A therapist who works with social anxiety specialises in helping individuals understand and overcome the intense fear and discomfort they experience in social situations. This type of therapist aims to equip clients with strategies to reduce their anxiety, build confidence, and engage more fully in social and public life.
Social anxiety can manifest uniquely in each person. What distinguishes its treatment is the need to directly address the fear of social evaluation and the associated avoidance behaviours. Unlike other forms of anxiety that might focus more on specific triggers or past events, social anxiety therapy often centres on the anticipation of social interactions, the experience within them, and the rumination afterwards. This requires a therapeutic approach that specifically tackles these social dynamics and the internal experiences that accompany them. A key difference is the focus on changing one’s relationship with social discomfort rather than solely trying to eliminate anxiety altogether.
A social anxiety therapist employs a range of tools, techniques, and strategies tailored to the client’s specific needs and the nature of their social fears. These might include:
- Psychoeducation: Providing information about social anxiety, how it develops, and what maintains it can help clients understand their experiences in a new light and reduce self-blame.
- Identifying Triggers and Avoidance Patterns: Working with the client to pinpoint specific social situations, cues, and triggers that heighten their anxiety, as well as the avoidance behaviours they employ to manage this anxiety.
- Exposure Exercises: Systematically and gradually facing feared social situations. This helps clients to challenge their negative predictions, learn that feared outcomes may not occur, and build tolerance for social discomfort. These exposures are often planned collaboratively and start with less anxiety-provoking situations, gradually progressing to more challenging ones.
- Social Skills Training: Addressing any deficits in social skills that might contribute to anxiety. This can involve learning and practising communication skills, assertiveness, and other interpersonal behaviours.
- Relaxation Techniques: Teaching skills such as deep breathing and mindfulness to help manage the physical symptoms of anxiety in social situations.
- Focusing on Solutions and Strengths: Some therapists might adopt a solution-focused approach, helping clients to identify their existing strengths and resources and to envision their preferred future in social situations. Questions might be used to explore exceptions to anxiety and previous successes in social contexts.
When working with the stages of change, a social anxiety therapist would tailor their approach to the client’s readiness to address their social fears.
- In the pre-contemplation stage, where the client may not recognise or acknowledge their social anxiety as a problem, the therapist might focus on psychoeducation and gently raising awareness of the impact of their social discomfort on their life.
- During contemplation, where the client is considering change but is ambivalent, the therapist might help them weigh the pros and cons of changing their social anxiety patterns. They might explore what the client hopes to gain by overcoming their fears.
- In the preparation stage, where the client is intending to take action, the therapist would collaborate with them to set realistic goals and develop a plan for facing their social fears, including creating a hierarchy of anxiety-provoking situations.
- During the action stage, the therapist would support the client in implementing their exposure exercises and practising new social skills, providing encouragement and helping them to process their experiences.
- In the maintenance stage, the focus shifts to preventing relapse by reinforcing new coping strategies and addressing any setbacks.
Acceptance and Commitment Therapy (ACT) offers a different lens through which to understand and address social anxiety. The six core processes of ACT impact social anxiety in the following ways, and a therapist using this approach would help clients:
- Acceptance: Instead of struggling to eliminate social anxiety, clients learn to make room for uncomfortable thoughts and feelings associated with social situations. The therapist would use mindfulness and experiential exercises to help clients observe their anxiety without judgment and recognise that these feelings are a normal part of human experience.
- Cognitive Defusion: Social anxiety often involves getting caught up in negative and self-critical thoughts. Defusion techniques help clients to create distance from these thoughts, recognising them as just words rather than absolute truths. The therapist might use metaphors and exercises to help clients notice their thoughts without being controlled by them.
- Being Present: Social anxiety can lead to a preoccupation with past social blunders or future worries. ACT emphasises bringing focus to the present moment. Mindfulness practices are used to help clients connect with their current experience in social situations rather than getting lost in their thoughts.
- Self-as-Context: This involves helping clients to recognise a transcendent sense of self that is separate from their anxious thoughts and feelings. The therapist might use exercises to help clients see themselves as the container for their experiences, rather than being defined by their anxiety.
- Values: ACT focuses on clarifying what is truly important and meaningful in a client’s life. For someone with social anxiety, this might involve identifying values related to connection, contribution, or personal growth. The therapist helps clients to connect their actions with their values, encouraging them to engage in social situations that align with what matters to them, even in the presence of anxiety.
- Committed Action: This involves taking concrete steps towards living in accordance with one’s values, despite the presence of social anxiety. The therapist would work with clients to set value-driven goals in social situations and to develop action plans to move towards these goals, viewing anxiety as a potential, but not insurmountable, obstacle.
In essence, a social anxiety therapist provides a supportive and collaborative environment to help clients understand their social fears, develop new ways of responding to social situations, and ultimately live a more confident and connected life.
Summary: A social anxiety therapist specialises in helping individuals overcome intense social fear and avoidance. This requires an approach that directly addresses the anticipation, experience, and rumination associated with social interactions, focusing on changing one’s relationship with social discomfort. Therapists use various techniques such as psychoeducation, exposure exercises, social skills training, and sometimes solution-focused or acceptance-based strategies. They tailor their interventions to the client’s stage of change, supporting them from awareness to action and maintenance. Acceptance and Commitment Therapy (ACT) provides a framework that helps clients accept anxious feelings, defuse from negative thoughts, be present, recognise a broader sense of self, connect with their values, and take committed action in social situations despite their anxiety.