A Personal Guide to Coping Chapter 13--Social Anxiety, Page 1

Coping with Social Anxiety

Ed Beckham, Ph.D. and Cecilia Beckham, L.C.S.W., B.C.D. Most of us have experienced times that we felt nervous or uncomfortable around other people. If our feelings were very strong, we may have even felt so out of place that we sensed we were being watched or observed. Perhaps we were in a social situation for which we were unprepared. We didnt know how to act or what to say. While this is not an unusual experience, some persons have it on a daily basis to the point that their lives are severely restricted. Anxiety in social situations is almost always tied to a fear of being negatively evaluated by others. The socially anxious person tends to be afraid that the people around them will see them as inadequate, inferior, weak, or stupid. They tend to fear that as a result of their poor social skills, they will be humiliated or rejected. Persons with social anxiety often realize that their fears of rejection are not totally realistic. Their fears may seem clearly excessive and unreasonable to them, but that intellectual realization doesnt stop the problem. In addition to a subjective feeling of anxiety, persons often have a variety of physical symptoms as well. These can include sweating, blushing, needing to urinate, shaking, hands trembling, voice quivering, rapid heart rate, and other symptoms. When physical aspects of anxiety start to occur, it can increase the fear that others are going to take notice of the person, which is the last thing that they want. At their strongest, the symptoms can even bring on an anxiety attack (see the Chapter/handout #9, Coping with Panic and Agoraphobia). Social anxiety is often particularly high in situations where persons have to speak or perform in front of others, such as a school presentation or a job interview. Public speaking anxiety is one form of social anxiety. The reaction of persons with social phobia to public speaking can be very pronounced and result in large increases in blood pressure and heart rate. For most persons, these physical symptoms decrease in a matter of minutes, but for persons who have a phobia of public speaking, their physiological reactions remain high until the speech is completed. Mild levels of social anxiety can usually be managed or overcome without any professional help. But when the anxiety reaches the point of interfering with important activities such as interviewing for a job, interacting with teachers or students in a classroom, or meeting new friends, then it is called a social phobia and counseling is often needed. We will generally use the term social anxiety throughout this chapter/handout rather than the term social phobia, because many persons have enough social anxiety to make them feel uncomfortable, even if it isnt severe enough to be diagnosed as a phobia. This is not to say that only a few people can actually be said to have a true social phobia. As many as 8% of persons may have a diagnosable social phobia in one year, and as many as 13% of persons are likely to have such a problem during their lifetimes. But, if the definition is extended to having any type of irrational social fear, then up to 23% of adults will have problems in this area at some point. Social anxiety can affect not only a persons social life but also their job and livelihood. For example, sixteen percent of students at a school of music said anxiety about performing limited

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their career. Despite this, not many people actually seek treatment for the problem. Only five percent of people with pure social phobia (who do not have other psychological problems) have sought mental health services. This is unfortunate, given the new, effective treatments which have been developed for it. An individuals social anxiety may be limited to just a few types of circumstances or it may apply to many different types of interactions with people. It can create difficulties in dating eating or speaking in front of others writing in front of others meeting new people starting conversations socializing at parties and other meetings Social anxiety can interfere with almost every area of life, since meeting, communicating with, and persuading others is such an ever present requirement. Since job advancement often entails social interaction with people and leadership skills, persons with this problem often find themselves settling for jobs that are beneath their abilities. They may turn down good employment opportunities which would require them to meet people or give presentations. Gradually, the person may constrict their life further and further. There may be an avoidance of public speaking, then meeting new people, then even eating in front of others. Many of their interpersonal needs can go unmet because of their fears of being around others. Even the thought of having to go into a social situation can make the person fearful. They may begin to dread it and to worry about it days ahead of time so that their anxiety has built considerably by the time that the actual social situation arrives. The person with social phobia is prone to have other psychological symptoms as well. For example, depression often occurs along with it. This is not surprising since these persons have low self-esteem. In addition to depression, it is not uncommon for different types of anxiety disorders to be present with it as well. Anxiety attacks can begin to occur in social situations, complicating their problem even further. Persons with social anxiety tend to be misunderstood by others. Not only do they avoid social contact, but when around people they may also avoid eye contact, for fear that people will misinterpret their gaze or that their anxiety will show through. As a result of these behaviors, people sometimes mistakenly view the socially anxious person as aloof or snobbish. Of course, this would surprise the anxious person since they actually feel so inadequate. Persons with social anxiety tend to have a heightened sensitivity to the moods and feelings of people around them. Actually, it may not be true to say that they are more sensitive, since that implies that their perceptions others are accurate. It is probably more correct to say that they are hypersensitive, because their tendency is to imagine what others are feeling and to read too much into the actions of the people around them. They see more in the thoughts and feelings of others than is actually there. They are very any indication of mockery or derision. A certain look, even a

