CBT for Social Anxiety Flashcards
(24 cards)
Social Anxiety:
Fear of negative evaluation
- can be linked to many things (depends on the person)
Ex: talking to a stranger OR someone you know, talking to men/women, not wanting to use public bathroom, not wanting to write in front of another person, not wanting to make a phone call
Social Anxiety: Safety Behaviours
what someone does to prevent the feared outcome
Ex:
- wearing clothing to obscure signs of anxiety
- Pretend I don’t see my friend (avoidance)
- Don’t look her in the eye
- Take control of my facial expressions
- Say as little as possible (to not make a mistake)
- Planning exactly what you’re going to say
- Avoid places you’ve seen your friend before
- Not going to class
What is something else that is unique that can help someone get over their social anxiety safety behaviours?
realizing that they have a gift to give someone which is a positive interaction
What are some thoughts a person woth social anxiety may have in relation to the “Jessica” situation?
- “I’m going to make a mistake and she will judge me”
- Intermediate belief: “it’s horrible to make a mistake”
- “she’ll see me blushing or shaking or walking funny and she’ll judge me”
- “other people will judge me harshly if my friend doesn’t wave back to me”
Are safety behaviours beneficial for someone with social anxiety?
No. They undermine the social interaction.
- you’re not looking in the right place to record what is actually happening
- not stickling around to have a rewarding interaction
Self-focus vs. outward focus
- paying attention inward instead of outward
- makes the situation awkward
- to have a meaningful interaction you must point your attention outwards onto the other person to see the situation for what it is
- This is why social anxiety is maintained over years - camera is focused inwards
Post-event processing
- Replaying the situation in your head after the fact
- Thinking of every detail: what you said/didn’t day
- Going back to review the tapes that you didn’t even record (ex: missing a smile your friend gives you)
Cognitive Conceptialization (Jake Scenario)
Focused specifically on Jake’s unique experience rather than a generic model.
Early session work helps build insight into how Jake’s social anxiety operates in real-time situations.
Situation-specific Exploration (Jake)
Use of a real-life scenario (a work event) to anchor the exploration.
Encourages Jake to mentally stay in the moment to activate anxious thoughts and emotions.
Identifying Automatic Thoughts & Core Beliefs
Key anxious thought: “People are going to look at me.”
Therapist uses guided discovery to unpack:
What Jake thinks people might notice (nervousness).
What he fears they’d think (e.g., “what’s his problem?”).
Underlying core beliefs: “I’m a bit weird,” indicating negative self-judgment.
Link Between Thoughts and Emotions (Jake)
Helps Jake connect anxious thoughts to his emotional and physical experience:
Emotions: Anxiety.
Physical signs: Blushing, twitching.
Thought linked to symptoms: “I’ll blush and people will notice.”
Safety Behaviors
Identified behaviors used to cope or avoid feared outcomes:
- Avoiding interaction, standing in a corner, avoiding eye contact.
- Focused inwardly (self-focused attention).
- Use of a standardized questionnaire to explore more subtle or common safety behaviors.
Self-Focused Attention & Negative Self-Image
Jake becomes aware of his internal focus and how it amplifies anxiety.
Discussion of mental imagery: how he imagines he appears to others (e.g., embarrassed, awkward).
Links between self-image and past experiences (e.g., bullying), tying into the development of social anxiety.
Maintenance Cycle of Social Anxiety
Trigger → Negative thought → Anxiety → Physical symptoms → Safety behaviors → Reinforced beliefs
Main intevrention for SAD (first behavioural experiment)
Video feedback experiment: we make it so that it’s like you do have a camera looking at yourself during a social interaction
Aim: help patients discover that self-focused safety behaviours are unhelpful -> rather than reducing anxiety, they make people more anxious and negative about their performance
- helps them realize this through experience instead of being told
how does the therapist begin the video feedback behavioural experiment?
by identifying the key components: feared outcomes, safety behaviours
Example:
Feared Outcomes:
- Fear of being judged (e.g., fidgeting, sounding boring).
- Rated fears: 80/100 (talking to a stranger), 70/100 (sounding boring).
Safety Behaviours (SB):
- Trying to control physical signs of anxiety (e.g., watching hands, sitting on hands).
- Avoiding speaking not to sound boring.
- Self-monitoring and internal focus.
How is the first round of interaction set up for the video feedback behavioural experiment?
Client intentionally uses all safety behaviours to:
- Heighten the anxiety.
- Observe the negative effects of self-focus and safety behaviours.
Example: outcomes
- High anxiety (80).
- Physical symptoms (hands shaking rated 50).
- Believed they came across as boring (60).
- Attention completely inward (-3 rating).
- Missed opportunities to speak naturally (sat on hands, didn’t say some things).
How is the second round of interaction set up for the video feedback behavioural experiment?
Client drops self-monitoring and safety behaviours.
Example: outcomes
- Anxiety reduced (rated 50).
- Felt better and more engaged.
- Realized safety behaviours actually worsened the experience.
What happens post interactions for the video feedback behavioural experiment?
- Client encouraged to drop safety behaviours throughout the week.
- Client reviews video footage of their own performance to:
- Compare their internal perception vs. actual impression
- Notice discrepancies (e.g., “my cheeks weren’t as red,” “I didn’t stumble as much as I thought”).
What is the aim of Decatastrophising Behavioural Experiments?
- to test catastrophic beliefs in real situations
- the client acts out scenarios related to their worst fears to observe what actually happens.
This helps confront and test the accuracy of the belief (e.g., “People will think I’m stupid”).
how does a therapist reduce certainty in a catastrophic belief, making a decatastrophising behavioural experiment more doable?
Before the experiment, the therapist helps the client reflect using Socratic questions:
- “What’s the evidence for and against that thought?”
- “What would be so bad if that happened?”
- “How do you know how others would react?”
In a decatastrophising behavioural experiment what can a therapist do if a client is very hesitant?
- the therapist themselves can perform the act
- seeing the therapist perform the action with no negative consequences can build trust and confidence.
What is a client asked to do before an exposure that will help them update their beliefs later on after the exposure?
to predict what they think may happen - how they think a person will react to their actions
if a feared outcome occurs after an exposure, is this okay or bad?
it can be a good thing because clients will learn they can tolerate the negative evaluation.
therapy doesn’t just disprove the fear—it also builds resilience against uncomfortable outcomes.
