This document discusses how cognitive behavioral therapy (CBT) can help treat social anxiety by developing new skills. It describes 10 common symptoms of social anxiety, such as high self-consciousness, avoidance of social situations, academic difficulties, and difficulties with friendships and relationships. For each symptom, it summarizes how CBT techniques can help by challenging negative thoughts and assumptions, using relaxation techniques, gradually exposing patients to anxiety-provoking social situations, and teaching social and communication skills.

1. How it Affects
People and How
CBT Can Help
Treat it
1. HIGH SELF-
CONSCIOUSNESS
• People with social anxiety find it very
difficult or impossible to relax around others.
They may feel certain other people are
judging them or observing them. Sufferers
are often worried they will make mistakes
and embarrass themselves or be shown up
in front of other people.
SYMPTOMS TREATMENT
• A CBT technique to work with self­
consciousness is to challenge the
assumption that the person is always
observed. The person might be asked to
consider whether they pay a lot of
attention to others or talk about how little
attention people pay to other individuals.
Step By Step Guide
Social Anxiety...
2. AVOIDANCE OF SOCIAL
SITUATIONS
People with social anxiety often prefer to
avoid social situations to prevent this
anxiety, missing out on various experiences
they may want to engage in. People with
social anxiety may want to engage more,
but feel they can't do it. Social anxiety may
make them avoid fun events or gatherings.
SYMPTOMS TREATMENT
To overcome avoidance with CBT, a
person is asked to think about social
situations where they might feel social
anxiety and rate those situations from 1
to 10. Then, the person is asked to
gradually enter situations, starting with
those that give them the least anxiety.
"CBT can help social anxiety symptoms..."

2. 3. ACADEMIC
DIFFICULTIES
Social anxiety can make it difficult to speak
in public, give presentations, or interact with
people during group projects or in the
classroom. People with social anxiety can
have a hard time participating, so all of this
can hinder their academic performance or
prevent them attending college.
SYMPTOMS TREATMENT
With CBT the person learns techniques
that involve controlling one's breathing to
reduce anxiety and help with being more
able to relax in difficult situations, like
exams and evaluations or presentations,
which are often a source of increased
anxiety, along with changing beliefs.
4. DEBILITATING PANIC
ATTACKS
All sorts of social situations and interactions
with others can be a source of increased
anxiety, which can make individuals so
nervous and overwhelmed that it leads to a
panic attack. Fear of losing control and
having a panic attack can cause social
anxiety sufferers to avoid situations more.
SYMPTOMS TREATMENT
The person learns relaxation techniques
that help to to reduce physical symptoms,
and being more able to relax in difficult
situations. CBT challenges the panic by
looking at evidence from previous
situations, how they coped and how the
fear of a panic attack rarely manifests.
5. DIFFICULTIES AT WORK
People with social anxiety might struggle if
their roles require them to do presentations
or even to engage with co­workers,
customers in person or in phone
conversations. Networking and training
opportunities might also be difficult. This
can limit career advancement or cause
them to remain unemployed.
SYMPTOMS TREATMENT
CBT works with cognitive distortions
(such as thinking in black and white) to
reduce them or eliminate them altogether.
These distortions help the person feel
more comfortable doing things required
for the job. For example, they feel more at
ease making mistakes rather than too
upset over it to think straight.
6. PROBLEMS WITH JOB
INTERVIEWS
To land a job or a scholarship or succeed in
beginning any number of things, an
interview, assessment or a similar setup is
often a requirement. For people with social
anxiety, this can be difficult to overcome.
They may feel judged and on display in
such situations, and worry they will look
bad. They may become tongue­tied or
stammer, or worry that their mind might go
blank. They might also connect the outcome
of an interview with a measure of self­worth.
SYMPTOMS TREATMENT
CBT teaches various relaxation
techniques. The person can practise
progressive muscular relaxation the
person when they want to avoid
appearing too tense or nervous. Role­
playing helps to prepare for interviews.
CBT also challenges negative
assumptions about what an interview
really is, and encourages thoughts, such
as: there is nothing to lose by trying or
thinking of it as people just having a chat.
"CBT can help to develop new skills..."

3. 7. DATING AND
RELATIONSHIP ISSUES
Dating means meeting new people, a
daunting prospect from the perspective of
social anxiety. People might feel too self­
conscious to approach new people
romantically. Social anxiety can produce
symptoms such as sweating, facial redness,
diarrhoea and nausea, all of which can feel
impossible in a romantic scenario.
SYMPTOMS TREATMENT
CBT offers support in the form of
structured exposure situations in which a
person might approach someone they
are attracted to and ask a question or for
direction, to experience the anxiety and
see that it wasn't as bad as they were
expecting. Simple, self­regulated
exercises can facilitate dating later on.
8. DIFFICULTIES WITH
FRIENDSHIPS
Platonic relationships may be affected, as
people might feel unwilling to go out and
even meet with existing friends, potentially
jeopardising the bond between them. It
helps to have friends that really understand
and who can support the sufferer with
gradual exposure to social settings.
SYMPTOMS TREATMENT
Social skills training is offered as part of
a CBT treatment regime. The person can
learn to better engage with others by
gradually challenging themselves to
social situations, and practising
communicating in more effective ways,
thereby helping their relationships.
9. RELUCTANCE TO TRY
NEW THINGS
People with social anxiety might avoid any
situations where they feel judged, including
courses or workshops for things that interest
them, any kind of group situation, or any
kind of situation where they might begin to
feel panicky or where they have reduced
control over circumstances.
SYMPTOMS TREATMENT
CBT encourages the person is to
experiment and branch out. They might be
given homework that involves new
activities, or explore new things in
practical ways during a therapy session,
learning new skills that can help them be
prepared for and open to new possibilities.
10. EVERYDAY STRESS
Social anxiety can lead to stress in simple
day to day situations that involve interacting
with other people, such as phone
conversations, going shopping, etc. – all
necessary parts of daily life. Even the
thought of these kind of activities can bring
on a great deal of anxiety for the sufferer.
SYMPTOMS TREATMENT
CBT works to reduce the physical
symptoms of anxiety, helping reduce the
stress the person is feeling. They are also
encouraged to break down goals and
daily life challenges into manageable
segments and to be mindful of stress
levels and thoughts that overwhelm.
For more information, or to book a CBT session with chartered psychologist
Dr Vanessa Ruspoli, visit www.dr­ruspoli.com or call +44 (0)7747­ 777361.
"CBT can help create lasting change..."