Бесплатный фрагмент - Social anxiety disorder

Disclaimer

This material is provided for informational and educational purposes only. It is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.

Psychology of social anxiety disorder

Social phobia, also known as social anxiety, ranks among the most prevalent mental disorders. It disrupts an individual’s capacity to engage with their environment, particularly in scenarios that necessitate public speaking, interaction with unfamiliar individuals, or assuming a central role in social settings. Those afflicted with social phobia endure profound anxiety and fear, which adversely affects their daily activities, professional endeavors, academic pursuits, and personal relationships.

What constitutes social phobia?

Social phobia is a persistent experience of fear, anxiety, and apprehension in social contexts. This anxiety may arise in specific scenarios (e.g., engaging with strangers, delivering speeches) as well as in more general settings (e.g., daily life, professional environments, or educational institutions).

Signs of social phobia can vary from feelings of awkwardness to intense panic. Individuals with social phobia frequently experience a fear of being judged, criticized, or rejected, which results in the avoidance of social interactions and restrictions in their social lives.

2. Factors Contributing to Social Phobia

Like many mental disorders, social phobia is inherently complex and may arise from a confluence of genetic, environmental, and psychological factors.

— Genetic factors: Studies indicate that social phobia may have a hereditary component. Individuals with relatives who have this disorder face an increased risk of developing social phobia.

— Neurological aspects: Disruptions in brain function associated with emotion regulation and threat perception may also play a role in the onset of social phobia. For instance, heightened sensitivity to negative emotions and an aversion to criticism.

— Psychological and social factors: Traumatic childhood experiences, including physical or emotional abuse, dysfunctional or neglectful family dynamics, and bullying in school, can precipitate the onset of social phobia. Additionally, positive socialization experiences play a crucial role in fostering self-confidence in later life.

— Low self-esteem: Individuals with low self-esteem may be more susceptible to social anxiety, as they often magnify perceived threats in social contexts while undervaluing their own capabilities.

3. Indicators of social phobia

Symptoms of social phobia can differ markedly among individuals, yet they universally entail the experience of considerable anxiety in social contexts. Principal symptoms include:

— Physical manifestations of anxiety include elevated heart rate, tremors, perspiration, dry mouth, dizziness, and nausea.

— Psychological symptoms: enduring thoughts regarding potential judgment, criticism, or ridicule from others; apprehensions about personal reputation or external perceptions.

— Avoidance of social situations: An individual may shun specific scenarios, such as meetings, public speaking engagements, or involvement in group activities, due to a fear of ridicule or rejection.

— Perfectionism and self-criticism: elevated expectations of oneself and one’s actions, coupled with a fear of miscommunication, which may result in a heightened self-critical disposition.

4. In what ways does social phobia impact an individual’s life?

Social phobia profoundly affects an individual’s quality of life, as it can obstruct education, career advancement, and personal relationships.

— In personal relationships: Individuals with social phobia may evade social interactions, dating, and the establishment of close friendships or romantic connections due to a fear of rejection or judgment.

— In academic and professional contexts: Social phobia can impede effective learning and career progression, as individuals may shy away from engaging in group projects, undermine their own abilities during interviews, or eschew leadership roles due to a fear of public speaking.

— General social isolation: A persistent fear of social situations and the subsequent avoidance of them can result in social isolation, depression, and a profound sense of loneliness.

5. Diagnosis of social anxiety disorder

The diagnosis of social phobia is generally founded on a comprehensive psychological interview and standardized questionnaires or scales, such as the Social Anxiety Scale. Additionally, diagnostic criteria from international classifications of disorders, including the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), are employed.

A psychotherapist collaborating with a patient may utilize instruments such as self-reports and observations to assess the degree of social anxiety and its influence on the patient’s daily existence.

6. Approaches to treating social phobia

Various treatments for social phobia are available, tailored to the severity of the disorder and the unique characteristics of the patient.

— Cognitive Behavioral Therapy (CBT): This is among the most effective methods for addressing social phobia. CBT assists patients in recognizing and altering the distorted thought patterns that contribute to anxiety. The therapist guides clients in evaluating their anxious thoughts and substituting them with more realistic and constructive alternatives.

— Exposure therapy: This approach entails a gradual and controlled exposure to feared social situations, aimed at diminishing anxiety levels and fostering the ability to manage stress within these contexts.

