Social anxiety: How cognitive behavioral therapy can help


Ever since elementary school, I’ve experienced intense fear during social interactions both virtual and in person, whether it was as small as figuring out a response to a text or as big as presenting at a work meeting. These are hallmarks of social anxiety, a phobia of being judged, negatively evaluated or rejected in a social or performance situation, according to the Anxiety & Depression Association of America.
Social anxiety is one of the most common mental disorders around the world, Fallon Goodman, an assistant professor of psychology at the University of South Florida, told CNN’s Chasing Life podcast: “About 4% of the world population will have social anxiety disorder at some point in their lives, which is roughly 300 million people.”

It can really limit a person’s life. “Clinical social anxiety is that level of social anxiety that keeps you from really living your life,” Wendy Suzuki, a professor of neural science at New York University, told Chasing Life. “It keeps you inside because the fear of having these social interactions is so high.”

“The treatment of choice (is) cognitive behavioral therapy, as it is with most anxiety disorders,” clinical psychologist Ramani Durvasula, a professor of psychology at California State University, Los Angeles, told Chasing Life. “If you can help a person change how they think or perceive about a situation, you’ll likely change the reactions and the behaviors.”

I decided to try cognitive behavioral therapy nearly two years ago.

Unpacking the fear through CBT also involves learning how to realistically evaluate anxiety, become more emotionally resilient, and shift one’s attention in social settings to being fully present and engaged. Some therapists include social skills practice and small exposure to usually avoided activities, according to Think CBT, a therapist-led organization based in the United Kingdom.

A life unlived

I remember being a shy and worried kid at a very young age. When my father and I would discuss some family issue, he’d see the anxiety in my face and emphatically say, “Don’t worry.”

The apprehension was ingrained in my personality, and it got worse as I got older. My earliest memory of debilitating social anxiety happened when I was 14 — a reflection of the trend that over the past 50 to 60 years, the average age social anxiety begins has gone from 20s to ages 12 to 14, Goodman said.

When working at internships or jobs, I frequently took different routes to avoid unexpectedly encountering people when I hadn’t prepared anything to say. In social situations, I’d become so scared and preoccupied with the possibility of judgment that my mind would go blank.

My reactions felt like a medical crisis: My hands shook, my stomach turned, my armpits got clammy, my body tensed, I stammered. Sometimes I had trouble visually focusing on whatever was in front of me. I even went to the hospital 10 years ago because my heartbeat had been suddenly speeding up before my breathing could catch up, leaving me out of breath. After having my vitals checked and undergoing scans, the doctors told me it was probably related to mild anxiety. These heart palpitations continued over the years.

I had trouble making friends because I was so guarded and mistrusting of people’s feelings, even if they had expressed affection and acceptance. Having “Happy Birthday” sung to me was nerve-racking. And large gatherings felt impossible: Amid thousands of people at concerts, I felt the audience might be judging me. I ping-ponged between this helpless fear and feeling shameful about how narcissistic my mindset seemed to me.

I overanalyzed what I said and sometimes cried or felt physically sick from the stress. It was even worse when I knew I had disappointed someone.

Changing my mind

For years, I didn’t tell anyone about my social anxiety because I was terrified people would judge me or not take me seriously.

The March 2020 shutdown due to the pandemic changed everything for me. I realized trying to fix my social anxiety on my own wasn’t working. I wanted to feel normal and not ruin my chances at a career, relationships or friendships.

I started CBT appointments in September 2020. This therapy can also include exercises focused on self-acceptance, mindfulness and breathing.

I had CBT assignments to complete and discuss with my therapist, who helped me integrate these lessons into my daily life. It wasn’t easy. I learned that constantly trying to be perfect was irrational, and that not being perfect didn’t make me any less lovable, qualified or worthy. What was most important was doing my best.

To prevent performance anxiety from interfering with a healthy sex life, mindfulness is an answer

Challenging negative thoughts meant asking myself several questions: Is there any substantial evidence for my thought, or evidence contrary to my thought? Am I trying to interpret this situation without all the evidence? If I look at the situation positively, how is it different? Will this matter a year or five years from now?

Answering these questions multiple times in therapy and on assignments helped me ask those questions in stressful times.

Mindfulness and self-acceptance work also meant I stopped taking people’s negative moods or cool responses personally, knowing sometimes their reactions had more to do with their lives. Before gatherings or work opportunities I was anxious about, I’d often do a few minutes of progressive muscle relaxation, which relaxed my heart rate, muscles and mind.
I was surprised CBT worked for me, but it has been found to be significantly more effective than supportive or talk therapy in reducing social anxiety symptoms and improving overall functioning. A CBT model similar to my experience was beneficial for a small group of adults with social anxiety, who did 14 weekly 90-minute sessions and homework after each meeting.
People who did 16 sessions of CBT experienced a greater reduction in negative emotions and improvements in the part of the brain that helps people reappraise the meaning of an emotional stimulus to change its impact, compared to a waitlist group that did nothing, according to a 2013 study.

Changing my life

Many who have recovered from addictions or cognitive distortions know all too well the path to recovery isn’t linear. There have been setbacks, plateaus and moments when CBT was painful because I had to confront how I felt about myself and the experiences that led to that self-perception.

It's time to become friends with your anxiety

Positive changes didn’t happen overnight — I occasionally noticed small improvements, but realizing total change has been more like painting a wall with thin layer over thin layer until the wall’s saturated in color — you don’t notice the difference until it’s a total 180 degrees from what it used to be.

Eighteen months in, I typically live such a good life between appointments that my therapist and I sometimes don’t get to discussing whatever we had planned to cover. I have an amazing group of close friends, whom I can’t see enough. I love being in the office and how much opportunity for connection it presents. I have the best time at concerts, and I’m dating. Before, avoidance overrode any desire to see people. Now, I sometimes resent the fact I have finite time on Earth, because there is so much to do and experience.

I still fumble in social settings now and then. Don’t we all? But the difference between my pre- and during-CBT self is that now, I laugh off my moments of social awkwardness instead of ruminating over them for days.

A couple weeks ago, I accidentally spilled coffee on a table at the beginning of my first meeting with a high-level supervisor. Instead of thinking the person would deem me incompetent and that that would harm my career, I lightheartedly apologized and accepted the box of tissues she gave me to clean it up.

I look forward to future career and social opportunities, knowing I’ll likely still face some nerves and awkward moments. My hands still might shake at times, and my armpits might feel clammy. But I’ll know that most people are understanding and likely won’t be thinking much of my social blunders — and that if they do, that’s on them. I’ll know it’s not the end of the world — and that the world is what I want to see and experience, even if I flub a little along the way.