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Cognitive behavioral therapy for social anxiety

Social anxiety disorder (SAD) is commonly treated with cognitive behavioral therapy (CBT), a form of therapy that was pioneered in the 1960s for the treatment of depression. It is now a leading treatment for many conditions, including anxiety disorders. Research has shown that CBT is an effective therapy for social anxiety disorder.

CBT uses a combination of techniques that may vary depending on the disorder being treated. For example, CBT for depression will be different from CBT for SAD or other anxiety disorders. Because there are so many different techniques, it is important to look for a therapist that has experience with the techniques that are most effective for treating SAD.

This article discusses the goals of CBT as a therapy for social anxiety disorder. It also covers some of the techniques and methods that may be used in this type of treatment.

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Goals of CBT for Social Anxiety Disorder

One of the central goals of CBT is to identify irrational beliefs and thought patterns and replace them with more realistic ones. Your thoughts, emotions, and behaviors are all linked. By identifying unhelpful thoughts, you can then change the way you feel and behave.

As part of the therapy process, you will work on a number of problem areas including:

  • Negative beliefs you may have about your abilities and self-worth
  • Guilt, embarrassment, or anger over past situations
  • How to be more assertive
  • Tackling perfectionism and being more realistic
  • Dealing with procrastination related to social anxiety
  • Mistaken beliefs that others are judging you

Your CBT therapy sessions may feel somewhat like a student-teacher relationship. The therapist will take the role of a teacher, outlining concepts and helping you on a path of self-discovery and change. You will also be given homework assignments that are key to making progress.

Keys for Success

There are a number of things that can help make CBT more successful in the treatment of social anxiety disorder.

The likelihood that CBT will help you depends largely on your expectations about success, your willingness to complete homework assignments, and your ability to confront uncomfortable thoughts.

People who are willing to work hard and believe that CBT will help them are more likely to improve. Although this form of therapy is intensive and requires active participation by the person with SAD, it is effective and the improvements are long-lasting.

Cognitive Techniques

CBT focuses on changing the problematic thinking that contributes to anxiety. Cognitive methods can help you learn to feel less anxious and more in control in social situations.

People with SAD experience negative thoughts that occur automatically and are out of step with reality. These thoughts increase anxiety and lessen your ability to cope.

For example, if you have a fear of public speaking, just thinking about the situation will elicit thoughts of embarrassment and fear of failure. The goal of CBT is to replace these cognitive distortions with more realistic views.

If you have SAD, you have probably had someone tell you to just “think positive.” Unfortunately, the problem is not that simple to solve; if it were, you likely would have overcome your anxiety long ago.

Because your brain has become hardwired to think negatively, it needs to be gradually trained to think in a new way. Just telling yourself “I will be less anxious next time” doesn’t work, given your current way of thinking.

Learning to change these thoughts can help you feel less anxious in social situations. Changing negative automatic thinking in the long term requires practice and repetition until it eventually becomes automatic and habitual.

Over time, your memory processes and neural pathways in your brain will change. You will begin to think, act, and feel differently.

Recap

The ultimate goal of cognitive therapy is to change your underlying core beliefs that influence how you interpret your environment. A change in your core beliefs will lead to long-lasting improvement of your anxiety symptoms.

Behavioral Techniques

Another element of CBT that focuses on changing socially anxious behaviors is known as systematic desensitization. This is a type of exposure training that involves learning to relax as you are gradually exposured to anxiety-provoking situations. Over time, you begin to feel less fearful of these situations.

Exposure training for SAD has to be a very gradual process. People may have told you to “toughen up and face your fears;” unfortunately, this is extremely bad advice. People with social anxiety are already forced to face what they fear on a daily basis.

With your therapist, you will gradually expose yourself to feared situations so that over time they no longer elicit fear. At first, you may practice imagined exposure, such as imagining giving a speech or practicing a job interview through role-playing.

Once the practiced or imagined situation becomes easier, you would move to the situation in the real world. Exposure that is not structured in a gradual step-by-step process does more damage than good. It will make your anxiety worse, keep you locked in a vicious cycle, and can lead to doubt and depression.

Recap

Exposure therapy can be an effective way to change behaviors associated with social anxiety, but it needs to be done carefully and gradually. Forcing yourself into frightening situations without preparation and support may actually make your anxiety worse.

Internet CBT for SAD

Cognitive behavioral therapy can also be provided over the Internet (i-CBT). This type of CBT is becoming increasingly common and has some research evidence to support its use. It can be particularly effective when it is supported by a mental health professional.

Because CBT follows a structured format, it is well-suited for online use in both self-help or therapist-supported interventions. This form of CBT may also be helpful for those with severe social anxiety who are not yet at the point of being able to leave home to attend in-person therapy appointments.

Summary

Cognitive behavioral therapy is one of the most effective types of therapy for social anxiety disorder. This treatment can be used to change the negative thoughts that contribute to anxiety, help you learn new coping strategies, and gradually decrease the fear you experience in social situations.