— Acceptance and Commitment Therapy (ACT): ACT underscores the importance of accepting one’s fears and learning to coexist with them rather than evading social situations. This methodology instructs the individual to concentrate on their values and actions instead of anxious thoughts.

— Medication: In certain instances, social phobia may necessitate pharmacological intervention. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, may be prescribed to alleviate anxiety symptoms.

— Group therapy: In group therapy, individuals with social phobia can engage with fellow participants, enabling them to exchange experiences and cultivate communication skills within a more supportive and secure environment.

Approaches to psychotherapy for social phobia

Social phobia, also known as social anxiety, ranks among the most prevalent mental disorders, defined by an intense and unwarranted fear of social interactions. It presents as feelings of embarrassment, anxiety, and apprehension regarding judgment, rejection, or humiliation in public spaces, workplaces, or educational environments. This condition can profoundly diminish quality of life and hinder professional growth, academic achievement, and personal relationships.

To effectively address social phobia, psychotherapists employ various strategies to assist patients in overcoming the fears and anxieties linked to social situations.

Cognitive Behavioral Therapy (CBT)

Principles and methodologies:

Cognitive Behavioral Therapy (CBT) is among the most effective and commonly employed treatments for social phobia. It operates on the principle that an individual’s behavior and emotions are intricately connected to their thoughts. CBT assists patients in recognizing and altering distortions in their perceptions of themselves and others that exacerbate anxiety in social contexts.

How Cognitive Behavioral Therapy Functions:

— Identifying and challenging negative thoughts: Patients are taught to recognize and confront catastrophic thoughts regarding social situations, such as «If I make a mistake during a presentation, everyone will judge me,» and to substitute them with more realistic beliefs.

— Behavioral activation: Patients may initiate gradual exposure to feared social situations, facilitating anxiety reduction and enhancing their ability to manage real-life risks and challenges.

— Development of problem-solving skills: The therapist instructs the patient in stress management techniques, effective communication strategies, and self-confidence enhancement.

Advantages of Cognitive Behavioral Therapy:

— High efficacy in short-term therapy.

— Organized and transparent methodologies.

Numerous studies validate the efficacy of this approach in treating social phobia.

2. Exposure therapy

Principles and methodologies:

Exposure therapy is a technique that involves the gradual and controlled exposure of the patient to anxiety-inducing situations. In the context of social phobia, this may entail engaging in social scenarios that initially appear daunting. The fundamental premise is that through repeated, safe exposure to the source of anxiety, the fear progressively lessens.

How does exposure function:

— Gradual fear conditioning: The patient is gradually exposed to anxiety-inducing social situations, commencing with less distressing scenarios. For instance, one might start with a brief conversation with a store clerk and progressively escalate the level of challenge.

— Mitigating avoidance behavior: A fundamental component of exposure therapy involves instructing the patient to confront rather than evade distressing situations, thereby facilitating a decrease in fear and anxiety.

Advantages of exposure therapy:

— Effective in diminishing avoidance and enhancing confidence.

Assists the patient in recognizing that numerous experiences in social contexts do not warrant his anxieties.

3. Acceptance and Commitment Therapy (ACT)

Principles and methodologies:

Acceptance and Commitment Therapy (ACT) is a contemporary approach that assists individuals in altering their perspectives on anxious thoughts and emotions rather than evading them. The central emphasis is on embracing one’s experiences and cultivating behaviors that align with the individual’s values, even in the presence of anxiety.

How ACT Functions:

— Acceptance of thoughts and emotions: Rather than battling anxiety or evading social situations, the patient learns to embrace their feelings as a natural aspect of life.

— Emphasize values: The patient learns to make decisions that align with his core life values, rather than evading situations due to fear.

— Cultivating mindfulness: Employing mindfulness techniques enables the patient to remain anchored in the present moment, thereby mitigating the effects of anxiety.

Advantages of ACT:

— Emphasize acceptance and individual accountability.

— Assists individuals in managing anxiety and taking action in spite of it.

4. Meditation and mindfulness practices

Principles and methodologies:

Meditation and mindfulness are techniques that assist patients in alleviating stress, enhancing emotional resilience, and diminishing anxiety. These practices involve cultivating focused attention on the present moment, which aids in mitigating concerns about the future and alleviating the psychosomatic symptoms of anxiety.

