Although there is little controlled research evidence that cognitive therapy alone benefits patients with social anxiety disorder, this form of treatment may be used in conjunction with behavior (referred to then as cognitive-behavior therapy) and medication therapies.
Most patients with social anxiety disorder strongly desire to correct the faulty cognitions (beliefs or thoughts) that are part of this illness.
Aware that their anxiety is excessive and their avoidance dysfunctional, sufferers who correct their misconceptions feel more in control, better able to cope, and thus more receptive to the benefits of the better established therapies.
In social anxiety disorder, anxiety and its accompanying physical symptoms produce misperceptions and fears that further increase anxiety, playing a crucial role in an ongoing vicious cycle, with anticipatory anxiety leading to avoidance.
Cognitive therapy teaches patients to monitor their tendencies to dwell on such thoughts, to refute them as misconceptions, and to better tolerate their anxiety.
Correcting cognitive misconceptions
Misconception: Common physical symptoms will progress to panic.
These symptoms are common, at least for me, and if I don’t avoid the situation, they will diminish as time passes and my anxiety will also diminish.
Misconception: Everyone is watching me.
Coping Technique: Make an actual survey of people around you. Is everyone truly watching you?
How many people actually even look your way?
Collect data, be objective, don’t catastrophize.
Misconception: Everyone will think me stupid if I (fill in your socially anxious behavior, e.g., shake, blush, forget my words, etc.).
Coping Technique: Ask what others think about the time(s) you have shaken, blushed, forgotten your words, etc.
Did they feel empathy for the distress you were having? Did they hope you’d feel better soon? What were their reactions?
Misconception: The only option is to avoid situations that trigger my social anxiety.
Coping Technique: Avoidance is an option but the costs of that all-or-nothing approach are very high. Alternatives I will try are:
* Standing my ground for at least 15 minutes to see if my anxiety symptoms diminish. If they decrease even slightly, I’ll wait an additional 15 minutes to see how much further they decline. (This is exposure in vivo and it usually leads to habituation or lessening of discomfort.)
* Let’s see if I can heighten my anxiety even more to the point that I don’t even feel like myself or know where I am (dissociation). (Usually this approach has a paradoxical effect of decreasing anxiety.)
* Let’s see if I can exaggerate my blushing, heart rate, sweating, etc., even more. (Again, attempts to increase physical symptoms of anxiety often lead to their reduction.)
Misconception: There is no way to control the anxiety that triggers my social anxiety.
Coping Technique: Write supportive, true statements on index cards and keep them with you to read when anxiety occurs in social situations. Such statements might be:
* I’m anxious but I’m here and that’s a victory.
* This is tough, but it will soon be over if I don’t blow it out of proportion.
* I’ve handled this before and can handle it now.
* Breathe slow and shallow.
* I’ve exaggerated how much others are aware of my anxiety. I’ll stay here and do my survey to see how much they’re really noticing.
* I’ll be fine in a bit if I don’t avoid this situation. If I can stay in this room 15 minutes, I’ll be proud of myself and it will be easier the next time.
Patients report that such techniques are helpful, and these successes have inspired further research that may uncover even more effective strategies.