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smile, can make the hypersensitive person absolutely sure that he/she is being looked down upon. Many persons with social anxiety have a personality style termed Avoidant. It involves a fear of rejection mixed with a desire to be accepted. Avoidant individuals want to participate and be a part of the action, but they feel like they dont know what to say or do. They generally have feelings of inadequacy. In cognitive therapy terms, there is a great deal of mind reading, such as the thought, I could see by their faces that they were thinking that I wasnt dressed right and that I was out of place. The avoidant person is reluctant to take risks socially. They are sure that trying new things will lead to further rejection and humiliation. It is important to realize that life is a risk. There is no way to avoid taking chances. Staying away from people brings a false sense of security, since it brings its own pitfalls, such as isolation and unhappiness. Many times in therapy, the socially anxious person will describe themselves as paranoid. This is not really correct. Social anxiety is not necessarily a sign of paranoia because individuals with that personality style feel that others are actively trying to take advantage of them or harm them. The socially anxious person does not. The paranoid person feels unfairly treated. The socially anxious person tends to think that others are simply discovering their inadequacy, and that probably they dont deserve much better anyway. But what the anxious person is trying to communicate by describing themselves as paranoid is their feeling of being constantly on guard, thinking that others are viewing them in an unfriendly way, and scanning the environment and people around them for indicators of negative feelings. Persons with social anxiety tend to put all of their eggs in one basket when it comes to having friends. Socially, their support network tends to be small and somewhat fragile. That is, if one of their friends moves away or dies, they may be left with few or no support persons. If someone proves themselves to be accepting and uncritical to the avoidant person, then a friendship may be possible. However, oftentimes other people cannot break through their fears and the anxious individual may give up on establishing friendships.

Getting Personal
Analyze your social anxiety. What is it that you tend to be afraid of? ____ Speaking in front of others; giving a talk ____ Eating in front of others ____ Walking in front of others ____ Writing something in front of others ____ Having to go to the front of a classroom ____ Meeting someone new ____ Going on a date with someone new ____ Using a public restroom if others are around ____ Being at a party ____ Having people look at you in any situation ____ Giving a performance

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____Having to talk in a group discussion ____Job interviews You may have your own particular situations that cause you to feel frightened. Write them down below. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ What kinds of beliefs do you tend to have that make you anxious in social situations? Do you tend to have any of the following thoughts and beliefs? ___I am boring to others. ___Other people are more interesting and have more to say than I do. ___Other people are more normal than me. ___I have nothing to offer others. ___People wouldnt want to talk to me. ___If I went to a party, I would just sit there and not interact. ___I wouldnt know what to say. ___I look funny (or I look funny when I eat, when I walk...) ___I talk in a funny, odd way. ___I need to entertain other people. If I were just to be myself, people would get tired of me. Shyness and Social Phobia There are both similarities and differences between shyness and social anxiety. Shy persons prefer to avoid situations where there are many people present, especially if they will have to meet them and interact with them. Shy persons tend to be reserved rather than venturing readily into social situations, but they are capable of interacting socially if need be. Shyness is not uncommon, and up to 90% of people believe they were shy at one time in their lives. Many people with childhood shyness go on to develop social anxiety and social phobia in adulthood. One distinction between shyness and social phobia is that persons with the latter can experience intense symptoms, such as heart palpitations and panic attacks, and they may not be capable of social interaction if the need arises. The general personality characteristic of being reserved versus outgoing appears to be inherited to some degree and also appears to be very consistent across the life span. How might a persons genes or biology lead to social anxiety? One answer to this is that persons with this problem tend to be very physically reactive under social stress. They have strong bodily symptoms, such as perspiring and trembling, which make the process of being with people very negative and uncomfortable for them.

