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Cognitive Behavioral Therapy for Social Anxiety

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Cognitive Behavioral Therapy is an excellent form of treatment for social anxiety. Cognitive Behavioral Therapy (CBT) for social anxiety is talk therapy that helps you to identify and change negative thought patterns into more positive ones. 

What is Social Anxiety?

Most people feel nervous in some social situations. Things like meeting someone for the first time, a first date, the first day of school or a new job, or giving a presentation can cause discomfort. This discomfort is completely normal. Social anxiety disorder, also known as social phobia, is much more severe. When you have social anxiety, everyday interactions can lead to anxiety, embarrassment, fear, and feeling self-consciousness. You may feel you are being judged by others, even if you are not.

Many people with social anxiety learn to ease their symptoms by avoiding the situations that trigger these feelings and reactions. This avoidance can be disruptive to life. The person may avoid family, friends, school, work, and other social environments that make them feel uncomfortable. The avoidance can prevent them from meeting new people, trying new things, and finding new opportunities. 

Social anxiety disorder is a chronic mental health condition, but it can be managed with coping skills. In therapy, thoughts can be challenged, and new social skills learned to help the person interact with others in more successful ways. 

Symptoms of Social Anxiety

Social anxiety can have emotional, behavioral, physical, and avoidance symptoms. Each person’s level of discomfort varies, and you may have some symptoms but not others. Unlike nervousness, social anxiety causes impairments to daily life. The following are some common symptoms of social anxiety:

  • Fear of being judged by others
  • Worrying about humiliating yourself
  • Intense fear of interacting with strangers
  • Fear that others will notice how anxious you are
  • Fear of embarrassing physical symptoms like blushing, trembling, or a shaky voice
  • Avoiding situations where you might be the center of attention
  • Analyzing a past social situation and identifying flaws in your interactions
  • Expecting the worst possible consequences from a social interaction
  • Avoiding dating or making new friends
  • Sweating
  • Rapid heartbeat
  • Avoiding eating in public, using public restrooms, or returning items to the store
  • Avoiding eye contact or conversations with strangers
  • Trembling
  • Dizziness
  • Upset stomach
  • Avoiding social situations with unknown people and circumstances
  • Blushing
  • Avoiding school or work

A white woman sits with her head on her hand. Her wrist is bandaged. And talks to someone in a blue shirt who is taking notes

Causes of Social Anxiety

Social anxiety disorder can have different causes, and may be caused by a combination of things.

Inherited Traits & Genetics

Social anxiety has a genetic factor, although it isn’t clear how strong of a genetic connection there is. It has a tendency to run in families. A person who has a first-degree relative with social anxiety disorder is two to six times more likely to develop the disorder. 


Social anxiety can be a learned behavior. It can develop after an embarrassing event, or it can be learned through behavior modeled by parents with an anxiety disorder, or who are controlling or overprotective of their children. It can also be learned as a response to how others act toward you in social situations. If you make a mistake in class at a young age and everyone laughs, you may feel so embarrassed that you are less willing to put yourself out there in the future.

Behavioral Inhibition

Toddlers who become upset when confronted with new situations and unfamiliar people and seek comfort from a parent to cope may have developed behavioral inhibition. These children are at an increased risk for developing social anxiety disorder later in life. This temperament is likely an inborn characteristic and is due to biology.

Brain Structure

The amygdala is the fear center of the brain. If a person has an overactive amygdala, they may develop a fear response to social situations.


People with social anxiety may have imbalances of neurotransmitters in the brain, which are used to send signals between the body’s cells. The four neurotransmitters involved in anxiety are norepinephrine, dopamine, serotonin, and gamma-aminobutyric acid (GABA).

Goals for Cognitive Behavioral Therapy for Social Anxiety

Social anxiety disorder can have a number of negative consequences, including:

  • Low self-esteem
  • Negative self-talk
  • Hypersensitivity to criticism
  • Trouble being assertive
  • Poor social skills
  • Isolation
  • Relationship difficulties
  • Low academic/work achievement
  • Substance use/abuse
  • Suicidal behaviors

Cognitive behavior therapy can help to identify irrational beliefs or faulty thinking, also known as cognitive distortions. These ways of thinking can then be replaced with more realistic perspectives and healthier beliefs. Problem areas for someone with social anxiety can include:

  • Misperceptions about the self, self-worth, and abilities
  • Guilt and embarrassment about past situations
  • The need to become more assertive
  • The need to be more realistic and less of a perfectionist
  • The ability to deal with procrastination related to social anxiety

Cognitive methods

CBT targets automatic negative thoughts misaligned with reality and interfere with your ability to cope. Because you’ve had these negative thoughts for awhile, your brain reinforced them and they are strong. To rewire this faulty thinking, you can counteract each negative thought by saying three positive affirmations for each one. Saying them out loud helps you to store them in your brain more quickly. Over time you will begin to think more positively about yourself and the world around you.

Behavioral methods

One of the most common behavioral methods for social anxiety is systematic desensitization. This type of exposure therapy involves gradually exposing yourself to something that makes you anxious. It is commonly used for phobias, but also is successful with social anxiety. Together with your therapist you begin by breaking an anxiety-provoking event into small steps. Then you tackle the first step only. With each step you do successfully, you then take on the next step. At the end, you do all of the steps.

Once you are able to accomplish the things that make you anxious once, doing them repeatedly reduces anxiety through continued exposure. This task may be calling to order a pizza every Saturday until it no longer bothers you, or saying “hello” to a stranger on your walk at the park every day until it no longer causes anxiety. Taking things slow is best, as moving too fast can sometimes make you even more anxious. That is why a gradual step-by-step process is so successful.

You also can role play to practice social situations with your therapist. If you are nervous about calling a stranger to order a pizza, you can make a pretend phone call to a safe person like your therapist and practice ordering a pizza. The more times you experience making the call with nothing bad or scary happening, the more comfortable you will become with actually making the call.

How Integrative Life Center can help

At Integrative Life Center, you can work with a trained cognitive behavioral therapist for social anxiety. Together you can break down anxious events into steps for exposure therapy, role play situations to practice social skills, and replace automatic negative thoughts with positive affirmations. We have experience using CBT with anxiety disorders, depression, and more. 

Social anxiety disorder can have a huge impact on your life, but it does not have to control your life. We can develop a successful treatment plan together that fits your individual needs and helps you learn to cope with your social anxiety. Please contact us so we can help.





Article Sources:

Mayo Clinic. Social anxiety disorder (social phobia) – Symptoms and causes. 2021. 

Verywell Mind. How Cognitive-Behavioral Therapy Can Treat Social Anxiety Disorder. 2020.

Verywell Mind. Understanding the Causes of Social Anxiety Disorder. 2021.

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