Challenging Negative Thinking

This involves looking at the thoughts associated with social anxiety and examining them to see if they are really ‘rational’, or if there are other, more helpful ways of looking at things. You may be able to identify the thoughts that upset you, or you may need to spend some time trying to recall what goes through your mind when you feel anxious. If that is the case, think back to a situation that you recently found difficult, and identify what came into your mind when you began to feel nervous or embarrassed. Which thoughts was it that triggered your anxious feelings?

Modifying the way you think is accomplished by regularly completing thought records, where you write down the thoughts that are upsetting and then trying to come up with alternatives that make you feel better. These thoughts should be rational and realistic, so that you are able to believe them, rather than unrealistically positive.

For example, if you were at a party, talking to another guest, and the conversation dries up, you might be thinking something along the lines of ‘I’m so useless’ or ‘I never have anything to say’ or ‘they must think I’m so boring.’ You might consider the following alternative thoughts: ‘Many conversations don’t necessarily go anywhere; the other person is also not saying very much’ and ‘I don’t know what they are thinking – they could also be worrying the gap in conversation is their fault!’ You will also record things such as how much better (or not) the alternative thoughts make you feel, and how you might approach things differently in the future if you are struggling to make conversation.

An example of a thought record sheet can be found here.

Trying to be more balanced in thinking can help disarm unhelpful thoughts and lead to healthier behaviours. For example, instead of thinking “Something might go wrong, and it will be an awful disastser” it might be more helpful to think “something might go wrong, but I’m sure it won’t be horrible, and I will survive”, or “something might go wrong, or it might not; I’m sure I will be alright”. The idea is not to convince yourself that everything will go perfectly, but to create a kinder and more balanced thought process which leads to being able to face more situations.

Re-examining your thoughts can also include identifying whether you tend to automatically fall into particular patterns of biased thinking, such as:
Mind-reading assuming you know what others are thinking about you: ‘they must think I’m so anxious/quiet/ridiculous/boring’
Fortune telling predicting the future: e.g. you will never be able to feel comfortable in conversation, or you will never be able to make a telephone call to someone you don’t know
Discounting the positive ignoring all the positive feedback you received for something and focusing on the one negative comment
Projecting in the context of social anxiety, believing that because you believe something negative about yourself, other people think that about you as well
Overgeneralization thinking that if one situation had a negative outcome, all other similar situations will also have negative outcomes
Catastrophizing where you believe that if anything goes wrong it will be a disaster.
Emotional reasoning mistaking your feelings for facts: if you feel inadequate, assuming that you must be inadequate.

Over time, the repeated practice of new ways of thinking can change neural pathways in your brain, meaning that you automatically think more positively!

Focussing attention and reducing self-consciousness

If you have social anxiety, it may be hard to focus on what’s actually happening in social situations. You may feel excessively self-conscious, which means you might try to monitor other people’s reactions to you, worry how you are coming across, and get distracted by your own negative thoughts and feelings. This in turn can make you want to escape from the situation as quickly as possible.

In CBT you will practice shifting your attention away from nagging negative thoughts and learn to direct more of your attention outwards to what is happening around you. This is similar to mindfulness, which is about learning to pay attention to the present moment. Not the present moment in terms of anxiety feelings, but to the people and situation you are engaging with. You can start with easy situations where it is relatively easy to shift your consciousness from your own thoughts or feelings, to something outside yourself, such as a piece of music or the street you are walking on, or anything that interests you in your surroundings. Then when you are able to do this in easier situations you can practise the same techniques in social situations.

Focusing your attention outwards will help you to engage with others more fully and to give less weight to your unhelpful thoughts and feelings. When you get better at this, you may find that other people do not pick up on your social anxiety as much as you expected, as it mostly feels worse than it appears outwardly. Or, if they do, they may not be as judgemental about it as you fear.

Behavioural experiments and hierarchies

Behavioural experiments are intended to test out negative predictions about social situations, and to help you stop using safety behaviours so that you are more free to be ‘yourself’ (or a version of yourself with less social anxiety).

