What is Cognitive Behavioural Therapy for Social Anxiety?

Cognitive Behavioural Therapy, commonly referred to as CBT, is an umbrella term for therapies based on cognitive and behavioural theories of psychotherapy. Some of these CBT therapies are recommended for people with social anxiety.

The NHS offers CBT as part of its Talking therapies program. Different mental health services cover the provision in Scotland and Wales. The principles of CBT are also applied in other therapy scenarios – including self-help.

So, what is CBT and how does it work?

C stands for cognition (thought), B (behaviour), T (therapy). CBT is based on the idea that your thoughts, feelings, physical sensations and behaviour are all interconnected.

For example, you are speaking to a friend (situation) and you may worry about how you are behaving or sound (thoughts). At the same time, you may feel anxious (emotion) and then experience sensations such as feeling shaky, tense or have a dry mouth (physiological symptoms). You may keep quiet, play safe, or leave the situation (behaviours). Afterwards, you may worry even more about how well you did, how you felt inside, what the friend may now think of you, and the cycle continues.

The central idea in CBT is that by applying techniques to change your thinking and behaviour you can break the cycle that keeps the anxiety going. See our page on the social anxiety maintenance cycle.

CBT is sometimes referred to as having a ‘here and now’ focus, unlike some other therapies. CBT will take into account of your past, but sessions tend to be focused on the present-day difficulties.

What Should I Expect from therapist-led CBT?

CBT for social anxiety has several main elements:

  • Assessment and formulation: A formulation is a diagram that helps the therapist and client come to a shared understanding about how a person’s focus of attention, thoughts, emotions, physiological symptoms, behaviours, and life experiences contribute to their difficulties today.
  • Psychoeducation: The therapist helps you understand social anxiety, how that anxiety impacts you physiologically, and the role of focus of attention, thoughts, physiological symptoms, and avoidance and safety behaviours.
  • Active therapy: Rather than just talking about difficulties to gain insight into them, CBT will involve active tasks to do in session and out of session as homework to work on those difficulties.
  • Skills development: An important part of CBT is to learn a set of therapeutic techniques that can be applied over time to benefit the person beyond their therapy sessions.
  • Regularity: regular and consistent practice is one of the most important factors in using CBT. This can be difficult, as it may initially increase anxiety. Maintaining the motivation to confront feared situations, even when some may not go well, is key.
  • Structured and goal focused: CBT is a highly structured and goal focused therapy. Sessions will likely include regular reviews and agenda setting.
  • Collaborative: working together as a team with your therapist. You bring your knowledge of yourself and your therapist brings their knowledge of CBT.

NHS CBT for social anxiety is recommended to be offered on a one-to-one basis but can sometimes be delivered in a group. You should be offered up to 14-16 sessions of 60-90 minutes each with a CBT Therapist over 4 months. The exact number of sessions and their length can vary depending on need and your local Talking therapy service. Sessions can be face-to-face or remote via an online video call. Both the type of support available and how you access it will depend on local availability.

Why CBT for Social Anxiety?

CBT is considered to be the frontline evidence-based treatment for social anxiety. The UK National Institute for Health and Care Excellence (NICE) have surveyed and reviewed the efficacy and effectiveness of different treatments for mental health conditions and made recommendations for what should be made available in the NHS, which includes CBT for social anxiety. See NICE guidance for social anxiety.

Figures on CBT social anxiety recovery rates vary and recovery can be hard to define and therefore measure. However, based on the research currently available, and how they measure recovery, CBT has the largest evidence base for both recovery and improvement.

An meta-analysis of the available research in 2022 showed moderate to large improvements in long-term social anxiety symptoms with therapist assisted CBT compared to no treatment. This shows that the improvements tend to last. Studies showing long-term recovery like this helped lead to the NICE guidance recommending CBT for people with social anxiety.

Real world recovery outcomes can vary between service providers but still show a lot of people making progress. The latest NHS Talking Therapy CBT social anxiety recovery data put 2024/2025 recovery at 35.1% and improvement at 68.5%. However, if CBT doesn’t work out for you, you haven’t failed – it is just that it didnt work this time or that other forms of help maybe more suitable.

In some regions you may be able to take a second course of NHS CBT treatment though there are often restrictions such as a time delay in re-referral.

If you feel CBT is not for you, the NICE guidelines also include alternative treatment options – depending on local availability – see Other NHS treatment options

Research is continually being produced and other therapies show promise, but many more studies are needed. Examples include Acceptance and Commitment Therapy (ACT), Eye Movement Desensitisation and Reprocessing Therapy (EMDR), Emotion Focused Therapy (EFT), and Compassion Focused Therapy (CFT). As the evidence is currently not strong enough for NICE to recommend these therapies for use in treating Social Anxiety, they are unlikely to be available on the NHS.

CBT models and interventions

On the recommendation of NICE, NHS CBT follows evidence-based protocols (treatment models) for social anxiety. Although these guiding protocols for treating social anxiety exist, every client and therapist are different, and the therapy is tailored to the specific client’s needs.

Some therapists may bring in other techniques that they think are helpful for your specific situation. What works for you may not work for someone else with social anxiety, and vice versa.

