Cognitive-Behavior Therapy for Social Phobia Monica Ramirez

Cognitive-Behavior Therapy for Social Phobia Monica Ramirez Basco, Ph.D. University of Texas at Arlington Department of Psychology

Social Phobia Fear of Social Situations Catastrophic Thinking Physiological Reactions to Social stress Avoidance

Social Phobia Specific or Generalized Fear of public speaking Fear of socializing Anticipates criticism or rejection Expects embarrassment or humiliation

Social Phobia Fear of social or performance situations Exposure always provokes fear The person knows its excessive Avoids or endures with anxiety Functional impairment Duration at least 6 months in kids Not illness or drugs Unrelated to another disorder

Generalized Social Phobia Fear of Most Social situations Fear of Social Scrutiny Interferes with functioning Recognized as excessive

Specific Social Phobia Social Embarrassment Eating in public Writing in public Performance Anxiety Public Speaking Musical Performance

Continuum of Impairment Shyness vs. Social Phobia vs. Avoidant Personality Disorder

Cluster C: Avoidant Personality Disorder Social inhibition Feelings of inadequacy Sensitive to criticism from others

Work Avoids work requiring contact with others Fears criticism Fears disapproval Fears rejection

Social Contact Avoids others unless certain that he or she will be liked

Intimacy Holds back emotions Shows restraint Fear of criticism Fear of embarrassment

Social Scrutiny Is overly preoccupied with fear of criticism Fears rejection by others in social situations Hates being the center of attention

Inadequacy Feels inadequate around others Acts show or inhibited Thinks he or she is less worthy than others

Self-View Sees self as socially inept Feels unattractive or unappealing Feels inferior to others Behavior is withdrawn, avoids eye contact

Risk-taking Reluctant to take risks Doesn’t want to embarrass self

Avoidance in Social Phobia Self-Criticism reinforces low confidence Avoidance

Breaking the Cycle in Social Phobia Self-Criticism reinforces low confidence Avoidance

Avoidance in Social Phobia Rational Thinking & Exposure &

Goals of CBT for Social Phobia Develop Social Skills Stop Catastrophic Thinking Reduce Anxiety Stop Avoidance

The Cognitive Model Thoughts Obsession Worry Catastrophizing Feelings Actions Ritual or Avoidance Fear Terror Embarrassment

CBT Methods for Social Phobia Social Skills Training Logical Analysis of Automatic Thoughts Differential Relaxation Graded In-vivo Exposure Coping Skills Training

Avoidance Coping Explain how avoidance is a way of coping Explain the negative reinforcement paradigm Avoidance helps you escape discomfort Avoidance lowers anxiety Because it works, it increases the chance that you will use it again as a way of coping Evaluate the pros and cons of using avoidance as a way of coping Ask the patient if he or she would like to learn a new way to cope

Social Skills Training Instructions How to say hello Getting a date Making conversation Behavioral Rehearsal w/Feedback Practice with Safe Targets Self-Monitoring Graded Exposure

Decatastrophizing NegativeThoughts Learn the cognitive model Monitor negative thoughts Recognize catastrophizing and mind-reading Analysis of negative thoughts Rational responses

Decatastrophizing Identify sequence of catastrophic thoughts People will look at me I will do something to embarrass myself They will laugh at me The humiliation with be unbearable Assess the likelihood that this sequence will occur Evaluate the Evidence (reevaluate likelihood) Risk Management (reevaluate likelihood) Plans for coping (reevaluate likelihood)

Differential Relaxation Learn standard relaxation induction Practice maintaining relaxed state while involved in tasks Normalize breathing Muscle relaxation Practice in non-threatening situations Practice with graded in-vivo exposure

In vivo Exposure Desensitization hierarchy developed Start with the easiest item Cognitive Rehearsal Practice differential relaxation and decatastrophizing at each step

In-vivo Exposure Construct desensitization hierarchy Choose an easy starting place Plan coping strategy Troubleshoot Assign as Homework Follow-up and Repeat

Schema Work I can’t tolerate rejection Embarrassment is horrible I’m inadequate I have to be liked I’m unworthy I’m inferior to others I can’t handle negative feedback

Interventions for Schemas Historical analysis Evaluate evidence Advantages and disadvantages of the schema “as if” exercises Role play the alternative schema Identify alternatives