Using hierarchies to confront your fears and gently expanding your comfort zone needs to be done carefully. Too much behavioural exposure too soon can be unhelpful! It’s important to start small with situations that don’t cause too much anxiety and build up gradually.

Hierarchies usually involve making a list of anxiety-provoking situations, and scoring them from lowest to highest according to how anxious they make you feel. These may be situations that make you uncomfortable, or ones you would avoid altogether. For example:

You then work your way through the hierarchy, starting with the least scary and ending with the most terrifying. For each situation, you write down your predictions about what you think will happen, and identify in advance the things you may try and do in order to ‘prevent’ negative occurrences. The latter are known as ‘safety behaviours’.

Safety behaviours actually increase anxiety in the long term, because they give the illusion that they are protecting you from the negative judgements of others, and that social situations are indeed dangerous. If you avoid speaking in meetings, every time it happens you feel you have avoided something bad happening, and that you need to continue the behaviour. But if you don’t speak up, you might never learn that your contributions are as welcome as anyone else’s. We need safety behaviours at times: they are part of fight or flight mechanisms that help us run away from predators and avoid oncoming traffic. But they are less helpful when you run away from that attractive person you’d really like to get to know, or when you’re trying to make friends, or in the vast majority of social situations.

You record the results of behavioural experiments on worksheets similar to thought records. Once you have practised dropping safety behaviours and behaving differently, you may find that situations turn out better than you thought, and you may begin to feel less anxious about them. And also that even if things do go wrong, or less smoothly than you’d like, it is generally not as catastrophic as you predicted.

For example, you may be conscious of your shaky hands in social situations and grip items tightly to prevent others from seeing them. You may have the thought “if I loosen my grip people will see my shaking hands and think something is wrong with me”.
As an experiment to see whether this is the case, you can stop trying to conceal your shaky hands and focus on the social activity. After the experiment you can note if your shaky hands were noticed by others. Did your predicted outcome take place, did you cope in the situation regardless?
To help create confidence, you can think of these as experiments as gathering evidence. More experiments can be done to monitor what happens if you continue to act freely without monitoring for physical symptoms of anxiety and focus on the situation in question.
Experiments may help someone with social anxiety gather evidence to challenge unhelpful thoughts and realise that some thoughts aren’t true, and even if they are they survived regardless.

Challenging beliefs

CBT also examines beliefs. Our thoughts and behaviours stem from our beliefs, which are a set of underlying assumptions about ourselves and other people. Beliefs that perpetuate social anxiety might include things such as ‘other people never like me’, or ‘other people are mostly hostile and critical’. They are probably based on negative experiences you have had in the past, or you may not know why you came to hold them. But beliefs can also be outdated and unhelpful, even if at one time they seemed useful (such as keeping quiet to avoid being bullied). But in the long run they can prevent you from making progress with social anxiety.

As with negative thoughts, the process starts with trying to identify the difficult negative beliefs you hold that may stop you from making progress. Then try to re-examine them: are things really as absolute as you think? Are you forgetting that no one is perfect? Or jumping to conclusions because of your experiences when you were younger? Unhelpful beliefs can be challenged in a similar way to unhelpful thoughts. You can start to look for new information: very often we only notice things that confirm our beliefs (this is known as confirmation bias). You may notice the person that frowned at you, and ignore the one who smiled.

Building up new and more positive beliefs should help you to feel more confident in yourself. As with previous techniques, you need to work out which new beliefs are going to work best for you. It’s important that the beliefs are realistic and you can actually believe them.

Practising and repetition

Regular and consistent practice is one of the most important factors in using CBT. This can be difficult, as it may initially increase anxiety, and maintaining the motivation to confront feared situations, even when some may not go well, is key. It can also be quite time-consuming.

You may find that while you can agree with new thoughts intellectually, you find it hard to ‘feel’ them and believe them. This is why CBT can be quite repetitive: the more you practise new thoughts and behaviours, the more they will start to become second nature, until gradually they become automatic, and you begin to feel better.