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Treating Social Anxiety with Cognitive Behavioural Therapy (CBT)

What is Social Anxiety Disorder (SAD)

According to DSM-IV, Social anxiety disorder or Social phobia, is defined as a persistent and excessive fear of social or performance situations lasting at least six months. Exposure to the feared social situation triggers anxiety or panic attack fearing that the individual will be humiliated or embarrassed. The individual with SAD is concerned about negative evaluation by others and makes predictions about the outcome of the situation.


Statistics on SAD

SAD affects people of all ages, but it is more common in women than men. Also, minority and social deprived groups are predisposed to developing a mental health problem due to stresses, marginalisation etc. Research suggest that SAD is one of the most predominant psychological disorders in Western countries reaching 12%, compared with other anxiety disorders such as generalised anxiety disorder with 6%, panic disorder 5%, post-traumatic stress disorder (PTSD) 7% and 2% for obsessive-compulsive disorder. National Institute for Health and Care Excellence Guidelines (NICE) classifies SAD as one of the most common mental health problems in the UK.


Causes of SAD

A combination of biological, psychological and environmental factors contributes to the development of SAD. For example, an imbalance of the neurotransmitter serotonin can lead to anxiety, a traumatic social experience (eg. loss) or a lack of mirroring and observation of others. SAD is mainly developed in childhood or puberty and if left untreated it is likely to have a detrimental effect on the individual’s life.


Consequences of SAD

SAD impacts the individual’s normal functioning, his social, work, educational life resulting in poor social impairment. Also, statistics indicate that individuals with SAD will experience another mental health issue in their lives such as anxiety, depression, post-traumatic stress disorder or substance abuse.


Treatment of SAD

NICE recommendation for treating SAD is Cognitive Behavioural Therapy (CBT). CBT is a process of identifying, processing and changing thought patterns and behaviours which are related to physical and emotional symptoms of SAD. The frequency of the sessions is weekly, offering if possible 90 minutes, up to 14 sessions over a course of 4 months.


The CBT Competencies Framework for working with SAD recommends the use of the model

devised by Clark and Wells in 1995. Clark and Wells model theorises that SAD can be triggered by a situation which activates anxiety, beliefs and assumptions that the individual holds about himself. The combination of these two factors makes the individual perceive the situation as threatening. As a way of managing this situation the individual develops three interlinked responses, safety behaviours to minimize the anxiety, become self-conscious and develops some physical signs of anxiety. Thus, SAD is developed and maintained impacting the individual’s functioning.



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