The mechanism by which these techniques operate:

— Mindfulness: Entails embracing your thoughts and emotions without judgment, thereby aiding in the avoidance of negative feelings and diminishing your responses to stressful circumstances.

— Meditation: Techniques for relaxation and stress relief, including breathing exercises, can assist individuals in managing anxiety and worry during episodes of social anxiety.

Advantages of meditation and mindfulness:

— The simplicity and accessibility of practices.

— Sustained advantages for the psycho-emotional condition.

— Alleviation of physical stress and anxiety.

5. Group psychotherapy

Principles and methodologies:

Group therapy provides individuals with social anxiety the opportunity to engage with others facing comparable challenges. This environment fosters a secure setting for the development of social skills, enhances communication, and diminishes feelings of isolation.

The mechanics of group therapy:

— Role-playing and social skills training: Group therapy encompasses role-playing and training designed to enhance self-confidence and refine communication skills.

— Feedback from fellow participants: Engaging in discussions about experiences, sharing insights, and receiving support from peers enables individuals to recognize the universality of their experiences and reassures them that they are not alone.

Advantages of group therapy:

— Assistance from peers in therapy.

— An opportunity to develop social skills in a secure environment.

Cognitive Behavioral Therapy for Social Anxiety Disorder

Social phobia, also known as social anxiety, is a mental disorder marked by an enduring fear of social evaluation and judgment, accompanied by a sense of inadequacy regarding one’s abilities in social contexts. This fear can be so intense that it disrupts daily life and hinders full functioning in both professional and personal spheres.

Cognitive behavioral therapy (CBT) is among the most effective treatments for social phobia. CBT seeks to modify the patient’s negative thoughts and beliefs, along with their behavior in stressful situations. This method not only alleviates the symptoms of social phobia but also markedly enhances quality of life.

Cognitive dimensions of social phobia

One of the primary factors contributing to social phobia is the distortion in self-perception and the perception of others. Individuals often amplify the perceived threat of social situations, viewing them as potentially hazardous or intolerable. These distortions may encompass:

— Catastrophizing refers to the tendency of an individual to anticipate the worst possible outcome. For instance, they may firmly believe that a mistake made during a public speech will result in universal judgment from the audience.

— Mind reading — an individual is convinced that others harbor negative thoughts about him, even when this is not the reality.

— Generalization: from a single unsuccessful experience, an individual concludes their incapacity to manage similar situations in the future.

Dichotomous thinking refers to the tendency of an individual to view a situation as either a total success or an utter failure, disregarding any intermediate possibilities.

Cognitive behavioral therapy seeks to address these distortions, enabling the patient to perceive situations more accurately and rationally.

2. Fundamental techniques of cognitive-behavioral therapy for social phobia

Cognitive Behavioral Therapy (CBT) for social phobia encompasses several essential techniques designed to assist patients in altering their perceptions and behaviors in social contexts.

2.1 Recognizing and Confronting Negative Thoughts

In the initial phase of therapy, it is crucial to identify and confront the negative thoughts that exacerbate anxiety in social contexts. The patient is guided to recognize these thoughts, evaluate their rationale, and make behavioral choices grounded in more realistic beliefs.

Example:

— Negative thought: «If I make a mistake during a meeting, everyone will evaluate me.»

— Analysis: The therapist assists the patient in comprehending that there are various responses to what is articulated, and not everyone will evaluate their perspective. It is also crucial to acknowledge that others do not concentrate on every word.

2.2. Exposure Therapy

Exposure is the process of gradually acclimating a patient to feared social situations. It is one of the primary techniques employed in cognitive behavioral therapy to alleviate anxiety. Exposure enables the patient to recognize that their expectations are unfulfilled and that their fears are unfounded. This process should be incremental, commencing with less distressing situations.

A patient might begin by casually greeting a stranger on the street and subsequently advance to more intricate scenarios, such as engaging in a group discussion or delivering a presentation.

2.3. Behavioral Studies

Behavioral experiments serve as a method for evaluating the validity of specific beliefs. The patient engages in an experiment to assess their negative predictions. For instance, they may take part in a public speaking session to observe how critically others perceive their errors.

Example:

— Prediction: «Should I err in my performance, individuals will begin to criticize me.»

— Experiment: The patient addresses a group, acknowledging that errors are an inherent aspect of the learning process. Subsequently, they reflect on the events that transpired and often find that the responses of those present were not as unfavorable as anticipated.

