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Approaches a psychologist might use for social anxiety

CBT can help reduce the symptoms of social anxiety and deal with situations that induce it, helping the person develop new skills, try new things, and overcome a range of difficulties associated with social anxiety in general. CBT can also effectively tackle fear of public speaking, a very common form that social anxiety can take.

1. High self-consciousness
People with social anxiety find it very difficult or impossible to relax around others. They may feel certain other people are judging them or observing them. Sufferers are often worried they will make mistakes and embarrass themselves or be shown up in front of other people.

CBT: a technique to work with self-consciousness is to challenge the assumption that the person is always observed. The person might be asked to consider whether they pay a lot of attention to others or talk about how little attention people pay to other individuals.

2. Avoidance of social situations
People with social anxiety often prefer to avoid social situations to prevent this anxiety, missing out on various experiences they may want to engage in. People with social anxiety may want to engage more, but feel they can't do it. Social anxiety might make the person avoid parties, fun events, or gatherings.

CBT: overcoming avoidance. To overcome avoidance, a person is asked to think about social situations where they might feel social anxiety and rate those situations from 1 to 10. Then, the person is asked to gradually enter situations, starting with those that give them the least anxiety.

3. Academic difficulties
Social anxiety can make it difficult to speak in public, give presentations, or interact with people during group projects or in the classroom. People with social anxiety can have a hard time participating, so all of this can hurt or hinder their academic performance or prevent them attending college.

CBT: the person learns techniques that involve controlling one's breathing to reduce anxiety and help with being more able to relax in difficult situations, like exams and evaluations or presentations, which are often a source of increased anxiety. Changing beliefs – the person learns to have more control over their ideas and beliefs, so they are able to reduce the weight given to an examination and the anxiety they feel in relation to it.

4. Panic attacks
All sorts of social situations and interactions with others can be a source of increased anxiety, which can make individuals so nervous and overwhelmed that it leads to a panic attack. Fear of losing control and having a panic attack can cause social anxiety sufferers to avoid social situations even more.

CBT: the person learns relation techniques that help to to reduce anxiety and anxiety's physical symptoms, and being more able to relax in difficult situations. The person challenges the panic by looking at evidence from previous similar situations, how they coped, how the fear of a panic attack rarely manifests in reality, for example. They may be asked to generate some balanced statements about situations to replace automatic thoughts and catastrophic predictions.

5. Trouble at work
People with social anxiety might struggle if their roles require them to do presentations or even to engage with co-workers, customers in person or in phone conversations. Networking and training opportunities might both also be difficult. This can limit career advancement or cause the sufferer to remain unemployed.

CBT: cognitive distortions – CBT works with cognitive distortions (for instance, thinking in black and white) to reduce them or eliminate them altogether. These cognitive distortions help the person feel more comfortable doing things required for the job. For example, they feel more at ease making mistakes rather than too upset over it to think straight.

6. Problems with job interviews and other interviews
To land a job or a scholarship or any number of things, an interview or a similar setup is a must. For people with social anxiety, this can be a difficult barrier to overcome, as they feel judged and on display in such a situation, and worried they will look bad. They may also become tongue tied or stammer.

CBT: progressive muscular relaxation – CBT teaches various relaxation techniques, for example, progressive muscular relaxation that the person can practice when they want to avoid appearing too tense or coming across as nervous. Role-playing helps to prepare for interviews. CBT also challenges negative assumptions about what an interview really is, and encourages helpful thoughts, such as: it’s not a measure of self-worth, there is nothing to lose by trying & thinking of it as two people just having a chat.

7. Dating and relationship issues
Dating means meeting new people, a daunting prospect from the perspective of social anxiety. People might feel too self-conscious to approach new people romantically. Social anxiety can produce symptoms such as sweating, facial redness, diarrhoea and nausea, all of which can feel impossible in a romantic scenario.

CBT: exposure – CBT offers structured exposure situations in which a person might approach someone they are attracted to and ask a question or for direction, to experience the anxiety and see that it wasn't so bad, which facilitates dating later on.

8. Difficulties with friendships
Other relationships also may be affected, as people might feel unwilling to go out and even meet with existing friends, potentially jeopardising the bond between them. It helps to have friends that really understand and who can support the sufferer with gradual exposure to social settings.

CBT: social skills training is offered as part of CBT. The person can learn to better engage others and practice communicating with others in more effective ways, thereby helping their relationships.

9. Reluctance to trying new things
People with social anxiety might avoid any situations where they feel judged, including courses or workshops for things that interest them, any kind of group situation, or any kind of situation where they might begin to feel panicky or where they have reduced control over circumstances.

CBT: the person is encouraged to experiment and try new things. They might be given homework that involves engaging in certain activities, or explore new things in a range of practical ways as part of the therapy session. The person is supported to learn new skills that can help them be more prepared for and open to new possibilities.

10. Everyday stress
Social anxiety can lead to stress in simple day to day situations that involve interacting with other people, such as phone conversations, going shopping, etc. – all necessary parts of daily life. Even the thought of these kind of activities can bring on a great deal of anxiety for the sufferer.

CBT: symptom reduction – one of the goals of CBT is symptom reduction. The approach works to reduce the physical symptoms of anxiety, helping reduce the stress the person is feeling. They are also encouraged to break down goals and daily life challenges into manageable segments and to be mindful of stress levels and thoughts that contribute to overwhelm.

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