Social Anxiety Disorder

Do you ever feel shy when talking to people you’ve never met before? Or get nervous before speaking in front of a large audience?
While these emotions are normal, people with Social Anxiety Disorder (or Social Phobia) have a persistent fear of social situations. Often, sufferers believe that they will say or do something embarrassing, such as blush or shake, and so tend to avoid these situations as much as possible.
If social situations cannot be avoided then the sufferer will carry out ‘safety behaviours’ such as wearing thick make up or hiding part of their face with a scarf to hide blushing. However, these actions rarely help and instead contribute to the maintenance of the disorder.

Social Anxiety Disorder is relatively common, with a lifetime prevalence of about 12% (Kessler et al, 2005) and it normally begins in childhood or adolescence. It an extremely persistent disorder if not treated.

The Cognitive Model of Social Anxiety
– developed by Clark & Wells (1995)
– states that people with this disorder have set beliefs about what will happen to them if they perform a certain way
– they therefore monitor their behaviour very closely and turn their attention inwards during social interactions
– this causes them to ignore any evidence from their conversation partner which suggests that they are pleasant to talk to
– sufferers also have extremely distorted self-images: for example when they blush they think their whole face goes bright red, whereas it isn’t at all this obvious.


As the safety behaviours are involved in the maintenance of the disorder, one of the main aims of cognitive therapy for social anxiety is to remove them. Wells et al (1995) asked patients with social anxiety to carry out two exposure sessions (social interactions): one with and one without safety behaviours. They found that decreasing safety behaviours reduced anxiety and the belief that their most feared outcome would take place. A ‘cognitive shift’ must also occur for the therapy to be successful – the sufferer must learn to direct their attention outwards and look for evidence that contradicts their belief that they are bad or boring to talk to.

Another aspect of cognitive therapy is for pictures or videos to be taken of the individual during a social interaction, which are then shown to them during a therapy session. The aim of this is to provide more contradictory evidence to their beliefs, for example by showing them that they do not go bright red when they blush, or look really nervous when talking to others.

Thank you for reading, I hope you found this interesting – check back soon for more posts!

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