Social anxiety therapy encompasses various therapeutic approaches designed to help individuals manage and overcome the intense discomfort, fear, and avoidance associated with social situations. The primary goal of social anxiety therapy is to reduce anxiety symptoms, increase confidence, and enable individuals to engage more fully in social, work, and public life.
One notable approach within social anxiety therapy is Solution-Focused Brief Therapy (SFBT). SFBT operates on the assumption that clients possess the inner resources to construct effective solutions to their problems. Instead of focusing extensively on the history or causes of social anxiety, SFBT emphasises creating a preferred future and identifying pathways to achieve it. Techniques in SFBT include asking future-oriented questions such as, “Suppose there is a solution to your social anxiety, what difference will that make in your life?”. This encourages clients to visualise and focus on desired outcomes rather than dwelling on current difficulties. Another technique involves identifying exceptions, exploring times when social anxiety was less intense or absent, and amplifying what was helpful in those situations. Scaling questions, such as “On a scale of one to ten, where one represents the worst your social anxiety has ever been and ten represents complete confidence in social situations, where are you now and what would a small step towards a higher number look like?” can help to assess progress and identify manageable goals. SFBT helps by shifting the focus from negative emotions to positive possibilities, building hope and a sense of agency. It acknowledges the client’s distress but quickly moves towards solution-building, often leading to more lighthearted conversations and potentially less burnout for therapists.
Another significant form of social anxiety therapy is Acceptance and Commitment Therapy (ACT). ACT takes a different stance on anxiety, suggesting that attempts to control or eliminate anxious thoughts and feelings can be counterproductive. Instead, ACT aims to help individuals accept anxious experiences as a normal part of human life and commit to actions aligned with their values. A core technique in ACT is acceptance, which involves learning to make space for unwanted thoughts and feelings without struggling against them. Mindfulness exercises are used to foster a non-evaluative awareness of present moment experiences, including anxious sensations. This is not about controlling anxiety but about cognitive defusion, where clients learn to observe their thoughts as just thoughts, rather than as absolute truths that dictate their behaviour. ACT also involves clarifying personal values – what truly matters to the individual – and using these values to guide actions, even in the presence of anxiety. Exposure exercises within ACT are framed as opportunities to move towards valued goals, rather than solely aiming for anxiety reduction. By shifting the focus from symptom control to living a meaningful life, ACT helps to reduce the impact of social anxiety on behaviour and well-being. From a brain science perspective, ACT helps to alter how individuals respond to their emotional and psychological experiences, creating psychological flexibility rather than getting caught in rigid avoidance patterns.
Neuro-Linguistic Programming (NLP) offers another set of techniques within social anxiety therapy. NLP focuses on understanding the patterns of thinking and behaviour that underpin anxiety and providing tools to change these patterns. Techniques in NLP can include altering submodalities, which involves changing the characteristics of internal representations (e.g., making a feared image smaller or less vivid) to reduce their emotional impact. The Swish Technique is a specific NLP technique aimed at replacing an unwanted thought or feeling with a desired one by linking their internal representations and quickly “swishing” from the unwanted to the desired. Timeline Therapy can be used to address the emotional history associated with social anxiety and to help release negative emotions tied to past events. NLP operates on the principle that by understanding and consciously modifying the “programming” of our minds – how we process information and experience the world through our senses and language – we can bring about positive change.
Exposure Therapy (when not explicitly framed within CBT) is a direct technique used in social anxiety therapy. It involves gradually confronting feared social situations in a controlled manner. The idea is that avoidance maintains anxiety, while repeated exposure to the feared situations, without negative consequences, can lead to a reduction in anxiety over time. This process helps the brain to learn that the feared situations are not as dangerous as perceived. Creating an exposure ladder, where social situations are ranked from least to most anxiety-provoking, allows for a systematic and manageable approach to confronting fears.
Social Skills Training is another important component of social anxiety therapy, particularly when social anxiety stems from or leads to perceived deficits in social abilities. This involves learning and practising specific social skills, such as initiating conversations, maintaining eye contact, and assertive communication. Techniques can include behavioural modelling (observing and imitating effective social behaviours), corrective feedback (receiving guidance on how to improve social interactions), social reinforcement (positive feedback for attempts and progress), and self-guided homework exercises to practise skills in real-life situations. By improving social competence, individuals can feel more confident and less anxious in social settings.
Applied Relaxation techniques, such as correct breathing exercises and self-affirming statements, can be used to manage the immediate physical and mental symptoms of social anxiety. Learning to relax on cue can interrupt the physiological arousal associated with anxiety and help to calm down instantly, reducing the flow of fear and negative thoughts.
Mindfulness practices, beyond their integration in ACT, can be used as a standalone technique in social anxiety therapy. Cultivating a present-moment, non-judgemental awareness of thoughts, feelings, and bodily sensations can help individuals to observe their anxiety without getting carried away by it. This allows for a greater sense of emotional regulation and reduces the tendency to react automatically to anxious triggers.
Compassion Focused Therapy addresses social anxiety by focusing on developing self-compassion. This involves learning to treat oneself with kindness, understanding, and acceptance, particularly in the face of social difficulties and perceived failures. Techniques include compassionate imagery and developing a compassionate inner voice to counteract self-criticism, which is often a significant factor in social anxiety.
In some cases, Analytical Hypnotherapy may be considered as part of social anxiety therapy. This approach involves using hypnosis to access deeper levels of the mind and explore the underlying roots of anxiety, aiming to create new perspectives on old wounds and beliefs.
To utilise these approaches in social anxiety therapy, several factors are important. Firstly, a willingness to engage in the therapeutic process and to practise the techniques is crucial. This often involves identifying one’s motivation for change and setting clear goals. For techniques like exposure therapy, a gradual and planned approach is essential to avoid overwhelming the individual. For skills-based approaches like social skills training, consistent practice in real-life situations is necessary to build confidence and competence. A supportive therapeutic relationship with a therapist who understands social anxiety and can explain the rationale behind the techniques is also beneficial.
The benefits of social anxiety therapy are numerous. It can lead to a reduction in anxiety symptoms and a greater sense of control over one’s emotional responses. Individuals often experience increased confidence in social situations and a greater willingness to engage in previously avoided activities. This can lead to improvements in relationships, work performance, and overall quality of life. By understanding the underlying processes involved in social anxiety and learning new ways of responding, individuals can break free from the cycle of fear and avoidance and live more fulfilling lives.
Summary: Social anxiety therapy
Social anxiety therapy offers a range of approaches beyond CBT and cognitive restructuring to help individuals manage their social anxiety. Solution-Focused Brief Therapy (SFBT) focuses on future solutions and exceptions to the problem. Acceptance and Commitment Therapy (ACT) emphasises accepting anxious feelings and committing to value-driven actions using techniques like acceptance, mindfulness, and defusion. Neuro-Linguistic Programming (NLP) aims to change thought and behaviour patterns through techniques like altering submodalities. Exposure Therapy involves gradual confrontation of feared situations. Social Skills Training focuses on improving social competence through modelling and feedback. Applied Relaxation teaches techniques to manage immediate anxiety symptoms. Mindfulness cultivates present-moment awareness. Compassion Focused Therapy promotes self-compassion. These therapies help by altering the individual’s relationship with anxiety, fostering psychological flexibility, and building confidence in social situations. Successful use requires willingness, practice, a gradual approach where needed, and a supportive therapeutic relationship, leading to reduced anxiety, increased confidence, and improved quality of life.