Psychotherapy for Social Anxiety
Psychotherapy is a very effective method of treatment for social anxiety disorder. Specifically, cognitive behavioral treatments — which include techniques such as exposure therapy, cognitive restructuring without exposure, exposure therapy with cognitive restructuring, and social skills training — appear to be highly effective in treatment social anxiety, in a time-limited manner. Most cognitive-behavioral therapy (CBT) can be administered within 16 sessions (usually one session per week). At the end of treatment, a persons anxiety symptoms are greatly reduced or even disappear in some cases. CBT for social anxiety appears to be equally effective whether delivered in an individual or group-format basis.
In addition to CBT, other psychological treatments have also been found effective in the treatment of social anxiety. These include cognitive therapy (a component of CBT), social skills training alone, relaxation exercises, exposure therapy alone/behavioral therapy, and some other types of less-practiced forms of psychotherapy. Group-based CBT has also shown to be effective, as the group component may directly target some of the core concerns of public speaking-related or generalized social anxiety.
Exposure therapy is often a primary component of psychotherapy treatment of social anxiety disorder. Exposure therapy, practiced either on an individual or group basis, involves a person learning to understand the irrational basis for their fears (cognitive restructuring), teaching simple relaxation skills to practice while in the moment, and gradually being exposed to the situation which causes the anxiety.
One format of exposure involves imagining an anxiety-provoking scenario and walking through it with the therapist in the safety of the psychotherapy office.
As the patients confidence grows, he or she will begin to apply the skills theyve learned in the therapy session to outside world events and environments. Termed in-vivo exposure, this can be assigned as therapy homework. In another scenario, a therapist can accompany their patient out in the community. This can be highly effective for building therapeutic trust and self-confidence within the patient. In-vivo exercises are meant to deliberately and repeatedly expose a patient to feared situations gradually as an attempt to show the individual, by objective example, that their feared outcome is either unlikely, not so bad, or less probable than are anticipated to be in their mind.
As one example, a person with social anxiety phobia may feel certain that if he were to speak up in a group or to a person of romantic interest, he would be utterly humiliated and rejected because he would stutter and say something stupid; therefore, this person has avoided making friends, dating, or interviewing for new jobs altogether. In-session the therapist may enter a grocery store with this patient and have them ask an intentionally embarrassing question (e.g., asking why blue cheese is moldy). Alternatively, in group therapy format, the therapist may have the patient deliver a short speech weekly in front of other group members concerning a hot topic or one in which they know little about. In any of these cases, the individual would essentially make themselves feel embarrassed purposefully to disprove their biased prediction about the consequences of such an action.
Cognitive processing may follow where the therapist and patient discuss how much anxiety was experienced by the patient from beginning-to-end of the exposure routine, as well as asking the patient (if anything) what was learned as a takeaway to challenge their original threat predictions (e.g., yeah, it was weird to do that, but the woman did not bite my head off for asking about the blue cheese…I bet people ask weird things all the time). Gradually, with repeated exposure, the patient would work up to achieving goals or tasks in life that have been avoided due to the social anxiety.
Psychotherapy treatments, especially those that are exposure based, have been shown to be highly effective in treating social anxiety disorder (Acarturk et al., 2009; Powers et al., 2008). Most people who try psychotherapy with a therapist who has experience in treating social anxiety disorder will find relief from their symptoms.
References
Acarturk, C.; Cuijpers, P.; van Straten, A.; de Graaf, R. (2009). Psychological treatment of social anxiety disorder: A meta-analysis. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 39, 241-254.
Powers, Mark B.; Sigmarsson, Snorri R.; Emmelkamp, Paul M. G. (2008). A meta-analytic review of psychological treatments for social anxiety disorder. International Journal of Cognitive Therapy, 1, 94-113.
Roy-Byrne, Peter P.; Cowley, Deborah S. (2007). Pharmacological treatments for panic disorder, generalized anxiety disorder, specific phobia, and social anxiety disorder. In: A guide to treatments that work (3rd ed.). Nathan, Peter E. (Ed.); Gorman, Jack M. (Ed.); New York, NY, US: Oxford University Press, 395-430.
