Cognitive Behavioral Therapy for Social Anxiety Disorder: Evidence-Based and Disorder-Specific Treatment Techniques by Stefan G. Hofmann & Michael W. Otto

Author:Stefan G. Hofmann & Michael W. Otto
Language: eng
Format: mobi
ISBN: 9780415954037
Publisher: Routledge
Published: 2008-04-23T21:00:00+00:00

C h a p t e r 5

Treatment in Action

Clinical Examples

susan is a 42-year-old, married, white female with two young children.

she has worked as a homemaker since the birth of her children, but in

the last two years she has returned to outside employment as a part-time

accountant. she describes herself as being socially anxious since grade

school. she reports that her time alone with her children was a respite

from the worst of her social anxiety, but now that she has more time at

hand, she realizes that she finally needs to attend to her social anxiety

disorder (sad). in seeking treatment, she stated that she needs to be less

anxious at work and at social gatherings, but that she also wants to be

less anxious so that she provides a better role model for her children.

in the first group session, susan easily presented herself as warm

and supportive as she introduced herself and enthusiastically stated her

eagerness to change this “lifelong disorder.” at the same time, she stated

that she believed she was much worse than other group members because

they all looked and acted like “normal people.” the therapist capitalized

on this statement to lead a brief discussion of how individuals with sad

tend to believe all their anxieties and symptoms show, and almost every

other group member said they felt similarly to susan—that they were

the only oddball in group and the others had a much less severe disorder

than they had. this discussion provided susan (and other group mem-

bers) with an initial chance to challenge her assumptions that (1) oth-

ers see her degree of social anxiety, (2) she routinely appears much less

competent than others, (3) she believes that others expect her to be more

competent, and (4) individuals with her disorder (sad) are oddballs. she

described herself as being “utterly incompetent” and a “social loser.”

susan further stated that when confronted with certain social evalua-

tive situations, such as public speeches, she feels panicky. she described

this feeling as a state of strong bodily symptoms characterized by heart

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Cognitive Behavioral Therapy for Anxiety Disorder

Believes that others expect

her to be competent/perfect.

Is anxious about a

Ruminates over

social situation

past situations

Avoids

Heightened

self-focused attention

Views herself as a

social loser

Views situations as

dangerous

Feels panicky

Views social skills as

inadequate

FIGuRE 5.1 Maintenance factors of susan’s social anxiety.

racing, being flushed, trembling, and dry mouth. she stated that the only

way to stop these symptoms is by leaving the situation.

she feels a great deal of sadness and frustration because she had a

number of “missed opportunities” because of her social anxiety (e.g., she

turned down a number of attractive career options). at the same time,

susan continuously avoids social situations because the consequences

can often be humiliating and embarrassing. as a result, she keeps avoid-

ing them. if she cannot avoid them, she endures them with extreme

discomfort and tends to ruminate about them long after the event has

passed. Figure 5.1 is an adaptation of the model to susan’s case.

Following the first session, susan gained an intellectual understand-

ing of the treatment model but was still hesitant to believe she could

achieve many gains from exposure given that she had been trying for

years to “be better” in social situations.

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