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But while a certain amount of the problem may be biological and genetic, it is also true that persons with social anxiety are likely to have had more traumatic events in their childhoods. Emotionally painful situations that occurred with other people appear to have conditioned them to be fearful in social situations, such as being on stage. Even one, single traumatic incident can cause a limited degree of social phobia in some people. Research has shown that the family members of persons with social phobia tend to have a higher than average rate of this problem also. This finding could reflect either an hereditary influence, or it could mean that families somehow pass on social anxiety by example--what psychologists call modeling. In other words, children may view how their parents interact with other adults and imitate their social style. Persons with generalized social phobia tend to come from families where there was limited social interaction outside of the family unit. It is likely that this prevents children from learning to develop the skills they need to socialize and to feel comfortable around others.

Getting Personal
If you have negative thoughts and beliefs about what people will think of you and how they will act towards you, try to determine where these came from: Were you ridiculed, criticized, or belittled by your parents? By your brothers and sisters? Or by other children in the neighborhood and at school? Did you observe your parents being worried about how people would react to them and judge them? Or did your parents stay away from social situations altogether? Did your parents or other adults warn you that people cannot be trusted? Unfortunately Social Success Doesnt Always Help On the surface, it would seem that if the socially anxious person could be in situations where they were successful and received positive feedback, they would begin to lose their anxiety. After all, what the person with this problem wants most is to be accepted and to be included. However, there is a paradox here. Studies have shown that success in socializing does not have a very beneficial impact. Being given positive feedback on social performance does not lead anxious persons to see themselves as more competent. Instead, it seems to place some kind of a burden on them. They begin to feel that now people are going to expect more out of them in the future. In addition, they often tend to discount any success with negative thoughts such as, They only think they like me. I didnt let them see the real me. If they had, they wouldnt like me so much. Socially anxious persons are self-conscious and mainly concerned about limiting losses rather than having fun and experiencing new, positive interactions. Thus, instead of thinking after a successful experience, That was a lot of fun; maybe Ill try that again, they tend to think, Well I survived that party without anything bad happening, but will I be able to do it again next time?

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Points to Ponder
Persons with social phobia are often concerned about being viewed as strange, unusual, or different from others. But the fact is that almost everyone has something that is different about them. It is normal to be different. The human species seems to have a built in variation of height, weight, intelligence, attractiveness, muscularity, and so on. The gene pool seems to allow and even encourage considerable variation. If someone were perfectly normal in every single way, they would be so rare as to almost be abnormal!

Spotlight On...
Learning Social Skills Social anxiety can be broken down into the anxiety itself and problems with knowing how to behave in social situations. Some persons with social anxiety need assistance in learning how to talk to and to relate to others. These behaviors can often be taught int therapy. Abilities which can be learned include such things as asking for information, asking for help, starting and maintaining a conversation, asking for a date, giving and receiving compliments, and refusing requests. Some persons with this problem, however, actually have the skills they need. They can interact quite well as long as they are in a socially non-threatening situation (such as with someone they know well). However, in new and different situations or with someone they perceive as important, they freeze up. Suddenly they feel as if they dont know how to make small talk, or even walk correctly! Social skills can be learned by working with a therapist or even a friend.

Things To Do
If you feel that you dont know how to act in a certain situation, choose a friend or someone who is positive and encouraging to help you practice it. Discuss with them how they would do it. Let them demonstrate it for you, and then role play it with them. Ask them for feedback on how you did. Dont just do this once but several times until it feels natural to you.