2.4. Advancement of social skills

Therapy encompasses social skills training, which enhances the patient’s confidence in diverse situations. The patient acquires communication skills, including active listening, appropriate intonation, and effective body language management.

Example:

— Conversational exercises: the patient acquires the skills to establish eye contact, maintain an open posture, and respond to questions.

— Engage in assertive behaviors: for instance, initiating conversations, offering compliments, and addressing criticism.

2.5. Techniques for Relaxation

Relaxation is essential for alleviating anxiety. Patients are instructed in a variety of relaxation techniques, including breathing exercises and progressive muscle relaxation, which assist in managing stress during real-life social interactions.

3. Therapeutic Process

Cognitive behavioral therapy may span several months to a year, contingent upon the severity and duration of social phobia. The therapeutic process is structured in multiple stages:

— Assessment and goal setting: The initial stage entails a diagnosis, during which the patient articulates their experiences and challenges, leading to the formulation of a treatment plan.

— Skills training and development: The patient is instructed in techniques for managing negative thoughts and engaging in social situations.

— Practical application: Throughout therapy, the patient starts to implement new skills in real-life scenarios, including engaging in social events, meeting individuals, and addressing challenges at work or school.

— Consolidation of outcomes: At the conclusion of the therapeutic course, patients persist in utilizing the skills they have acquired, while the therapist assists in reinforcing these results.

4. Outcomes of cognitive behavioral therapy

Cognitive behavioral therapy for social phobia yields positive outcomes and is recognized as one of the most effective interventions for this condition. Following only a few sessions, patients typically observe enhancements: their anxiety diminishes, they gain confidence, and they experience greater ease in social interactions. In the long term, CBT markedly enhances quality of life and enables patients to feel more at ease in social contexts.

Exercise Examples — Cognitive Behavioral Therapy for Social Anxiety

Cognitive Behavioral Therapy (CBT) is among the most effective interventions for social phobia, with exercises serving as a fundamental component of this therapeutic approach. These exercises are designed to assist patients in identifying and altering distorted thoughts while adapting their behavior in social contexts. This chapter will present examples of exercises applicable in CBT for the treatment of social phobia.

Recording and analyzing detrimental thoughts

Objective: To recognize and confront distorted thoughts related to social anxiety.

Exercise Description:

During the day, the patient records his thoughts that emerge in social situations that induce anxiety.

— For instance, when an individual attends a meeting with colleagues, they may contemplate: «Everyone will scrutinize me and evaluate my every word.»

— After documenting negative thoughts, the patient evaluates them by employing the following questions:

— What is the foundation of this idea? What evidence supports or contradicts it?

Is it possible that my understanding of the situation is skewed?

What alternative interpretations might exist for this event?

— How genuine is the threat I anticipate?

Example:

— Thought: «If I make a mistake during a meeting, everyone will evaluate me.»

— Analysis: Recognizing that errors in meetings are a typical aspect of communication and that it is improbable for everyone to concentrate on the mistake. The genuine risk is negligible.

2. Exposure to intimidating social scenarios

Objective: Gradually acclimate to anxiety-inducing situations and diminish apprehension through experiential learning.

Exercise Description:

The patient compiles a list of scenarios that induce fear, such as negotiations with colleagues, public speaking, and participation in group discussions.

Next, the patient prioritizes these situations based on their intensity, ranging from the least frightening to the most distressing.

With the assistance of a therapist or through self-guidance, the patient gradually engages with these situations sequentially, commencing with the least distressing and progressively advancing to more intricate scenarios.

It is essential for the patient to confront situations rather than evade them, utilizing these experiences as opportunities for personal development.

Example:

— Step 1: Greet a stranger in a store.

— Step 2: Engage in a brief meeting with colleagues.

— Step 3: Prepare a brief presentation for the group.

— Step 4: Deliver an extended presentation to a larger audience.

3. Behavioral Studies

Objective: To evaluate the validity of one’s beliefs and hypotheses regarding social situations.

Exercise Description:

The patient contemplates a social scenario that induces anxiety. They are required to construct a prediction regarding the outcome of this situation (e.g., «Everyone will ridicule me if I err»).

Following this, the patient must finalize this situation and evaluate the outcome against the prediction.

It is crucial for the patient to confront dangerous situations rather than evade them, adhering instead to the established course of action.

