Bhavya Dixit
What’s better than going for therapy to cope with social anxiety? Actively facing and tackling that anxiety during therapy. CBT has been widely used to help with anxiety disorders and has been proven effective (Hoffman, 2007). To cater to the specific needs of those within the larger bracket of social anxiety come Cognitive Behavioural Group Therapy (CBGT) and Social Mishap Exposures. The shift to these newer techniques came about when the notion of exaggerated social costs had to be addressed. Social cost refers to the over-analytical perception of others’ reactions in a social situation, especially social blunders. An anxious individual perceives a social mishap differently; they tend to over-analyse the situation; thus, the implications, according to them, escalate (Fang, 2013). This blog will focus on how a clinical psychologist; Stefan Hoffman, administers the therapy to a group, simultaneously tailoring it to the needs of the individuals who were part of that group.
Social anxiety is defined by a persistent fear of negative evaluation by others in social or performance situations (Fang, 2013). Common fears include formal public speaking, speaking up in a meeting or class, and meeting new people (Ruscio et al., 2008). It also happens to be the case that these situations can be distinctive in the ways they provoke anxiety for each individual. But, most clients with Social Anxiety share similar underlying core fears, such as being rejected, looking stupid or unintelligent, expressing disagreement or disapproval, and being the centre of attention (Fang, 2013). An important reason behind the continual presence of Social Anxiety despite being given repeated exposure to social cues is because individuals with Social Anxiety engage in a variety of avoidance and safety behaviours to decrease the risk of rejection (Fang, 2013). This is the underlying principle being targeted when Social Mishap Exposures are being administered.
These exposures are based on reducing anxiety levels due to the overestimation of social costs and implications with regard to a particular mishap. This is accomplished by having the client behave in a way that causes a social mishap by purposefully violating the client’s perceived social norms (e.g., singing in a subway). As a result of this violation the client is encouraged to break out of the self-reinforcing cycle of negative anticipation. The case chosen in the study, Mary, had crippling levels of social anxiety that directly affected her decision making and functioning. She was diagnosed with social anxiety disorder, comorbid with depression. Her treatment plan was spread over 12 weeks with 2.5 hours of group cognitive behavioural therapy. The program initially contained in-session exposures followed by mishap exposures. The final weeks included tasks like walking backwards slowly in a crowded street for three minutes, reciting “’ Twas the Night Before Christmas” in the subway platform, going to every table in a crowded restaurant asking for Joe Smith, to name a few (Fang, 2013). Along with these exposures, the clients were also trained on relapse prevention; they were asked to work on areas where there was scope for improvement. The members helped each other figure out their strengths and weaknesses. Post all the exposures not only were there reductions in Mary’s anticipatory anxiety levels but the progress held for more than six months (Fang, 2013).
The exposures proved to be an effective way to cope with social anxiety. The course is spread over a long duration and covers a plethora of instances that can help individuals with social anxiety. However, the study has a few limitations. For one, there is always room for more incidents that can lead to a relapse. Another limitation of the study could be the lack of attention it offers to comorbid conditions. It is administered on a group and therefore the scope for individual improvement is likely to be compromised. Despite the social blunders it is difficult to generalize the effects of such mishaps that occur in absolutely naturalistic settings. Furthermore, the therapy focuses on the person seeking therapy violating their social norms. However, the tasks covered can inconvenience other people involved in the social situation.
What’s better than going for therapy to cope with social anxiety? Actively facing and tackling that anxiety during therapy. CBT has been widely used to help with anxiety disorders and has been proven effective (Hoffman, 2007). To cater to the specific needs of those within the larger bracket of social anxiety come Cognitive Behavioural Group Therapy (CBGT) and Social Mishap Exposures. The shift to these newer techniques came about when the notion of exaggerated social costs had to be addressed. Social cost refers to the over-analytical perception of others’ reactions in a social situation, especially social blunders. An anxious individual perceives a social mishap differently; they tend to over-analyse the situation; thus, the implications, according to them, escalate (Fang, 2013). This blog will focus on how a clinical psychologist; Stefan Hoffman, administers the therapy to a group, simultaneously tailoring it to the needs of the individuals who were part of that group.
Social anxiety is defined by a persistent fear of negative evaluation by others in social or performance situations (Fang, 2013). Common fears include formal public speaking, speaking up in a meeting or class, and meeting new people (Ruscio et al., 2008). It also happens to be the case that these situations can be distinctive in the ways they provoke anxiety for each individual. But, most clients with Social Anxiety share similar underlying core fears, such as being rejected, looking stupid or unintelligent, expressing disagreement or disapproval, and being the centre of attention (Fang, 2013). An important reason behind the continual presence of Social Anxiety despite being given repeated exposure to social cues is because individuals with Social Anxiety engage in a variety of avoidance and safety behaviours to decrease the risk of rejection (Fang, 2013). This is the underlying principle being targeted when Social Mishap Exposures are being administered.
These exposures are based on reducing anxiety levels due to the overestimation of social costs and implications with regard to a particular mishap. This is accomplished by having the client behave in a way that causes a social mishap by purposefully violating the client’s perceived social norms (e.g., singing in a subway). As a result of this violation the client is encouraged to break out of the self-reinforcing cycle of negative anticipation. The case chosen in the study, Mary, had crippling levels of social anxiety that directly affected her decision making and functioning. She was diagnosed with social anxiety disorder, comorbid with depression. Her treatment plan was spread over 12 weeks with 2.5 hours of group cognitive behavioural therapy. The program initially contained in-session exposures followed by mishap exposures. The final weeks included tasks like walking backwards slowly in a crowded street for three minutes, reciting “’ Twas the Night Before Christmas” in the subway platform, going to every table in a crowded restaurant asking for Joe Smith, to name a few (Fang, 2013). Along with these exposures, the clients were also trained on relapse prevention; they were asked to work on areas where there was scope for improvement. The members helped each other figure out their strengths and weaknesses. Post all the exposures not only were there reductions in Mary’s anticipatory anxiety levels but the progress held for more than six months (Fang, 2013).
The exposures proved to be an effective way to cope with social anxiety. The course is spread over a long duration and covers a plethora of instances that can help individuals with social anxiety. However, the study has a few limitations. For one, there is always room for more incidents that can lead to a relapse. Another limitation of the study could be the lack of attention it offers to comorbid conditions. It is administered on a group and therefore the scope for individual improvement is likely to be compromised. Despite the social blunders it is difficult to generalize the effects of such mishaps that occur in absolutely naturalistic settings. Furthermore, the therapy focuses on the person seeking therapy violating their social norms. However, the tasks covered can inconvenience other people involved in the social situation.
It is a step that will definitely increase the probability of success in dealing with social anxiety but, whether or not Social Mishap Exposures will be the most sought-after method to help with social anxiety will be determined by the efficiency with which it is administered using nuanced, tailored versions of it.
REFERENCES:
REFERENCES:
- Fang, A., Sawyer, A. T., Asnaani, A., & Hofmann, S. (2013). Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient. Cognitive and behavioral practice, 20(2), 213–220. doi:10.1016/j.cbpra.2012.05.003
- Hofmann S. G. (2007). Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cognitive behaviour therapy, 36(4), 193–209. doi:10.1080/16506070701421313
- Ruscio AM, Brown TA, Chiu WT, Sareen J, Stein MB, Kessler RC. Social fears and social phobia in the USA: Results from the National Comorbidity Survey Replication. Psychological Medicine. 2008;38:15–28.
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