A Word From Verywell

If you live with social anxiety that impairs your day-to-day functioning, it is important to seek help from your doctor or mental health professional. If you are diagnosed with social anxiety disorder, an effective treatment plan including CBT can help you to overcome symptoms and manage your social anxiety.

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People often confuse social anxiety with shyness or introversion, but social anxiety, also called social phobia, is a mental health condition that often requires professional treatment.

Social anxiety involves extreme and persistent feelings of worry, nervousness, and dread. These feelings show up in social situations, or at the mere thought of social situations.

More specifically, you might:

  • fixate on how others perceive you

  • believe you’ll do something to embarrass yourself
  • feel very self-conscious around others
  • assume people will reject or laugh at you when you try to make friends
  • notice physical symptoms of anxiety in social settings
  • avoid most situations involving anyone beyond a few trusted loved ones

If you’ve noticed any of these key signs, you might start to wonder whether working with a therapist could help.

Therapy can absolutely have benefits for social anxiety. The most effective treatment approach often depends on your unique symptoms and therapy needs, but cognitive behavioral therapy (CBT) is one common approach known to make a difference.

CBT teaches you to identify specific thoughts, emotions, and behaviors fueling your distress. From there, you can begin to explore these feelings and reframe them into more helpful beliefs.

How can it help?

To put it very simply, social anxiety involves a desire for acceptance. You want others to like you and leave your interactions with a positive impression of you. At the same time, you hold a deep conviction you’ll do something to embarrass yourself, drawing negative attention and criticism instead.

As a result, you avoid those very interactions or, when that’s not possible, find yourself fixating on what people are thinking and how they really feel about you. These anxious thoughts can prompt sweating, blushing, and nausea or dizziness. You might have trouble making eye contact or speaking loud enough for others to hear.

Any situation that involves other people can become anxiety-provoking: purchasing groceries, asking for directions, or calling your landlord about a leak under the bathroom sink.

CBT for social anxiety aims to help you examine and change the behaviors driving the avoidance, self-consciousness, and physical symptoms you experience.

A quick primer on CBT’s core concepts

The key principles underlying CBT suggest:

  • Mental health symptoms and emotional distress stem from unhelpful and incorrect thought patterns. For example, “I can’t share my idea in the meeting. It’ll come out wrong and not make sense, and everyone will laugh, and I’ll feel so embarrassed.”
  • These thoughts and feelings can, in turn, drive unhelpful or harmful behaviors. You don’t share your idea, or any other ideas you have, and your manager and co-workers start to notice your lack of participation.
  • Unchecked, this pattern will persist and eventually extend into other areas of life. Maybe you stop speaking up in other situations, including around friends and family. You doubt your ability to make any sort of useful contribution, and the fear of embarrassment and rejection becomes so strong, you avoid people more and more.
  • Recognize and adapt these beliefs to more helpful ones can ease distress and promote change. This might involve accepting that your ideas have value, or learning that people generally won’t laugh if you misspeak — even if they do, they’ll probably forget it shortly afterward, not judge you.

More specifically, CBT can help you learn to recognize distorted thought patterns and reframe them more realistically.

  • “I look so awkward” might become “Well, hardly anyone else dressed up, but that’s OK — I do look very nice.”
  • “Everyone’s waiting for me to mess up” might become “People seem really attentive. I’m glad I worked so hard on this report.”
  • “I’m so boring. Who’d want to talk to me?” might become “I’m not sure what to talk about, but I can always ask a few questions to get the conversation going.”

CBT also teaches coping skills to help you manage anxious feelings and related physical symptoms that come up in social situations.

These techniques can help you feel calmer in the moment, but that’s not all. They can also teach you to gracefully navigate blunders, like pronouncing someone’s name wrong or grabbing your dinner partner’s drink instead of your own, without feeling overwhelmed.

Here’s a more in-depth explanation of how CBT works.

Common techniques

CBT involves a number of different techniques, but CBT for social anxiety won’t involve every single strategy.

Many therapists treating social anxiety in adults operate from the Clark and Wells cognitive model of CBT. According to this model, social situations prompt negative beliefs and assumptions you hold about yourself. These beliefs trigger a sense of danger, which then trips an anxious response.

This response might involve:

  • safety behaviors, like dodging conversations, agreeing with everyone, or avoiding eye contact
  • physical and emotional symptoms of anxiety
  • shifting your focus internally

Your therapist will likely use some of the following techniques to help you address this response and navigate social situations more productively.

Psychoeducation

Learning more about the psychological components of social anxiety can help you understand how the beliefs that lead you to avoid social situations only limit you and make social anxiety worse.

Your therapist can also:

  • offer reassurance that your symptoms are both a normal part of social anxiety and very treatable
  • explain how therapy works to reduce anxiety
  • provide more information on how certain strategies work and why they’re effective

Cognitive restructuring

This technique encourages you to examine cognitive distortions, or the negative thought patterns that show up in social situations.