The therapist assists in analyzing the results obtained and recommends ways to accurately interpret the ongoing events.

Example:

— Prediction: «Should I make an error during the presentation, my colleagues will begin to evaluate me.»

— Action: Deliver a presentation to colleagues.

— Reality: The presentation was successful; my colleagues were not overly concerned with the errors; in fact, they became engaged with the subject matter.

4. Relaxation and respiratory exercises

Objective: To diminish anxiety levels and the physiological response of the body in social contexts.

Exercise Description:

The patient acquires relaxation techniques, including deep breathing and progressive muscle relaxation, to manage the physical manifestations of anxiety (e.g., elevated heart rate, perspiration, bodily tension).

It is advisable to perform these exercises daily to master their application in anxious situations.

It is essential for the patient to be able to employ these techniques prior to or during anxiety-inducing social situations.

Example exercise:

— Breathing utilizing the 4-7-8 technique:

Inhale through your nose for a duration of four counts.

— Inhale deeply and hold your breath for a count of seven.

— Exhale slowly through your mouth for a count of eight. This exercise aids in calming the nervous system and alleviating tension.

5. Role-playing and social skills development

Objective: To cultivate confidence and enhance social skills across diverse situations.

Exercise Description:

Role-playing can be utilized as a therapeutic technique, wherein the patient enacts different social scenarios. The therapist or other participants may assume the roles of interlocutors or group members.

Role-playing assists patients in honing vital communication skills, including initiating conversations, responding to inquiries, and addressing both criticism and compliments.

— Activities designed to enhance non-verbal communication, such as establishing eye contact, posture, and intonation, may also be employed.

Example exercise:

— Situation: The patient is encouraged to envision themselves in a job interview scenario. They respond to questions, honing their ability to speak with confidence and composure.

— Implementation: The patient receives feedback from the therapist regarding his behavior and determines which areas require enhancement.

6. Constructive self-reflection

Objective: To enhance self-confidence and foster self-acceptance.

Exercise Description:

The patient documents their successes and accomplishments in social contexts. It is essential to note even minor victories, such as a successful interaction with a colleague or involvement in a small social gathering.

This assists the patient in altering their perception of their own capabilities and recognizing that they can manage distressing situations.

Example:

— Task: Each evening, document three accomplishments from the day that pertain to overcoming social anxiety (e.g., «I greeted a stranger,» «I contributed to a meeting and articulated my perspective»).

Example of a Therapeutic Session: Cognitive Behavioral Therapy for Social Anxiety

A 28-year-old patient reports experiencing significant anxiety in social contexts, including public speaking, professional meetings, and interactions within large groups. He harbors a fear of being evaluated for every word he utters, leading him to frequently evade these situations, which in turn intensifies his anxiety.

1. Commencement of the session:

Therapist:

«Hello, how are you feeling today? Have there been any circumstances that have induced anxiety since our last meeting?»

Patient:

«I remain apprehensive about meeting a new client on Friday. I fear I may appear foolish, struggle to articulate my thoughts, and he might perceive me as incompetent.»

Therapist:

«I recognize that such a meeting can generate considerable tension. Today, let us delve deeper into the thoughts that arise when you contemplate this meeting.»

2. Recognition of detrimental thoughts:

The therapist assists the patient in identifying and documenting thoughts that induce anxiety.

Therapist:

«What thoughts arise in your mind when you envision this meeting?»

Patient:

«I will assume that something is amiss, and the client will begin to question my professional competence.»

«I will appear insecure, and everyone will take notice.»

«He will perceive that I am unprepared and will be reluctant to collaborate with me.»

Therapist:

«What emotions arise when you contemplate such thoughts?»

Patient:

«I sense my heart rate quickening, my palms becoming clammy. A profound discomfort begins to envelop me.»

3. Confronting and Transforming Distorted Thoughts:

The therapist engages with the patient’s thoughts to assist him in identifying and altering cognitive distortions.

Therapist:

«Let us consider these thoughts. You assert that if you harbor any negative thoughts, the client will begin to question your competence. Is there any substantial evidence to suggest that the client will doubt you based on a single meeting?»

Patient:

«While I am uncertain, I frequently contemplate the possibility that I may be mistaken, which would inevitably lead to discontent.»

Therapist:

«I understand. However, how frequently have you encountered professional errors that resulted in a breakdown of collaboration? Can you provide specific instances where your competence was challenged?»

