Social Anxiety: Getting an Idea of What Cognitive Behavioral Therapy Is About

The following is a part of a conversation between Olga Khazan, staff writer at The Atlantic and Stefan G. Hofmann, psychologist and director of the Social Anxiety Program at Boston University regarding cognitive behavioral therapy (CBT).

Khazan: What are some strategies that help alleviate symptoms or combat social anxiety when it starts creeping in?

Hofmann: What needs to happen is that people should face their anxiety. What we do is called cognitive behavioral therapy, a non-medication option which is more effective in the long term than medication treatment. You try to identify what kinds of thoughts people have in these situations, what sort of drives the anxiety.

Then you gradually challenge these maladaptive thinking patterns by asking people to engage in what we would call exposure practices, where they expose themselves to these situations repeatedly and for a long period of time so that they can realize that nothing bad is happing.

It is very effective. We have a response rate of at least 75 percent. Alternative treatments to CBT are medication—primarily with SSRIs.

Khazan: So what are some of the situations that you might send someone into? Like, go give a speech?

Hofmann: Initially, we use speaking in front of the rest of the group. In the seventh or eighth session, we go on to do more individualized exposure treatments, constructing something that we would call a social mishap exercise. We expose them to their worst-case scenario. For example, if someone is not engaging in any dating behaviors because they are concerned about being rejected, we would ask them to go to a restaurant and ask every woman at the table for her number. And obviously, he would get rejected a lot, and that's the purpose of it.

Khazan: Thats crazy! That sounds so intense. What do they say to the women?

Hofmann: We script it very clearly. We say, youre going to go in there now, and say the following: Hi, I like your face. Would you like to go out with me? Would you like to give me your number? And she would obviously say, No, go away, you freak, or something, and that would be desirable. That would be perfect.

Or other examples might be, inconveniencing people, so lets say go to a coffee shop and you spill your coffee and you say, I'd like to have a new one. Or you go to a book store and ask for a book on the joy of sex. You do something that is over the top that nobody likes to do, that violates their personal social norms and engages them in re-evaluating their maladaptive beliefs. And its very effective. Its very successful. People speak to this treatment, they love it.

Read the full conversation here: https://www.theatlantic.com/health/archive/2015/10/what-is-social-anxiety/411556/