exercise in a way you enjoy
  • Limit alcohol and caffeine intake
  • Get adequate sleep every night
  • Try to focus outward, not inward, in social situations
  • Read a book about social anxiety
  • Practice guided breathing, yoga, or relaxation
  • Volunteer
  • Sign up for an activity outside of your comfort zone

Medication for Social Anxiety

Psychiatrists may prescribe medication along with therapy for social anxiety. These could include antianxiety medications. An antidepressant could also be prescribed.

However, medication is shown to be less effective than therapy for social anxiety. This may be the case especially when medication is taken alone.

Medication for social anxiety may take 2 to 6 weeks to have an effect. Beta blockers may be used to treat temporary physical symptoms of anxiety.

Therapy for Social Anxiety: Case Examples

  • Therapy to treat fear of public situations. Ezekiel, 29, seeks help for his fear of going out in public. He has anxiety when he notices others looking at him in public. He does any necessary tasks quickly and avoids speaking with strangers. He tells his therapist he «just knows» he will say the wrong thing and embarrass himself.

    Ezekiel has been taking an anti-anxiety medication for a few months. But he reports no improvement. The therapist helps Ezekiel uncover the origins of his fears. Before long, he is able to discover feelings of anger toward his parents. They reprimanded him in public in his youth, often for no great offense. He also notices feelings of shame and a fear of his own inadequacy.

    Ezekiel's therapist helps him work through these feelings. Encouraged by his therapist, Ezekiel begins to venture out in public for longer periods of time. He is often accompanied by his best friend. This exposure helps to reduce Ezekiel's anxiety. He finds himself able to speak to strangers and make eye contact with them. He continues in therapy to further improve.

  • Treating feelings of rage experienced in crowds. Kay, 59, has a long history of severe anxiety. She often has feelings of rage when in crowds. Kay has been in therapy off and on for many years to treat this anxiety. Stress at work and anxiety about her age have triggered an increase in panic attacks.

    She finds herself running home after work and locking herself in her apartment all night. There, she reads or watches movies in bed. She sees and talks to no one. A sense of shame about these actions compounds her anxiety. She has always seen herself as a strong person. She is embarrassed that she is afraid of crowds and public spaces. Kay has little insight into her behaviors.

    She knows only that she feels calm at home and when in public she panics. Her previous therapist recommended she take a disability leave. But after a week at home, her anxiety gave way to depression. It was even harder to go out than it had been when she was working. Her new therapist encourages Kay to spend an hour outside every night. She does this even if she has a panic attack.

    The therapist recommends against medications. They point out the irrational nature of Kay’s fear. The therapist also praises and encourages Kay when she makes an appointment. Doing so requires her to walk for several blocks in a crowded part of town. Kay begins to unravel her attitude toward other people. She fears their judgment.

    This causes her to resent and judge them as a defense against shame. She sees that working on her self-image, rather than avoiding discomfort, can help her regain confidence.

References:

  1. Bhandari, S. (2017, July 18). What are the treatments for social anxiety disorder? Retrieved from https://www.webmd.com/anxiety-panic/treatments-social-anxiety-disorder 
  2. Bögels, S. M., Wijts, P., Oort, F. J., & Sallaerts, S. J. M. (2014, February 27). Psychodynamic psychotherapy versus cognitive behavioral therapy for social anxiety disorder: An efficacy and partial effectiveness trial. Depression and Anxiety, 5(31), 363-373. doi: 10.1002/da.22246 
  3. Dallas, M. (2015, July 10). For those with social anxiety, acts of kindness may be therapeutic. Retrieved from http://health.usnews.com/health-news/articles/2015/07/10/for-those-with-social-anxiety-acts-of-kindness-may-be-therapeutic
  4. Jacobs, A., & Antony, M. (n.d.). Social anxiety support. Retrieved from http://www.socialanxietysupport.com/disorder/#treatassess
  5. Treating social anxiety disorder. (2010). Retrieved from https://www.health.harvard.edu/newsletter_article/treating-social-anxiety-disorder

Last Update:09-05-2018

Источник: https://www.goodtherapy.org/learn-about-therapy/issues/social-phobia/treatment

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