Cognitive Behavioural Therapy (CBT) is the talking treatment of choice for social anxiety, and you will probably be offered this on the NHS if you go to your GP. Please see the NHS overview about CBT here.
Some psychological and alternative therapies – albeit with less clinical evidence than CBT – are listed below.
Through ACT, instead of trying to eliminate or reduce your negative thoughts, you choose to accept them but not pay as much attention to them. For example, you might be taught to view your thoughts as leaves blowing in the wind or as passengers coming and going on a bus: they are there but you don’t need to get caught up in them. Acceptance and commitment therapy is also a good candidate for self-help that you can practice at home. An ACT therapist uses experiential exercises, values-guided interventions, and mindfulness skills training as part of therapy.
See here for a link where you can buy the Mindfulness and Acceptance Workbook for Social Anxiety and Shyness
CBT or Cognitive Behavioural Therapy is the most common form of therapy for social anxiety. It is the treatment with the most clinical evidence (ref.1) for helping improve symptoms of social anxiety. Find out about NHS CBT here.
Cognitive restructuring is not so much a therapy in its own right, more of a technique within other psychological therapies. It focuses on the cognitive symptoms of social anxiety: poor self-concept, fear of negative evaluation by others, and negative attribution bias (i.e. attributing positive outcomes to chance but negative outcomes to your own failings or faults).
Cognitive restructuring involves a series of exercises designed to identify negative thoughts, evaluate how true they are, and construct alternative thoughts to challenge the original thoughts.
Compassion-based therapy (CFT) is used among people who live with problems related to shame and self-criticism and can include those with social anxiety disorder.
While self-compassion seems to come naturally for some people, many with social anxiety disorder will find their ability to treat themselves with compassion is lowered.
Alternative treatments for social anxiety disorder include such things as dietary supplements, aromatherapy, hypnotherapy, reiki and yoga.
Most alternative treatments have not been scientifically proven to work in the treatment of SAD, and so we cannot particularly recommend them. In addition, alternative treatments may not be regulated as strictly as standard forms of treatment.
Dialectical Behavior Therapy is a type of Cognitive Behavioral Therapy (CBT), but what makes it different is its emphasis on mindfulness and dialectical thinking. Dialectical thinking refers to the ability to view issues from multiple perspectives and to arrive at the most economical and reasonable reconciliation of seemingly contradictory information and postures. Rather than only treating symptoms as problems to be solved, DBT places an equally important emphasis on acceptance of experiences as they are in this moment. It is one of several acceptance-based behavior therapies (ABBTs).
Exposure Therapy is not so much a therapy in its own right, more of a technique within other psychological therapies.
Depending on your form of anxiety, you may be nervous in all social situations or may only be triggered by very specific occasions. Social anxiety exposure therapy typically works through a series of hierarchies – an ordered list of situations that trigger anxiety from least to most anxiety-inducing triggers. This process is an essential part of behavioural therapy.
This is not really a treatment. Flooding yourself with intensely difficult situations has been shown NOT to work for social anxiety. Most of us have constantly been facing our fears but without changes in our thoughts and behaviours the anxiety does not go away.
Many therapeutic approaches now incorporate elements of mindfulness. It has evolved from Buddhist traditions that involve bringing your attention to what is occurring in the present moment.
It involves being fully involved in what is going on rather than focusing on your anxiety symptoms. By paying full attention to the activity (even if it is just remembering to enjoy the tastes of food or drink you are having) you take away some of the intensity of your anxiety. It can be part of cognitive restructuring and minimising automatic negative thoughts .
Mindfulness meditation for social anxiety via Verymind.com
Mindfulness based cognitive therapy via Verywellmind.com
Mindfulness whilst conversing at AboutSocialAnxiety.com
Mindfulness workbook at AboutSocialAnxiety.com
Psychoanalysis and psychodynamic therapy involve a therapist helping you to understand underlying issues from childhood that may have contributed to your social anxiety. It is most useful for people who have deeper unresolved conflicts contributing to their anxiety. Psychoanalysis may also be useful in some instances to explore potential resistance to change.
Rational emotive behavior therapy (REBT) is a type of therapy introduced by Albert Ellis in the 1950s. It’s an approach – like many others – that helps you identify irrational beliefs and negative thought patterns that may lead to emotional or behavioral issues. It is similar to CBT but there are a few differences; for example REBT places more emphasis on unconditional self-acceptance (see the links below for more details).
More information on REBT for social anxiety via Verywellmind.com
See our book list at self-help-books
Short-term psychodynamic psychotherapy
If you decide not to have NHS CBT, CBT-based supported self-help or medication, you may be offered a psychological therapy called short-term psychodynamic psychotherapy designed for social anxiety disorder. The therapy is called ‘dynamic’ because it focuses on the different forces (or dynamics) in a person’s life that may be causing them difficulties. The aim is to examine, understand and work through the dynamics and difficulties, which may have begun in childhood. It should include information and discussion about social anxiety, a focus on any relationships that might be linked to the person’s social anxiety and exploring any feelings of shame. The therapist should encourage the person to confront any social situations they are anxious about and help them improve their social skills.
The NHS NICE guidance states that this therapy is usually not as helpful for social anxiety disorder as CBT, CBT-based supported self-help or antidepressants. If you decide to have short-term psychodynamic psychotherapy you should have 25–30 meetings with your therapist over 6 to 8 months, with each meeting lasting 50 minutes.
It’s important to note that people with social anxiety do not have deficits in their social skills, although they may believe this to be the case. However anxiety may sometimes mask their true social skills, and they may try and improve themselves to appear more acceptable, entertaining or likeable. Trying to “perfect” socialising techniques rarely leads to a resolution of difficulties. More typically people seem to benefit from discovering that it is ok to be imperfect, look anxious, or sometimes make mistakes. Learning about social skills, such as how to be assertive, asking open questions and listening skills may make people with social anxiety feel more confident, but is not generally necessary.
Below are some links to articles written specifically for people who have actual deficits in social interaction above and beyond social anxiety eye contact, conversation skills, assertiveness, and telephone calls.
Also see Information on Social Skills Training via Verywellmind.com
Some other useful articles:
www.verywellmind.com – List of psychological therapies for social anxiety
www.socialanxietyalliance.org.uk – NHS NICE guidance
www.socialanxietyireland.com – Social Anxiety Irelands pages on Psychotherapy
www.socialanxietysupport.com – The main USA discussion Boards pages on Psychotherapy treatments
www.ncbi.nlm.nih.gov – USA based NCBI research article on Intervention options for adults