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Overcoming Negative Thinking Cognitive therapy for social anxiety works on strengthening the logical parts of the persons thinking and challenging the irrational aspects of it. Details on how to use cognitive therapy techniques were set forth in Chapter/handout #3, Coping with Negative Thinking. Here are some of the specific types of negative thoughts which occur in social anxiety. Personalizing involves seeing events around you as aimed at, caused by, or in some way directly relevant to you. If you hear people laugh, you may feel that they are laughing at you. If you are giving a talk and someone in the audience has a blank look on their face, you may think that they are bored or disagreeing with you, when in reality, they could be thinking of something else besides you and your talk. They could be remembering that they left their car unlocked or some other issue totally unrelated to the speech. When people are laughing or frowning, you may interpret these expressions as signaling that the other person is laughing or frowning at you. In fact, people can have many things on their minds besides you. Even if a person were to laugh at something you said, it could be a positive, humorous laugh rather than a derisive one. A frown does not necessarily indicate disapproval, but could be a sign of concentration. Persons with social anxiety have a very high level of focus on themselves. For this reason, they tend to: focus a great deal on what to say or do next wonder what impression they are making on other people focus on how nervous they are feeling or how nervous or afraid they might become focus on what is going on in their bodies and different sensations they are having, especially breathing and heart rate think back to past situations in they felt that they failed to interact well or felt they were humiliated For example, a college student might be afraid that they are drawing attention to themselves and feel that everyone is looking at them as they walk to the front of the class to sharpen their pencil. Or a person might think that they are not dressed as nicely or as appropriately as others and so want to leave a party. Once the individual becomes focused on his, he may feel that everyone else is, too, making it very difficult for him to pay attention to anything but himself. Here then is the basic idea in personalizing which can lead to social anxiety: If anything is going wrong here in this social situation, or in this interaction (if people seem bored, distracted, or unhappy) then it must be a problem with me. I must be doing something wrong. But even if people do not seem to be having any negative reaction, I am still likely to do something which will make me look stupid. Mind reading occurs when the person knows what others are thinking about him. The person with social anxiety believes that they are highly attuned to what other people are thinking. They read (or misread) peoples faces very carefully. But in reality many of the conclusions they come

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to are not accurate. Peoples feelings and thoughts are not always apparent from their outward appearance. Moreover, some people do not show their feelings very much. Or they have blank looks on their faces because they are lost in thought. This kind of blank look often invites mindreading by persons with social anxiety, and leads to incorrect conclusions. In general, mindreading causes negative thoughts which in turn lead to anxiety. Ignoring the positive involves overlooking any success experiences or positive reactions from other people. The individual is likely to focus on negative expressions or behaviors from others and may be oblivious to positive responses. They can fail to absorb into their awareness the interactions which would affirm them as a person. Or they may be aware of these positive exchanges but discount them as not really being relevant. They might think, for example, This person seems to be enjoying our discussion. But then Im their supervisor, so they have to look that way. Or they might think, This is person is being nice to me, but its probably only because they feel sorry for me. Catastrophizing When an individual is afraid of social situations, there is not just a concern that they might be rejected or appear foolish. There is also a belief that this would be terrible and catastrophic. This type of thinking is a way of the seeing the world which can neither be proved nor disproved. It is an attitude or a belief rather than a fact. If you go to a party, and no one seems to want to talk to you, is that a catastrophe? If you give a speech, and people yawn and do not clap very loudly, is that terrible? These are events which are mildly annoying to some people but devastating to others. That is why seeing a situation as a catastrophe is a belief rather than a fact. The negative thoughts in social anxiety then are of two types. There are thoughts about what might happen, and there are thoughts about what the meaning of those events would be. The person with social anxiety generally overvalues the opinions of others in judging themselves. Negative opinions that others may have excessively undermine their self-esteem. They assign a high cost to being rejected and have an attitude similar to: If someone rejects me then it is awful and terrible. It means that there really is something wrong with me. I will be humiliated and hardly able to withstand the embarrassment. In addition, persons with social anxiety have attitudes and beliefs about how they are supposed to behave around others: I must always sound intelligent and not say something which would make me seem stupid. I must entertain the people around me and keep things interesting and lively. If there is anything different about me then people will think that I am weird. If people think that I am different, they will reject me or make fun of me.