Patient:

«In reality, there were no such instances. Even when I erred, they supported me, and everyone persisted in collaborating with me.»

Therapist:

Indeed. It seems your thoughts may be somewhat exaggerated. You frequently leap to the conclusion that others will judge you based on a single mistake or word, without any substantial evidence to support this belief. Might we consider substituting these thoughts with more realistic perspectives?

Patient:

«Yes, I suppose I must acknowledge that mistakes are a natural part of the process, and they do not determine the caliber of specialist I am.»

Therapist:

«Excellent. Let us substitute thoughts such as «I will appear insecure, and everyone will notice’ with a more objective perspective. For instance, you might consider: «I may feel slightly nervous, but that is normal, and it does not imply incompetence. People are likely to pay less attention to my nervousness than I anticipate.»»

Patient:

«Indeed, that is a more rational perspective. I must remind myself that the client is not evaluating me based on a single meeting.»

4. Presentation and practical assignment:

Therapist:

«Now, let us proceed to the next step — exposure. It is well established that evading social situations heightens anxiety. How do you believe you would feel if you engaged in such encounters multiple times, perhaps initially in less stressful environments?»

Patient:

«It may seem intricate, but I believe I should attempt it. I can begin by merely greeting the client and then progressively transition to more complex subjects.»

Therapist:

«Excellent. Let us approach this exercise as a component of our practice. For instance, you might prepare for the meeting ahead of time by formulating a strategy regarding what and how you will communicate. Engaging in a brief rehearsal with a friend or colleague could enhance your confidence. Do you believe that would be beneficial?»

Patient:

«Yes, that could be beneficial. I will be prepared and less anxious.»

Therapist:

«Excellent. I also recommend that you document all your experiences and reflections before and after the meeting, as this will allow us to analyze them in our next session. This practice will aid us in comprehending what transpired and in assessing whether your concerns were warranted.»

5. Session Conclusion:

Therapist:

«During our upcoming meeting, we will evaluate the client’s experience and further develop strategies to enhance confidence in social interactions. Do you have any questions or thoughts you would like to address?»

Patient:

«I already feel somewhat improved. I am pleased to be able to approach my thoughts with greater objectivity and to prepare for various situations.»

Therapist:

«These are excellent measures! Gradually incorporating these strategies will enhance your confidence. We will focus on each step, and you will observe the outcomes.»

Session outcomes:

As a result of the session, the patient gained greater awareness of his cognitive distortions and learned to approach anxiety-inducing situations with increased objectivity. He consented to a practical assignment that entailed preparing for and engaging in social situations through exposure, while documenting his experiences. The therapist and patient established a work plan for future sessions, which bolstered the patient’s confidence in the ongoing therapeutic process.

Treatment Outcomes — Cognitive Behavioral Therapy for Social Anxiety

Cognitive behavioral therapy (CBT) for social phobia has demonstrated efficacy as a treatment approach focused on altering negative thoughts and behaviors linked to social interactions. Outcomes of CBT for social phobia generally encompass enhanced emotional well-being, diminished anxiety in social contexts, heightened self-confidence, and a more adaptable response to stress.

1. Decreased anxiety levels

One of the primary outcomes of therapy is a notable decrease in anxiety and apprehension regarding social situations. Patients start to experience greater calmness in scenarios such as public speaking, interacting with colleagues, or forming new relationships. Cognitive Behavioral Therapy (CBT) assists them in recognizing that many fears related to judgment are baseless, and that their amplification is a manifestation of cognitive distortions.

A patient experiencing social phobia indicates that his anxiety in situations requiring self-introduction during meetings has diminished following therapy. He now feels at ease when introducing himself to a group and is less concerned about potential judgment.

2. Modifying cognitive distortions

Cognitive Behavioral Therapy (CBT) assists patients in recognizing and altering cognitive distortions, including catastrophizing, misattribution of errors, and overgeneralization. Individuals with social phobia often perceive that even minor miscommunications will result in catastrophic outcomes. Within the therapeutic setting, patients are guided to confront these thoughts and substitute them with more rational alternatives.

A patient learned to identify his automatic thoughts, such as, «If I make a mistake, everyone will notice and ridicule me.» With the therapist’s assistance, he substituted them with, «Mistakes are a natural part of life, and they do not define how others perceive me.»

3. Enhancing social engagement