CBT Social Anxiety Therapy Chicago
Chicago is huge. So big, in fact, that you could radically screw up many social interactions and still have millions of chances to get it right. Nonetheless, the brains of social anxious clients that come into our Lakeview offices reliably believe a myth – “If you mess this interaction up, everyone will reject you.” Sound familiar?
Do you avoid dating or talking to strangers because it makes you too nervous? Worry for weeks before a social gathering? Have a hard time telling people no? Have problems falling asleep because you’re worried about what you might have said or done that was embarrassing? Does your voice shake when you talk to strangers? If so, it might indicate that you suffer from Social Anxiety Disorder.
Social Anxiety Disorder
It’s normal to feel embarrassed at times or feel judged, but when these feelings are consistent and impact day-to-day activities like work, school, or socializing, they are cause for concern and intervention. It’s the intense, persistent fear of being judged and embarrassed that indicates Social Anxiety Disorder.
Further, knowing that the fear is not proportionate to the threat isn’t enough to make the fear go away. The persistent anxiety often leads to avoidance of some, or almost all, social situations. Worse still, the avoidance often makes the problem worse.
If these experiences sound like yours, know that it’s not your fault. Social anxiety is the result of a variety of factors including heredity, childhood experiences (e.g., anxious parents that passed down beliefs about you, others, and the future; frequent criticism that leads to expectations you will be criticized; even, abuse and neglect), and even later life experiences (e.g., experiencing a panic attack around people; or, a boss who uses their power to bully).
Although the cognitive behavioral therapy (CBT) approach to social anxiety disorder focuses less on the origin of the fear and more on the present day problem, it’s origin illustrates that you are not wrong for feeling socially anxious.
CBT Explained
Cognitive behavioral therapy (referred to as CBT) has been shown through research to be highly effective at treating Social Anxiety Disorder. CBT focuses on the combination of thoughts, feelings, and behaviors. It empowers you to change your reactions to situations, so that you feel better and function more effectively.
For example, if you are generally socially anxious and show up for a date. You notice your palms start to sweat, your face get flush, and your heart beat faster (the “feelings” CBT focuses on). Then, these feelings trigger thoughts like “My date will know I’m anxious” or “I’m going to make a fool of myself” or “I can’t do this” (the “cognitions” CBT focuses on).
Likely, the thoughts exacerbate the feelings in a feedback loop. Most people respond with certain actions like leaving the date, withdrawing, or not dating altogether (the “behaviors” CBT focuses on). Without intervention, the beliefs go untested and are never disproven, which can result in perpetual social anxiety and avoidance.
Cognitive restructuring helps you learn to identify the thoughts that are at the core of your social anxiety and then examine them with real-life, rigorous tests of logic. As a result, you can develop a more realistic view of yourself and social situations. Here are 5 “tests” to consider:
1. Look at your thoughts instead of through your thoughts (sometimes called metacognition). Instead of assuming that all of your thoughts hold the truth, examine them. Are they representative of reality or distorted by your anxiety? A helpful test can be to ask yourself, “Would a friend believe that was the reality if you told them what you were thinking?”
2. Challenge your automatic thoughts. Our brains create automatic thoughts to nearly every situation we encounter. Start to pay attention to your automatic thoughts. For example, if you’re talking to someone at a party and then turn to talk to a friend, you might have the automatic thought “They don’t want to talk to me because I’m boring.” Once you notice these automatic thoughts, you can start to write them down. Beside each of the automatic thoughts, write down challenges to the automatic thoughts. In our example, you might challenge your automatic thought with alternative explanations: “They feel nervous and turn away to cope.” “They haven’t talked to the friend yet at the party.” As you start to challenge your automatic thinking, you will decrease your anxiety.
3. Ask yourself, “Am I a fortune teller?” Social anxiety is future oriented. It assumes that you can know what the future will hold. The reality is that we don’t know what the future holds. In fact, you might have made this prediction many times before and it’s unlikely it’s come true 100% of the time. So, asking yourself if you are a fortune teller might remind you that you can’t see into the future and don’t know for certain what an outcome will be. Your thought is a guess, not a vision of the future.
4. Recognize cognitive distortions. Our brains attempt to create shortcut explanations for situations in our lives. The problem is that sometimes the conclusions drawn by our brains, especially for people with anxiety and depression, are wrong. These thoughts are called cognitive distortions.
These exercises focus on a core component of CBT for Social Anxiety Disorder. However, sometimes thought based exercises alone are not enough. Reducing your social anxiety may require you to do the exercises above, but also these behavior focused exercises.
5. Approach your fears, least scary first. Social anxiety often leads people to avoid social situations. While this eliminates the anxiety in the short-term, it does nothing to change it in the long-term (and sometimes makes it worse). So, identify a list of behaviors that create social anxiety (e.g., text someone, send a Facebook message, say “hi” to a stranger, tell someone “no,” attend a party, etc.) and organize them from least anxiety inducing to the most. Use the cognitive techniques above (and skills to cope with anxiety, such as breathing techniques) to engage in the least scary behavior. Don’t move too fast and repeat the same action over and over until you feel less anxious doing it. Then, move to the next behavior on your list. Gradually, you will build confidence in yourself and see that the beliefs at the core of your anxiety aren’t representative of reality. Note: if you find you aren’t able to engage in even the least scary on the list, it’s time to find a CBT therapist.
6. Baby steps. A helpful CBT skill, known as successive approximation, acknowledges that some social anxieties are so big and scary that approaching them seems impossible. For these, consider breaking them down into many small actions. For example, if introducing yourself to a stranger seems daunting, you might need to break it into baby steps (i.e., 1. Consider what you might say to a stranger if you were to introduce yourself. 2. Play out the scenario in your imagination. 3. Role play the scenario with someone you feel comfortable with. 4. Put yourself around strangers. 5. Introduce yourself.) Through each of these steps, remember to use the cognitive skills above, as well as your coping skills and mindfulness.
7. Consider dealing with the worst case scenario. If you’re able to come up with a way to deal with the worst case scenario, the anxiety may not be as threatening. Problem-solve ahead of time.
8 Practice mindfulness. You might have heard of mindfulness from friends or even come across mindfulness apps like Headspace or Calm. In short, mindfulness is focusing on the present moment, on purpose, without judgement. The better you become at being aware of the present moment, the more aware you will be of your thoughts and behaviors. This awareness allows you to use the techniques described here and change the status quo. Get hung up on what to say next in a conversation? Considering what to say next is probably an indicator that you aren’t focused on the present moment and what’s being said. Consider it a reminder to refocus on the present.
9. Improve your active listening, communication, assertiveness, and social skills with direct instruction and practice. Consider the skills you might need to improve and find someone to teach you those skills and practice them with you (via role play).
Social anxiety can be debilitating and impact you across many areas of your life, but – it doesn’t have to. These techniques are a good start, but most people benefit the most from working with a CBT therapist to guide you.
Although CBT requires effort and active participation, the lasting benefits it offers are often remarkable.