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To overcome social anxiety, it is necessary to develop a proper attitude. Here is a way of seeing life that would lead to little if any social anxiety: No one will be accepted by everyone all the time. It will not be unusual if I am not approved of by some persons. And it will not be a disaster or a catastrophe. Those things happen. When I am with others, it is not my responsibility for keeping everyone entertained. All I have to do is be myself. If other people dont like the way I am, that is unfortunate, but it is okay. It wont harm them or me just because we dont hit it off. Im not going to set my expectations too high. Ill just aim at being a average person. Thats all that others expect of me. Of course, this type of attitude is not developed overnight. It takes considerable work to change the attitudes which provoke social anxiety to other ways of seeing yourself and the world which allow you to be comfortable with being yourself.

Getting Personal
Consider the situations below and how they would affect you. Rate each one as unimportant, annoying, very bothersome, or catastrophic. After answering each, you may want to ask friends or family how they would have viewed each of these.

Social Situation

Rating

Writing a check at the grocery store and your hand starts trembling You are at a party and forget someones name You spill a drink at a social get together You are giving a speech and some people in the audience seem bored You are at a social function and only a few people speak to you. You are on a date and cant think of anything to say. The professor calls on you in class to talk.

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The professor calls on you to talk and your voice is shaky as you speak. You ask a person for a date. Someone next to you on an airplane tries to talk to you. You are talking with someone at a social gathering. They see someone else that they say they need to talk to. They excuse themselves and walk away.

Changing Your View of Yourself and Your Situation

Old ideas about oneself are often very persistent and difficult to change. The goal of cognitive therapy for anxiety is to help a person to challenge negative thoughts and to learn from any positive social experiences which they have. One patient, aged 60, had many success experiences throughout his professional life. He had been the vice-president of a firm, and in his work life had many positive accomplishments. Yet his self-image remained stuck as it had been in his teens. In his mind, he was still the gangly, awkward teenager that nobody wanted to be around and that girls didnt want to date. His mind has not absorbed the information of a lifetime that people could actually like him and want to be around him. The reason that persons may not improve their self-image despite success experiences is that individuals with social anxiety do not really take in how others are responding. Therefore, simply being successful in social situations is not enough to reverse this problem. No matter how well things seem to be going on the outside, the person may still think that others are laughing at them inside. There is some evidence that persons with social anxiety are so immersed in their own internal dialog that when they actually have a successful talk or other social event, they do not know it. They are not aware of the positive reactions of people around them, or they do not pay attention to those reactions (ignoring the positive). Here are some examples of how negative thinking can be challenged and diminished using the four column technique from cognitive therapy. In the first column, the client writes the objective situation that they have faced or will face. In the second column, they write the negative thoughts which produce their anxiety. The purpose of the third column is to make the person aware of all of the problematic feelings and behaviors which the negative thoughts cause. Finally, and most importantly, the fourth column is the place to write down ideas which would challenge the negative thoughts.

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Objective Situation (The Event) Walking into teachers lounge at school. There seems to be a slight pause in the conversation of the other teachers as you enter.

Automatic Negative Thoughts The other teachers turned and stared at me when I walked in there. Ill bet they were talking about me. They never liked me anyway. Well, Ill show them. I just wont go in there in the future.

Negative Consequences Anxiety Avoiding the teachers lounge. Avoiding other teachers. Anger

Realistic, Logical Thoughts It is normal when people hear the sound of an opening door to look around and see who is walking in. That doesnt mean that they were talking about me. I am personalizing this situation. They could also have been talking about something or someone else which was private among them. Im mindreading. They have never indicated that they didnt like me. Im only hurting myself to stay out of there. If I stay away, Ill do even more mindreading, wondering what they are saying. They wont even know why I am staying away from the lounge. I wont be showing them anything. They will think I am cold and aloof.

Here is another example of the four column technique with public speaking.

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Objective Situation (The Event) Giving a speech in front of a moderate sized group (25-50 people).

