Research has indicated the role of ‘core’ or ‘unconditional’ negative beliefs (e.g. I am inept) and ‘conditional’ beliefs nearer to the surface (e.g. If I show myself, I will be rejected).
They are thought to develop based on personality and adverse experiences and to be activated when the person feels under threat.
One line of work has focused more specifically on the key role of self-presentational concerns.
The resulting anxiety states are seen as interfering with social performance and the ability to concentrate on interaction, which in turn creates more social problems, which strengthens the negative schema.
Also highlighted has been a high focus on and worry about anxiety symptoms themselves and how they might appear to others.
A similar model emphasizes the development of a distorted mental representation of their self and over-estimates of the likelihood and consequences of negative evaluation, and of the performance standards that others have.
Such cognitive-behavioral models consider the role of negatively-biased memories of the past and the processes of rumination after an event, and fearful anticipation before it. Studies have also highlighted the role of subtle avoidance and defensive factors, and shown how attempts to avoid feared negative evaluations or use ‘safety behaviors’ (Clark & Wells, 1995) can make social interaction more difficult and the anxiety worse in the long run.
This work has been influential in the development of Cognitive Behavioral Therapy for social anxiety disorder, which has been shown to have efficacy.
The most important clinical point to emerge from studies of social anxiety disorder is the benefit of early diagnosis and treatment.
Social anxiety disorder remains under-recognized in primary care practice, with patients often presenting for treatment only after the onset of complications such as clinical depression or substance abuse disorders.
Research has provided evidence for the efficacy of two forms of treatment available for social phobia: certain medications and a specific form of short-term psychotherapy called Cognitive-behavioral therapy (CBT), the central component being gradual exposure therapy.
Research has shown that cognitive-behavioral therapy (CBT) can be highly effective for several anxiety disorders, particularly panic disorder and social phobia.
CBT, as its name suggests, has two main components, cognitive and behavioral. In cases of social anxiety, the cognitive component can help the patient question how they can be so sure that others are continually watching and harshly judging him or her.
The behavioral component seeks to change people’s reactions to anxiety-provoking situations.
As such it serves as a logical extension of cognitive therapy, whereby people are shown proof in the real world that their dysfunctional thought processes are unrealistic.
A key element of this component is gradual exposure, in which the patient is confronted by the things they fear in a structured, sensitive manner.
Gradual exposure is an inherently unpleasant technique; ideally it involves exposure to a feared social situation that is anxiety provoking but bearable, for as long as possible, two to three times a day.
Often, a hierarchy of feared steps is constructed and the patient is exposed each step sequentially.
The aim is to learn from acting differently and observing reactions.
This is intended to be done with support and guidance, and when the therapist and patient feel they are ready.
Cognitive-behavioral therapy for social phobia also includes anxiety management training, which may include techniques such as deep breathing and muscle relaxation exercises, which may be practiced ‘in-situ’. CBT can also be conducted partly in group sessions, facilitating the sharing of experiences, a sense of acceptance by others and undertaking behavioral challenges in a trusted environment (Heimberg).
Some studies have suggested social skills training can help with social anxiety.
However, it is not clear whether specific social skills techniques and training are required, rather than just support with general social functioning and exposure to social situations.
Additionally, a recent study has suggested that interpersonal therapy, a form of psychotherapy primarily used to treat depression, may also be effective in the treatment of social phobia.