There are many treatment options out there. There isn’t a lot of controlled research into how effective these different methods are for social anxiety, so how do you know which one to choose? You don’t want to waste time trying all the options out there. You want to find one that works and move on with your life.
Let us consider the various options. As you read through the list, consider how many have you tried and whether or not they were effective. You want to consider what has worked and what hasn’t in the past when developing a new treatment plan.
Medications – There are tons of medications out there that can help with social anxiety. I have tried a couple but I usually had side effects and didn’t like relying on a pill to make me feel better. I wanted to beat this condition, not treat the symptoms for the rest of my life. I will say that medication can be great in the short run. It can help you calm down enough to see what’s happening in the mind during an anxiety attack. But I wouldn’t suggest staying on it indefinitely.
Exposure to feared situations – What’s the best way to conquer your fears? Face them! This is easier said than done, but exposure to the things you fear is a great strategy to include in your treatment plan.
Communication skills training – Learning to be more assertive, learning how to small talk, and learning how to engage people is another tactic some people use to overcome their social anxiety. This however, is usually just a small part of the treatment plan.
Self-help books – I have read so many self-books to try and figure out how to become a better communicator, how to get over shyness, how to overcome social anxiety, how to become a better person, and on and on. Self-help books are great, but you have to have real world experience too. You have to take action and get hands on with the principles you read about.
Insight-oriented therapy – This is usually focused on childhood experiences and how they have impacted you later in life. It’s good to understand why, but what’s more important to understand is what you can do now.
Supportive therapy – Client describes experiences over the past week or two and the therapist offers solutions to the client’s problems.
Cognitive Behavioral Therapy (CBT) – focuses on changing anxious thinking through various techniques and exposing yourself to feared situations (as mentioned above).
Others – prayer, relaxation training, distraction, yoga, hypnosis, herbal remedies, exercise, alcohol or drugs (not all treatments are necessarily good for you), acupuncture, diet, education, reward and punishment, past-life regression, etc.
Social Anxiety Treatment History
Ok, so maybe you have tried some of these in the past and had mixed results. Maybe you were partially successful with some and others were completely useless for you. Either way, take note of which ones helped and which ones didn’t. As I said before, it’s good to keep this info in your mind when developing a treatment plan.
Also, consider why some worked and why some didn’t. Was it the right time to tackle social anxiety? Did you have other stresses at the time? Sometimes therapy doesn’t work for various reasons:
- The therapist is inexperienced
- You didn’t get enough exposure sessions (frequency and intensity)
- You didn’t really believe in the treatment
- Treatment didn’t last long enough
- You didn’t follow through with the treatment (didn’t do the exercises, etc.)
If you tried medication and it didn’t work, consider the various reasons it may have failed:
- Side effects were too rough
- You weren’t consistent with the medication
- You were abusing other substances (alcohol, drugs, etc.)
- Dosage was too low
- Wrong type of medication (obviously a big one). Which ones have you tried? Which ones haven’t you tried?
- Treatment didn’t last long enough
Many psychotherapies have never really been studied for the treatment of social anxiety and shyness, so it is no wonder that many therapies miss the mark. Some show little benefit at all.
Which Treatments are Proven to Work?
The most effective and well studied type of psychotherapy is CBT (Cognitive Behavioral Therapy). CBT and medication are the only treatments that have been proven (by controlled research) to be effective in overcoming social anxiety and shyness.
CBT is my preferred choice as a long term solution. It focuses on challenging and changing your anxious thoughts, beliefs, and predictions. It also forces you to get out of your comfort zone by exposing yourself (in a controlled manner) to social situations that may feel a little uncomfortable at first.
Before we dive deep into CBT, let’s cover a couple more treatments that have shown some promise through preliminary/limited research: Mindfulness training, acceptance and commitment therapy, applied relaxation training, and interpersonal psychotherapy.
Mindfulness training – focusing on the present moment instead of worrying about the future or dwelling on the past.
Acceptance and Commitment Therapy (ACT) – There are two choices in life; accept or resist. We can either accept the things that happen to us, including our emotions, thoughts, experiences, or we can resist them and create more stress for ourselves.
By accepting and allowing them to be there, you don’t get lost in the vicious cycle of anxiety. ACT cuts the anxiety from spiraling out of control. ACT also includes making a commitment to live by your values and goals. This technique reminds me of stoicism. Stoics are all about living by your values and accepting that which happens to you.
Keep in mind, although CBT and ACT are different, there are still many similarities. There is no reason why you couldn’t adopt some practices from CBT, ACT, and other treatments to come up with your own treatment plan.
Applied relaxation therapy – relaxing your muscles while exposing yourself to challenging situations.
Interpersonal Psychology (IPT) – Examining the problems you have with others.
Cognitive Behavioral Therapy
CBT is a proven strategy (numerous studies) and consists of three components – cognitive therapy, exposure, and improving social skills.
In CBT, your beliefs and behaviors are thought to be at the heart of the problem of social anxiety. By changing your anxious thought patterns and behaviors, you can halt social anxiety.
Cognitive therapy – when you interpret a situation in a negative way, the result is a negative emotion. For example, when you are too concerned about what other people think, then you will have a lot of nervousness and anxiousness in certain social situations.
This component of CBT (cognitive therapy) teaches you to become aware of your thoughts. Once you start paying attention to your thoughts, you must challenge them and then make an effort to replace them with less anxious and more realistic thoughts.
Cognitive therapy teaches you to treat your thoughts like guesses rather than facts. When you begin to challenge your thoughts and examine the evidence that is upholding your false beliefs, you begin to change those anxious beliefs to alternate, more realistic thoughts.
Use a journal to record your anxious thoughts and then examine if they are accurate. Over time, this will become automatic, but it’s important to record this in a journal at first to get the habit down.
Exposure – confronting your fears is the best ways to overcome them. It’s good to have a handle on your anxious thoughts first, but once you do, moving on to exposure practices is extremely effective in overcoming your social anxiety.
Understanding is one thing, but you also need the hands on practice. Just reading about it will only get you so far. Exposure allows you to practice your cognitive therapy lessons. You are able to apply what you have learned to real world experiences.
You want to approach exposure gradually. You don’t want to jump in too deep (unless you can handle it) otherwise, it will backfire. Small, gradual steps is the best approach.
Why does exposure work? Because you learn that the situations you have feared so much and avoided because of that fear, are nothing to fear at all. By exposing yourself to these situations, you learn that you can handle them and even thrive in them.
When you expose yourself to the feared situation, you will learn that your assumptions and beliefs about it, was wrong. Boom – the fear is diminished, just like that! This will also give you a chance to practice your communication skills that you may have been neglecting due to your social anxiety.
Social skills – Cognitive therapy and exposure are the two main ingredients, but improving your social skills can also have an effective impact on your social anxiety.
Although many people with social anxiety aren’t lacking in social skills, working on your communication skills will give you that extra bit of confidence to take it to the next step. Simple things like making eye contact, being more assertive, making small talk, and learning how to meet new people can have a hugely positive impact on overcoming social anxiety.
While CBT and medication are both proven to work (and can work well together), CBT is a more effective approach over the long run.
The next question to consider is if you want to treat via self-help methods or a professional.