Automatic Negative Thoughts I cant do this. Ill freeze up in front of the group. Ill mispronounce words or forget my speech. They will be bored with what I have to say. I dont have anything interesting to say anyway. Theyll laugh at me-maybe not out loud but on the inside. I wont look right. I dont have the right kind of clothes. Ill look funny. Ill never be able to show my face around them again. Ill be humiliated.

Negative Consequences Fear, anxiety Perspiring heavily, heart beating rapidly, mouth is dry Wanting to call it off

Realistic, Logical Thoughts Telling myself that I cant do this is fortune-telling, and it could become a selffulfilling prophecy. I have given talks to smaller groups before, and this is not fundamentally any different. I didnt freeze up with those groups. Ill just keep my written speech in front of me so that Ill always have something to refer to. Being an interesting speaker takes practice. I want them to be interested in what I have to say, but if theyre not, Ill just have to work harder at it next time. Its not a catastrophe if they are not totally interested.

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Alternative, Disputing Thought Continued If I hesitate for a minute, it wont be the end of the world. While Im giving the speech, its important that I dont make too much of the looks on peoples faces. Im not going to start mindreading. To tell myself that I wouldnt be able to show my face is catastrophizing. So what if the speech doesnt go great? Theyre not expecting a national speaker. They just need someone who can do this job.

Usually, persons can recognize that their fears are not totally reasonable. But the fear remains nevertheless. In cognitive therapy of social anxiety, it is important to constantly work on strengthening the logical parts of your thinking. This takes practice, such as using the four column technique above and challenging negative thoughts as you go about you business each day. One goal of therapy is to interrupt the constant self-monitoring (that is, paying excessive attention to ones self). The socially anxious person is often wondering, How do I sound? How do I look? What are other people thinking about me? These are the kinds of questions which go around and around in their minds. To overcome this problem, you will need to start focusing on other aspects of what is happening around you. What is the person you are talking to saying? What is it that he or she would like to get across? Is it possible that they are feeling uncomfortable or anxious as well? It is important to remember that you are not the center of the social universe. Everything does not revolve around you.

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Points to Ponder
The person with social anxiety is often egocentric but not egotistical. The egotistical person thinks that they are the center of attention because they are so wonderful. For the socially anxious person, there is a fear that others will stare at them and note all of their shortcomings and inadequacies. People have much better things to do with their time than constantly examine all of our behaviors. Even if we do commit a faux pas, it is not clear that others will notice it. Moreover, even if they do notice it, they are likely to realize that everyone makes mistakes. It is also possible that they will not even remember what happened! Time for Practice

Now, try the four column technique for yourself to work on a situation that has caused you social anxiety or for one that is coming up.

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Objective Situation (The Event)

Automatic Negative Thoughts

Negative Consequences

Realistic, Logical Thoughts

Things to Do
If you are unsure of how to act in public or around certain types of people (such as members of the opposite sex), observe how other people act. If you are unsure of what to say, you might even engage in a little innocent eavesdropping. What do other people talk about when socializing? If you are always feeling that you need to be saying something important, notice the following: Do other people always seem to be entertaining the other people around them? Or do they seem to feel comfortable without always being charming and witty? Focus your attention away from yourself and how you are doing. Instead focus on what others are saying and doing. Decide upon some personal goals, and then construct a ladder of subgoals (a hierarchy) for yourself that would help you get there. Start with some easily achievable goals. Here is an example:

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Ultimate Goal: Steps towards that goal:

Going on a Date 1. First, I will start going to a church or organization where there are women 2. I will practice talking to men there 3. I will practice talking to women there 4. I will go out with a group if possible to have coffee after meetings and talk 5. I will talk to one or more of the people there on the telephone between meetings 6. I will talk to one of the women there on several different occasions 7. I will ask her out on a date

