Treatment for social anxiety

What can group therapy provide that individual therapy cannot?

Teens with social anxiety may have difficulty

• being around unfamiliar people
• worry about scrutiny and judgment
• worry about acting or behaving in a way that is embarrassing
• having panic symptoms when in such situations
• have anxiety related to performance, grades, academic performance, peer comparisons, and judgment.

While individual therapy may evoke these types of panic symptoms, group therapy may be more likely to do so because it includes multiple observers. If your teen is struggling with social anxiety, he/she may have considerable difficulty sitting through class. In fact, anxiety may be getting in the way of the ability to pay attention, get needed information, and perform well.

Group therapy is very unique in that it specifically focuses on tasks to help people tolerate anxiety when around other people. No other setting specifically offers the opportunity to work on fears and anxieties among peers while controlling for the fact that group members don’t see each other outside of the group.

Fear is a justifiable and useful emotion…

It absolutely makes sense for people to avoid situations in which they might be judged, attacked, criticized, or shamed. However, sometimes fear is so overwhelming that it restricts an individual from attending events in which the actual threat of public humiliation is low. In some cases social anxiety can be so debilitating that the person starts to avoid all or any social situations. When this happens, people often tend to miss out on a lot of life experiences- because they never experience the positive social interactions, either. A restricted social life can result in less social support, less confidence, and less experiences of connection. In some cases, this can also contribute to depression.

What we know about treatment for anxiety:

Anxiety disorders generally have one thing in common- that the anxiety is so extreme that it gets in the way of other aspects of functioning. Scientifically supported treatments for anxiety disorders all include some form of exposure. What is exposure? It is when people come into direct contact with the threat- and don’t escape or avoid the feelings or thoughts that arise when in these situations. Over time, the person gets better at tolerating uncomfortable sensations (such as shortness of breath or a racing heart) associated with fear. The person actually experiences being in or near the threatening situation without censoring thoughts and feelings associated with the threat. Over time, the person becomes more confident in his/her ability to approach and handle these types of situations and the situation itself is experienced as less threatening.

How would this work with social anxiety and groups?

Here are some of the tasks for figuring out how this works:

1)    Figure out how fear is valid, justifiable, and understandable. If fear is working, there is no point in trying to change it.

2)    Figure out how fear gets in the way: Does it prevent your teen from doing the things he/she wants to do, block goals, contribute to depression, make him/her feel incompetent or impaired, disconnect him/her from potentially socially rewarding situations, gets him/her to avoid things he/she used to enjoy, or interfere with the ability to be successful in school?

3)    Identify a range of behaviors (see below) that put him/her into contact with thoughts and feelings that arise in social situations

4)    Experiment with doing the behaviors in group while tolerating fears and anxieties.

The only way that exposure treatment for social anxiety works is if people are willing to do it. Otherwise, it can turn out to be a very bad experience. Not everyone is ready to take this leap! It is important to note that clients shouldn’t have to do anything in my groups that they don’t agree to.

Here is a list of sample items that I would consider asking a person with social anxiety to do in my group: Read out loud, interrupt someone (planned or unplanned), stay in group while crying or upset, do something to draw attention to oneself (sing, hyperventilate, tripping on purpose), disagree or state one’s opinion, discuss a situation at home or at school with the group, make eye contact, sit up straight, breathe deeply, rehearse making a request, role play a scenario at school, talk about a past situation where social contact was avoided, publicize intensity of emotion, or inform the group of current level of anxiety. Different tasks may be structured differently based on the individual, and some of these tasks can be modified to make them challenging without being overwhelming.

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