Effective Strategies for Treating Social Anxiety

Smashing Shyness-- Shame-Attacking and Beyond Come to our Full-Day Workshop on Sunday, October 2, 2022 For therapists and lay people alike Click here for registration and more information Today we interview our beloved Jill Levitt, PhD who will be joining me in teaching the upcoming social anxiety workshop on October 2nd. Jill is the co-leader of my weekly psychotherapy training group at Stanford, and is the co-founder and Director of Training at the Feeling Good Institute in Mountain View, California. Social anxiety was one of the most frequent problems that patients sought help for when I was in private practice in Philadelphia. Because of my own severe and persistent social anxiety since childhood, it’s my favorite problem, too. Whatever you’ve had, I can tell you that I’ve had the exact same thing, too, and know how sucky it can be. I can show you the path to freedom from that affliction, and what a joy that will be! According to the DSM5, there are at least five types of social anxiety:

1. Shyness
2. Public Speaking Anxiety
3. Performance Anxiety. This a broad category that can include athletic or musical performance, or any time you have to demonstrate your skills in front of people who might judge you. For example, I had a severe camera phobia since I was a child, and only got over it a couple years ago!
4. Test Anxiety
5. Shy Bladder / Bowel Syndrome

In addition, other negative feelings typically go hand-in-hand with social anxiety, such as shame and loneliness, as well as depression and feelings of inferiority and even hopelessness. This workshop will focus on therapists looking for training. However, the general public are also included, since you will get the chance to practice and work on your own fears during the workshop. I (David) have noticed that feelings of social anxiety, especially performance anxiety, are almost universal among therapists, at least judging from those who attend our weekly TEAM-CBT training group at Stanford. So, come to heal yourself AND to learn how to heal your patients and loved ones. We will be covering not one, but four treatment models for social anxiety in the workshop: 1. The motivational model: Nearly all anxious individuals resist exposure, which is a crucial part of the treatment. Most therapists also resist exposure for a variety of reasons, thinking the patient is too fragile, or the technique will be too dangerous or upsetting for their patients. This is unfortunate, since this pretty much dooms the treatment to failure, especially if you are aiming for a “cure” rather than endless talk and hand-holding. 2. The Cognitive Model. Although usually not completely curative, the Daily Mood Log is essential to treatment, so you can find out exactly what patient are thinking and feeling at one specific moment when they were feeling anxious. I present the case of Jason, a young man feeling shy and anxious while standing in line to check his groceries one Saturday morning at the local grocery store. Many cognitive techniques are incredibly important and useful in the treatment of social anxiety, including Explain the Distortions, the three types of Downward Arrow (uncovering) Techniques, the Double Standard Technique, Externalization of Voices, the Feared Fantasy, and more. Although these methods are helpful and illuminating, they will rarely or never be quite enough for a complete cure. For that you will need: 3. The Exposure Model. In the workshop, we will be teaching:

• Smile and Hello Practice: In today’s podcast Jill discussed the purpose of this technique, how to introduce this technique to your patients, and how to implement it. This is an example of the many techniques we will teach on October 2. David provided a dramatic example of how this humble technique changed the life of a young man from India.
• Flirting Training
• Talk Show Host
• Rejection Practice
• Feared Fantasy: We role-played how I used this humor-based technique in my work with Jason
• Self-Disclosure
• Survey Technique
• Shame-Attacking Exercises.

We will also explain how to use several techniques crucial to the reduction of the patient’s resistance:

• Dangling the Carrot
• Gentle Ultimatum
• Sitting with Open Hands
• Fallback Position

However, many therapists have intense resistance to making patient accountable with these techniques that are absolutely central to TEAM-CBT, thinking they are cruel or crude or narcissistic, or some such thing. In the podcast, Jill illustrates a beautiful and gentle but firm way of introducing these techniques to patients, and emphasizes that they are actually ethical, therapeutic, and necessary for a good outcome. She also emphasizes, and I totally agree, the importance of going with the patient into the real world to do the Exposure Techniques. I have used extreme exposure techniques on hundreds of occasions when treating anxious colleagues on Sunday hikes for example, urging them to stop hikers we meet and disclose their own shyness, for example. The advantages of doing this type of thing in the real world include the ability to coach the “patient” with the best examples of how to use whatever technique you’re advocating, and to be there to support the patient during and after the experience. 4. The Hidden Emotion Model. This technique is often extremely helpful in the treatment of any form of anxiety, but is perhaps less often used in the treatment of social anxiety. I can think of one example when it was extremely helpful. This was a woman whose boss kept pressuring her to give presentations about their company locally and to groups in other locations as well. She opted out because of her social anxiety. But lurking behind her symptoms were her feelings of resentment about being asked to do too much. Once she brought these feelings to conscious awareness, she decided to discuss his expectations, her feelings, and her compensation with her boss. This worked well, and her public speaking anxiety magically disappeared. Although this pattern is not common, it is always worth consideration in your treatment plan, because family and friends often pressure people with social anxiety to confront their fears, and this typically does trigger feelings of resentment and resistance. We also discussed two Self-Defeating Beliefs that are nearly universal in individuals with social anxiety: the Spotlight and Brushfire Fallacies. In the podcast, I give examples of several techniques that were life-changing for patients. Jill emphasizes that one of the underlying treatment themes is how to “wake up” from your trance so you can learn not to take yourself so seriously and begin to have fun and enjoy yourself and others way more. Improvement is not the goal of treatment. The goal of treatment is word that many mental health professionals fear and resent: CURE! In the podcast, I describe the difference between a 100% cure for any form of anxiety, and a 200% cure. Do you know the difference? I give an example of my own fear of heights when I was in high school. Of course, that’s a phobia, and not a form of social anxiety, but you can also have a 200% cure for social anxiety, too! In a 100% cure your fears go to zero. You are no longer particularly anxious about talking to strangers, or public speaking, for example. In a 200% cure, you come to LOVE the very thing that terrified you in the past. Rhonda, Jill and I think this will be a powerful one day experience. We will focus on a common problem that is usually treatable fairly quickly, and often with fabulous and life-changing results. We hope you can join us! For registration information, please go to: CBTforSocialAnxiety.com Thanks! Jill, Rhonda, and David