Workshop 11 - Cognitive-Behavioral Therapies for Social Anxiety Disorder: An Integrative Strategy
Saturday, November 19, 2022
12:00 PM – 3:00 PM EST
Location: SoHo/Herald, 7th Floor
Earn 3 CE Credit
Keywords: Social Anxiety, Anxiety, CBT Recommended Readings: Warnock-Parkes, E., Wild, J., Thew, G. R., Kerr, A., Grey, N., Stott, R., Ehlers, A., & Clark, D. M. (2020). Treating social anxiety disorder remotely with cognitive therapy. The Cognitive Behaviour Therapist, 13, E30. doi: 10.1017/S1754470X2000032X Hofmann, S. G. & Otto, M. W. (2017). Cognitive behavioral therapy for social anxiety disorder (2nd ed.), 24-63. Routledge. Hope, D. A., Heimberg, R. G., & Turk, C. L. (2019). Managing social anxiety: A cognitive-behavioral approach - Therapist guide (3rd ed.), 1-34. Oxford University Press. McEvoy, P. M., Saulsman, L. M. & Rapee, R. M. (2018). Imagery-enhanced CBT for social anxiety disorder, 16-38. Guilford Press. Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E. & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet: Psychiatry, 368-376. doi.org/10.1016/S2215-0366(14)70329-3
Cochair and cofounder National Social Anxiety Center Washington, District of Columbia
This session provides an intensive overview of five evidence-based cognitive-behavioral strategies for the treatment of social anxiety disorder: behavioral experiments/exposure; cognitive restructuring; external mindfulness plus thought defusion; assertion training; and core belief change work. Attendees will learn how to apply, combine, and adapt these strategies to the needs of socially anxious individuals. Many of these strategies are demonstrated in video-recorded clinical role-plays, which will be made available to attendees. There will also be discussion on how to design and implement exposures as behavioral experiments to test and modify automatic thoughts, underlying assumptions and core beliefs for the purpose of decreasing social anxiety and building self-confidence. Many client worksheets, instructional handouts and questionnaires are provided for use and adaptation in your own practices.
Outline: INTRODUCTION • Resources for therapists and for consumers • Basic facts about social anxiety, and the role of shame • Diversity factors in social anxiety • The vicious cycle of socially anxious cognition, feelings and behavior • Overview of outcome studies on social anxiety treatment • Integrating the 3 waves: debates and syntheses • Assessment, progress monitoring and relapse prevention
EXTERNAL MINDFULNESS (CURIOSITY TRAINING) • Rationale: self-focus and self-evaluation as safety-seeking behavior • Debate on external mindfulness + thought-feeling defusion vs. internal mindfulness (meditation) • Helping clients understand and master external mindfulness and defusion • Clinical demonstrations
COGNITIVE RESTRUCTURING (REFRAMING) • Rationale: changing cognition that contributes to anxiety • Themes of socially anxious hot thoughts • Debate on defusing from negative thoughts vs. changing them • Debate on how and when to do cognitive restructuring for social anxiety • Use of experiments and imagery to do cognitive restructuring • Helping clients understand and master cognitive restructuring • Use of cognitive restructuring, mindfulness and defusion to overcome worry/rumination • Clinical demonstrations
BEHAVIORAL EXPERIMENTS (EXPOSURES) • Rationale: changing cognition, pursuing values and reducing anxiety through real-life experience • Debate on exposures vs. experiments: habituation / value pursuit / changing cognition • How to help clients choose experiments • Straightforward vs. paradoxical (social mishap, de-catastrophizing, shame-attacking) experiments • Helping clients understand, identifying, and minimize safety-seeking behaviors • How best to carry out experiments: before, during and after • In-session experiments and use of video evidence • Homework experiments and strategies to increase follow-through • Use of surveys as experiments • Clinical demonstrations
ASSERTIVE DEFENSE OF THE SELF (HEAD-HELD-HIGH ASSERTION) • Rationale: increase self-confidence in handling fears come true • Practicing the strategy in session • Homework to master the strategy • Debate on the limitations of the strategy, and ways to address these limitations • Clinical demonstrations
CORE BELIEF CHANGE WORK • Rationale: to modify beliefs that contribute to shame and anxiety • Debate on whether to target core beliefs at all when treating social anxiety • Helping clients identify their unhealthy core beliefs and healthy alternatives • Homework and in-session strategies to modify core beliefs • Clinical demonstrations
Learning Objectives:
At the end of the session, the learner will be able to:
Describe 3 strategies to train clients in the use of external mindfulness and thought-feeling defusion when socially anxious.
Describe 3 strategies to train clients in different means of doing cognitive restructuring before and after social anxiety triggers.
Describe 3 strategies to help clients design, carry out and learn from behavioral experiments / exposures to test socially anxious thoughts and underlying core beliefs, and to increase client motivation to carry out such experiments.
Describe 2 strategies to train clients in the use of assertive defense of the self to increase self-confidence in handling fears come true.
Describe 3 strategies to help clients identify and modify underlying core beliefs that contribute to their social anxiety.
Long-term Goal: Design individualized, evidence-based treatment strategies to help their socially anxious clients test and modify their anxious cognitions and behaviors while pursuing their values and goals.
Long-term Goal: Design individualized, evidence-based strategies to help their socially anxious client decrease their reliance on avoidance, self-monitoring, rumination and other safety-seeking behaviors.