Scientifically Proven Treatments for Social Anxiety

It can be difficult for individuals with social anxiety disorder to seek treatment as they may feel that this is part of their personality as being ‘shy’ or ‘introverted.’ Also, the act of reaching out to a therapist for help can trigger social anxiety due to fear of speaking to a new person. Additionally, individuals with social anxiety may experience feelings of shame or discomfort when sharing their symptoms with a therapist which can act as a barrier to seeking care. It is important to address these fears early on with your mental health provider.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is the gold standard and an empirically supported intervention for anxiety and related disorders. CBT is the umbrella term for interventions that focus on how our thought patterns and belief systems impact our feelings and behaviors. 

Identifying anxious thought patterns: For people with social anxiety disorder, they often experience intrusive negative thoughts regarding social events such as assuming they will be humiliated, rejected, bullied, or teased. For example, someone might enter a room and experience thoughts like “everyone is staring at me” or “no one wants to talk to me”, these thoughts can then lead to feelings of anxiety and panic. The person may now either leave the room or hide themselves in a corner avoiding eye contact and not speaking to others. The person then leaves the event feeling that their negative beliefs were confirmed and that no one wanted to speak with them. Through CBT, a client first learns to identify the anxious thought patterns that contribute to their negative interpretation of events.

Cognitive Restructuring: Once an individual can identify and label these thoughts as anxious and irrational, they then work on modifying these thoughts to a more effective and factual thought. This process is known as cognitive restructuring. For example, instead of thinking “This is going to be the worst presentation ever”, a person may give themselves a counter thought “I do not want to mess up, but if I do mess up it won’t be the end of the world and after an hour it will be over.” While this takes practice, overtime a person becomes more effective at catching their anxious and unhelpful thoughts and modifying them to more helpful thoughts.

Role Plays:  Role plays are also a component of treatment for individuals with social anxiety disorder. A client may practice engaging in conversations with the therapist before trying it out in the real world. For example, a client may want to roleplay a conversation with a boss, meeting a new friend or going on a date. If a client is experiencing anxiety over having a tough conversation with a friend or loved one, they may opt to practice the conversation with the therapist first.

Exposure and Response Prevention (ERP)

A central part of CBT for social anxiety disorder includes exposure and response prevention. In this type of therapy, an individual is exposed to their fears in a gradual way where they learn to tolerate their anxiety. A client would work with their therapist to create a list of their feared activities or situations and work gradually to master each fear. For someone who is afraid of meeting new people, they may create a list that includes: imagining talking to a new person, going to a bar and standing near a stranger, meeting a friend’s friend, going into a store and asking an employee for help etc. All of these are activities are where the client must work on their target fear (talking to a new person). There are some therapists who will go with the client to new places such as the mall, a coffee shop or library and engage in the exposures with the client. Other therapists will have the clients engage in the exposures on their own during the week and in sessions, the client will process how the experience was for them.

Through therapy, a client and therapist work to uncover what is the client’s feared outcome. Often with social anxiety, the feared outcome is being bullied, rejected, or humiliated by another person. Through each exposure, a client learns that the outcome is never as aversive as the feared outcome in their head. Moreover, a therapist may have a client purposely put themselves in an embarrassing situation (tripping or spilling in public) as a way of learning that they can experience their feared outcome (public embarrassment) and be okay.

Supportive Talk Therapy

A large portion of CBT is the relationship developed between the client and therapist. It is important for the client to trust their therapist and bring up if they are ever experiencing feelings of being judged or evaluated in unhelpful or negative ways. Talking through these experiences can be a powerful way to work through these thoughts and feelings in real time. In this nonjudgmental and empathic space, a client can freely share their fears and anxieties about social events and situations. To get to the root of the social anxiety disorder, it is important to talk about the early childhood events that contributed to this fear or anxiety of social settings. This may mean talking about conflictual family relationships, traumatic experiences, and incidents of bullying, teasing and rejection. Through these conversations, clients can learn how they were impacted by these situations and learn new strategies to cope with social situations for the future.