Treatment Strategies Current studies evaluating treatments for social phobia have pointed to the importance of one particular technique: exposure. While some therapists prefer to use cognitive therapy and others prefer to teach social skills, both of these lead up the process of actually coming into contact with the feared social situation, first in the imagination and then in reality. In both forms of exposure, an initial goal of the therapist is to identify what the client is actually afraid of. This goes beyond simply labeling a situation such as, public speaking or eating in public. It involves the full fear, which also includes for many people the fear of humiliation. Here is an example of a situation which one client most feared: I am giving a talk in front of the class. Most of the other people are like me--middle aged people who are starting over. But some of them are different. Some of them are young hot shots just out of high school. And others of them are older people--managers and supervisors. They are getting bored with my talk. They think that it is childish and silly. They realize that I am making a lot of errors in my talk. They are having all sorts of critical thoughts. One of them gets up and leaves the room to get a drink of water because he is so bored. This reveals the full fear of the person. It isnt just the public speaking but also the fear of public humiliation and the presence of other people whom they consider to be more knowledgeable.

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In using the exposure technique, the therapist assists the patient in confronting their fear. The initial reaction of the mind to encountering the feared situation (as in the example above) is anxiety. This anxiety persists over a period of minutes and can last for half an hour or more. But it does not last forever. There comes a point at which the anxiety begins to decrease and the brain begins to tolerate the image without fear. This process is called habituation. When persons attempt this process themselves, they often withdraw--either in their mind or in real life--before habituation starts to occur. Unfortunately, they tend to pull away just when the anxiety is at its highest. The brain has not habituated, and nothing therapeutic has occurred. Just the opposite. When the person withdraws at the height of anxiety, the brain has learned two things: The situation does cause anxiety and is to be feared. Withdrawing from the situation is the remedy for the anxiety. For habituation (and therefore therapy) to be successful, the situation must be encountered until true habituation is occurring. Facing up to the situation in ones imagination is then followed by encountering it in real life. If you decide to use these techniques on your own, be prepared for the possibility that you will want to discontinue them too early, before they start to help you. This is a typical reaction to the desensitization process. You will need to be committed to staying with the scene until at least partial habituation occurs. This is one reason why it is very helpful to have a therapist, since remaining in the anxiety producing situation--even in your imagination--requires considerable selfdiscipline and motivation.

Things to Do
If you do decide to try this technique by yourself, face your social anxieties in your imagination first. Find a place where the light level is low and there are few distractions. Work on imagining the scene as vividly as you can. For some people this is easy and for others quite hard. Label your anxiety on a SUDS (Subjective Units of Distress) scale, with 0 being complete calm and 100 being the highest level of anxiety that you can imagine. Stay with each image until the SUDS level has been reduced by 50 percent or more. For example, if you are imagining that you are going to a party and your anxiety reaches an 80 on a scale of 100, stay with the scene until your anxiety is reduced to a level of 40 or below. Be prepared to stay in the imagined scene for 30 to 60 minutes if necessary. Most persons, however, will need to have a counselor or therapist to guide them, coach them, and encourage them. Is treatment effective? Yes, the good news is that not only do persons benefit from cognitive behavioral treatment of depression while they are in therapy, there is also evidence that they continue to improve after leaving treatment. While some persons respond better than others to therapy, almost all can experience significant relief and be able to live life more fully. There are other chapter/handouts from this book which you may find helpful in dealing with social anxiety. Some of the most relevant would be:

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Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 7 Chapter 9 Chapter 12 Chapter 17

What is Stress and What is Coping? Coping with Negative Thoughts You Can Assert Yourself Coping with Worry and Anxiety Coping with Depression--A Look at Relationships Coping with Panic Attacks and Agoraphobia Coping With Phobias Understanding and Using Medications for Depression and Anxiety

Further Reading for Clients

Gabor, D. (1983). How to start a conversation and make friends. New York : Fireside. Markway, B.G., Carmin, C.N., Pollard, C.A., & Flynn, T. (1992). Dying of embarrassment: Help for social anxiety and phobia. Oakland, California: New Harbinger. Marshall, J.R. (1994). Social phobia: From shyness to stage fright. New York: BasicBooks. Zimbardo, P.G. (1977). Shyness: What it is, what to do about it. Reading, Mass.: Perseus Books.

Further Reading for Therapists

Beidel, D.C., & Turner, S.M. (1998). Shy children, phobic adults. Washington, D.C.: American Psychological Association. Clark, D.M. & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. Hope, & F. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford Press