These might include, among others:

  • catastrophizing
  • mental filtering, or ignoring any positives
  • all-or-nothing thinking
  • emotional reasoning, or believing your emotions are truths
  • overgeneralization

Identifying these unhelpful and inaccurate patterns is an important first step toward reframing, or restructuring them.

Your therapist may walk you through an imagined situation, or one that actually happened, to help you get more insight on distorted thought patterns. From there, you can begin to identify (and put into practice) alternate ways of thinking.

Example

Say you recently gave a presentation at work. You felt so nervous that you started off by tripping over your words and speaking quickly, and you couldn’t meet anyone’s gaze.

Afterward, you focus only on these memories, filtering out everything else about the presentation, like the fact that you were so prepared you could answer questions smoothly, or the “Good job” you received from your boss.

Restructuring in this scenario might involve helping you consider the presentation as a whole, rather than focusing on only the negatives or positives.

Restructuring won’t involve overly positive replacement thoughts. Rather, it aims to promote more neutral and realistic ways of thinking:

  • “Some people may not like me, but that’s OK — it’s normal.”
  • “I might feel anxious, but I can cope with it and the feeling will pass.”

Systematic desensitization

This approach to exposure therapy helps you confront feared social situations, beginning with those that inspire the least amount of anxiety and dread.

You don’t face your fears empty-handed, though. As part of systematic desensitization, you also learn various relaxation exercises. At the first whisper of worry or fear, you can reach for one of these techniques to soothe those emotions and ground yourself.

If talking to people you know fairly well is a low-level fear, you might start by greeting the classmate who sits next to you. When your heart begins to pound, you can take a few slow, deep breaths until you feel calmer. Within several days, you can say hello without the deep breathing.

Behavioral experiments

Experiments aim to accomplish two main goals:

  • identify unhelpful safety behaviors and self-monitoring
  • check and test negative self-beliefs and worst-case scenario predictions

Say you’re planning to go to a party. You worry you might end up saying something awkward, and you’re also afraid no one will even talk to you.

Experimenting might involve going to the party and talking to a few people, instead of sticking to corners and avoiding all conversations. At your next session, your therapist will ask whether what you predicted actually happened.

Your therapist might also record role-play exercises in therapy so you can review the video and observe how you actually come across in social settings.

Attention training

This strategy involves learning to shift your attention back to other people.

Focusing on yourself can help you monitor your thoughts, actions, and words, certainly. But this also tunes out the real reactions of others, which can effectively reinforce your negative self-perceptions.

Keeping your focus on others during conversations and other interactions helps you pay attention to the way they actually respond to what you have to say. You’ll probably realize pretty quickly that they don’t even notice the things you feel anxious about.

Learn about other common CBT techniques.

Is it effective?

Quite a lot of evidence supports the effectiveness of CBT for social anxiety.

A 2014 research review evaluated a total of 101 studies that used 41 different treatment approaches, including medication, self-help, and other treatment approaches. According to the results, CBT appeared to have the most benefit for treating social anxiety.

Research from 2015 comparing CBT and exposure therapy suggests that while both can help improve social anxiety symptoms, CBT may be more helpful than exposure therapy plus applied relaxation.

A small 2015 study suggests even 6 sessions of CBT may help reduce feelings of self-consciousness and avoidance, though it won’t necessarily ease your fears of criticism or negative evaluation.

A 2016 study of 42 adults living with social anxiety suggests CBT could help treat social anxiety symptoms that don’t respond to antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are often part of social anxiety treatment, though, as this study points out, they may not always work.

Finding a provider

Ready to give CBT a try?

Keep in mind that not every therapist uses CBT techniques. When you find someone who seems like a good fit, make sure to mention your interest in CBT, plus key symptoms or issues you’d like to address.

For more tips on what to consider in your search, check out our guide to finding the right therapist.

Prefer to try therapy online?

Internet-based CBT (iCBT) appears to have some benefit for social anxiety symptoms.

With these programs, you use your computer or phone to learn and practice CBT techniques. Depending on the program, you might work with a therapist or coach or complete the exercises on your own. iCBT isn’t quite the same as teletherapy, though some programs do involve some interaction with a therapist.

iCBT may be ideal when:

  • Symptoms are severe enough that the thought of working with a therapist face-to-face overwhelms you.
  • You can’t find a local therapist who offers CBT for social anxiety.
  • You can’t afford to pay for in-person sessions, which may be more expensive than some iCBT options.
  • You feel more comfortable working your way up to in-person treatment.

The bottom line

CBT is widely recognized as an effective treatment for social anxiety. Still, that doesn’t mean it works for everyone.

At the end of the day, it’s just one potential approach. If it proves less than effective, it never hurts to ask your therapist about other treatments for social anxiety.

Crystal Raypole writes for Healthline and Psych Central. Her fields of interest include Japanese translation, cooking, natural sciences, sex positivity, and mental health, along with books, books, and more books. In particular, she’s committed to helping decrease stigma around mental health issues. She lives in Washington with her son and a lovably recalcitrant cat.

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