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Disclaimer: My content is NOT a substitute for professional advice, diagnosis, or treatment. When in doubt, ask a therapist!
Cognitive behavior therapy (CBT) is the godfather of all psychotherapy approaches.
There’s a lot of research proving its effectiveness, and its principles are intuitively appealing:
- The root of mental health challenges is unhelpful thoughts and behaviors. i.e. cognitive distortions.
- The solution is two-step a) challenge these thoughts and behaviors b) introduce more helpful ones.
That’s why it’s usually the first choice of treatment across the board. Researchers wrote:
“CBT is the most researched form of psychotherapy… No other form of psychotherapy has been shown to be systematically superior to CBT”
But the question is…
Does CBT work for social anxiety?
Yes! According to a meta-analysis of 101 trials, individual CBT is the most effective treatment for social anxiety.
It’s more effective than other therapies, exposure therapy, social skills training, meditation, mindfulness training, and even medication (!)
After learning from Larry A. Cohen, the co-founder of the National Social Anxiety Center, and collaborating with Iffah Suraya Jasni, M.Couns., and Yue Yun Aw Yong, B.Sc(Psych), I’ve put together a list of CBT techniques to help you manage your social anxiety:
CBT techniques to help you manage social anxiety
Cognitive restructuring
Cognitive restructuring is the process of noticing and reframing your anxious thoughts, which can help reduce your anxiety.
CCC is one of the many cognitive restructuring techniques. Take these three steps when you feel anxious:
- Catch it: Identify your anxiety-driven thought
- Check it: Evaluate the evidence around the thought — how true is it? How likely? And is there evidence against it?
- Change it: Come up with a more realistic, helpful thought.
If you still feel anxious, fill out the full Cognitive Restructuring Worksheet now. (Alternatively, you can try an app like CBT Thought Diary.)
Belief restructuring
Note: It's best to work with a therapist, as it's hard to examine and rewrite your core beliefs — products of years if not decades — on your own! (There's the risk of cementing unhelpful beliefs further.)
We also suggest that you practice cognitive restructuring until you are familiar with it before working on your core beliefs.Your thoughts originate from your beliefs. Beliefs are more universal i.e. generalized, while thoughts are more specific i.e. related to certain situations. In CBT, the three unhelpful beliefs are:
| Unhelpful belief | Helpful core belief |
| I’m worthless (never good enough) | I’m worthy (good enough) |
| I’m unlovable | I’m lovable |
| I’m helpless | I’m resourceful |
So how do you restructure your beliefs? Here are a few steps:
1. Catch your thoughts
Whenever you catch yourself having anxious thoughts about a certain situation, ask yourself what the thoughts mean to you. One common thought socially anxious folks have is, “I am boring and no fun to be around”.
2. Reveal the belief
- Ask yourself, “If this thought is true, what would it say about me?”
- Repeat this a few times until you can’t go on further. This helps uncover the belief behind the thought. One belief could be “People would leave me for good and I am incapable of being loved”
3. Restructure the belief
- List down these unhelpful beliefs.
- For each unhelpful belief, review the evidence and come up with a more realistic and helpful belief.
- Review your helpful beliefs regularly. You could listen to an audio version of them, read them out, or mentally recite them — whatever you find most effective. Ideally, do this once a day at least.
Note: it’s important that your new beliefs feel realistic — otherwise. Larry A. Cohen advises: “Make sure your new beliefs are believable to you (ie. you consider them to be probably true, or at least that you believe them at your best of times).”
Assertiveness training
What cognitive restructuring and belief rewriting don’t address is this: “What if your social fears come true?”
There’s where assertiveness training — developed by Christine Padesky – comes in handy. It helps you handle even the worst criticisms or rejections, which grows your social confidence!
In Christine’s words:
“While socially anxious individuals are characterized by fears of criticism and rejection, most social phobia treatment programs do not teach these clients to cope with criticism and then expose them to it”
Here’s how to do assertiveness training on your own:
- Identify your worst social fears, specifically what others might say or do that would trigger your anxiety the most.
- For each fear, brainstorm an assertion (what you would say in response to the other person). Make sure that it is non-aggressive and non-defensive, by sharing how you feel in “I feel..” statements, rather than making assumptions about them.
- Practice saying the assertions. Repetition is very important, as these assertions will sound and feel awkward at first. By repeating the assertions, you will get used to them. You can also tweak them to make them sound more natural.
(Ideally, you would practice with a therapist or a friend, who plays the role of the “rude person”.)
Behavioral experiments
Based on my experience, conducting a behavioral experiment is possibly the most impactful thing you can do. Why?
This is how you systematically test your anxious thoughts and core beliefs in real-life situations. And as you collect evidence against them, your anxiety will have less power over you.
Larry A. Cohen is a big advocate of experiments as well. He said:
“This is where the deepest learning happens — you’re learning through experience.”
Here’s how you can start designing your Social Anxiety Experiment:
- Brainstorm experiment ideas using this worksheet.
- Pick one experiment to implement: The ideal experiment should be easy to implement, allows for frequent practice say a few times a week, and creates just enough anxiety (not too little that you don’t learn from it, but not too much that you get overwhelmed!)
- Get an accountability buddy to help with follow-through. This is critical for two reasons: a) you might just give up before you start b) they can provide more objective feedback after your experiment.
- Reflect after the experiment. What did you learn? What surprised you? What will you do next? Will you do this experiment again?
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