Changing what you do or how you think is often a powerful way to improve how you feel and your quality of life. It is important to remember change can take time and practice. It is rarely as simple as just one or two techniques or changes to behaviour. There is a process, and that can often take time. This is why CBT equips individuals with a range of practical tools and techniques they can use independently to manage their emotions and behaviours even after therapy ends.

Common techniques that a CBT therapist might use in the treatment of social anxiety include:

You can try some of these techniques out for yourself as part of your CBT therapy.

NHS Guided self-help

NICE guidelines recommend that guided self-help for social anxiety is only offered if the person does not want CBT. However, in some services, it may be offered as a first step, especially for those with mild to moderate symptoms. This is because the wait list is usually shorter and it can be an accessible first step for some.

Guided self-help is considered a less “intense” treatment than the CBT described above. It means going through a CBT-based self-help book or online programme with the support of a therapist, usually a “Psychological Wellbeing Practitioner”. Psychological Wellbeing Practitioners have had university-level training in CBT interventions, but this training is shorter than it would be for a CBT therapist. The support they offer may be brief sessions via the telephone or face to face, or messaging via an online programme.

iCT-SAD (Internet delivered Cognitive Therapy for Social Anxiety Disorder)

In some areas, you may be offered iCT-SAD. This has been created by the developers of one of the main models of CBT for Social Anxiety used in the NHS. It includes all of the same interventions and techniques as in the original treatment, including te homework to try particular techniques and behaviours in real-world scenarios. There has already been some research that suggests it could be as effective as “traditional” face to face CBT and this research ongoing.

iCT-SAD typically involves the use of a secure online programme with self-study modules, videos, stories from people who have already been through the treatment and sometimes a “virtual audience” you can practice with. The self-study modules will be tailored to you. You can access the programme whenever you wish. You would have weekly short calls with a CBT therapist and some longer calls where needed for specific techniques. You would also have the option for SMS reminders and encouragement throughout the week and you would be able to contact your therapist via messaging in between sessions.

What about self-help CBT?

The NHS social anxiety webpage states “self-help can help reduce social anxiety and you might find it a useful first step before trying other treatments”. Although therapist led NHS Talking Therapy (via CBT) is the key recommendation, self-help CBT approaches can be useful if you are not yet ready to see a therapist, are on a waiting list, or you prefer to start working on your social anxiety at your own pace. See our pages on self-help.

How to access CBT?

You can access talking therapies, including CBT, through the NHS. You can usually refer yourself directly to your local talking therapy service without a referral from your GP. Alternatively, your GP can refer.

You will then be offered an opportunity to speak with a clinician about your difficulties and consider what treatment and/or service would be best suited to support you and your current needs. The NHS NICE guidance recognises that attending a doctor’s appointment – or talking to a clinician – can be very difficult for those with social anxiety. It provides a series of recommendations to make communication and appointments easier. You may be able to ask your GP to ring you rather than you having to attend the GP practice in person. You could ask friends or family to help you make the first phone call. You could ask your health and social care team to communicate with you over text or email.

You can also self-refer – find details of your local NHS Talking Therapies service here.

Different areas often have different service providers and policies, and the waiting times might vary. This might mean you want to choose a different way to access therapy, and you might want to work with a therapist privately, self-funded or through a health insurance policy.

If you are going to work with a private therapist, it is important to find the right one. In the UK, ‘therapist’ is not a protected title which means anyone can call themself a therapist. We recommend checking if they are ‘accredited’, which means they are governed by a professional body (in the UK, this is BABCP for CBT therapists). More information is included on our pages on finding a private therapist.

Common Misconceptions

The idea of simply changing our thoughts might suggest CBT is a simplistic therapy.

“It’s just positive thinking”.

CBT is not simply learning to think more positively. It involves identifying and changing unhelpful thinking patterns into more realistic and balanced thoughts to see if there are other ways to view ourselves or situations. It’s not about ignoring problems but addressing them in a constructive way.

“NHS CBT is too short, I can’t fix all my problems in this time”.

When you have been experiencing our difficulties for a long time, you can often feel like a short-term intervention is not enough support. While CBT is often more short-term compared to some other therapies, it’s not an overnight solution. It requires commitment and practice over time to see lasting results.

“It ignores the past”.

CBT does focus on ‘the here and the now’. It looks at how thoughts and behaviours in the present maintain the effects of the past. This can include exploring how past experiences influence current thought patterns, but the emphasis remains on the present and future.

“It’s too structured and rigid”.

While NHS CBT (via therapist-led Talking therapy) has a structured framework, it’s not overly rigid. Although there are guiding protocols for treating social anxiety in general, every client and therapist are different, and the therapy is tailored to the specific client’s needs.

Conclusion and Links

For further exploration and a deeper understanding of CBT:
NHS website: Overview – Cognitive behavioural therapy (CBT)
NHS website: How it works – Cognitive behavioural therapy (CBT)
British Association for Behavioural and Cognitive Psychotherapies (BABCP) website: What-is-CBT
MIND provide valuable insights into the nature and practice of CBT including video: Cognitive behavioural therapy (CBT)