Cognitive-Behavior Therapy for Social Phobia Monica Ramirez ...

Cognitive-Behavior Therapy for Social Phobia Monica Ramirez Basco, Ph.D. University of Texas at Arlington Department of Psychology Social Phobia Fear of Social Situations Catastrophic Thinking Physiological Reactions to Social stress

Avoidance Social Phobia Specific or Generalized Fear of public speaking Fear of socializing Anticipates criticism or rejection Expects embarrassment or humiliation

Social Phobia Fear of social or performance situations Exposure always provokes fear The person knows its excessive Avoids or endures with anxiety Functional impairment Duration at least 6 months in kids Not illness or drugs Unrelated to another disorder

Generalized Social Phobia Fear of Most Social situations Fear of Social Scrutiny Interferes with functioning Recognized as excessive

Specific Social Phobia Social Embarrassment Eating in public Writing in public

Performance Anxiety Public Speaking Musical Performance Continuum of Impairment Shyness vs. Social Phobia vs. Avoidant Personality Disorder

Cluster C: Avoidant Personality Disorder Social inhibition Feelings of inadequacy Sensitive to criticism from others Work

Avoids work requiring contact with others Fears criticism Fears disapproval Fears rejection Social Contact

Avoids others unless certain that he or she will be liked Intimacy Holds back emotions Shows restraint Fear of criticism Fear of embarrassment

Social Scrutiny Is overly preoccupied with fear of criticism Fears rejection by others in social situations Hates being the center of attention Inadequacy Feels inadequate around others Acts show or inhibited Thinks he or she is less worthy than others

Self-View Sees self as socially inept Feels unattractive or unappealing Feels inferior to others Behavior is withdrawn, avoids eye contact Risk-taking

Reluctant to take risks Doesnt want to embarrass self Avoidance in Social Phobia Social Contact Self-Criticism reinforces low

confidence Catastrophizing Avoidance Anxiety Reduced Breaking the Cycle in Social Phobia

Social Contact Self-Criticism reinforces low confidence Catastrophizing Avoidance

Anxiety Reduced Avoidance in Social Phobia Social Contact Anxiety Reduced &

Rational Thinking & Exposure Confidence Increases Goals of CBT for Social Phobia Develop Social Skills Stop Catastrophic Thinking

Reduce Anxiety Stop Avoidance The Cognitive Model Thoughts Obsession Worry Catastrophizing

Feelings Actions Ritual or Avoidance Fear Terror Embarrassment CBT Methods for

Social Phobia Social Skills Training Logical Analysis of Automatic Thoughts Differential Relaxation Graded In-vivo Exposure Coping Skills Training Avoidance Coping Explain how avoidance is a way of coping

Explain the negative reinforcement paradigm Avoidance helps you escape discomfort Avoidance lowers anxiety Because it works, it increases the chance that you will use it again as a way of coping Evaluate the pros and cons of using

avoidance as a way of coping Ask the patient if he or she would like to learn a new way to cope Social Skills Training Instructions How to say hello

Getting a date Making conversation Behavioral Rehearsal w/Feedback Practice with Safe Targets Self-Monitoring Graded Exposure Decatastrophizing

NegativeThoughts Learn the cognitive model Monitor negative thoughts Recognize catastrophizing and mind-reading Analysis of negative thoughts Rational responses Decatastrophizing

Identify sequence of catastrophic thoughts People will look at me I will do something to embarrass myself They will laugh at me The humiliation with be unbearable Assess the likelihood that this sequence will occur

Evaluate the Evidence (reevaluate likelihood) Risk Management (reevaluate likelihood) Plans for coping (reevaluate likelihood) Differential Relaxation Learn standard relaxation induction Practice maintaining relaxed state while

involved in tasks Normalize breathing Muscle relaxation Practice in non-threatening situations Practice with graded in-vivo exposure In vivo Exposure Desensitization hierarchy developed Start with the easiest item

Cognitive Rehearsal Practice differential relaxation and decatastrophizing at each step In-vivo Exposure Construct desensitization hierarchy Choose an easy starting place Plan coping strategy Troubleshoot

Assign as Homework Follow-up and Repeat Schema Work I cant tolerate rejection Embarrassment is horrible Im inadequate I have to be liked Im unworthy

Im inferior to others I cant handle negative feedback Interventions for Schemas Historical analysis Evaluate evidence Advantages and disadvantages of the schema

as if exercises Role play the alternative schema Identify alternatives