CBT for Social Anxiety Disorder: Using downward arrow and thought challenging techniques

Case study example for use in teaching, aiming to demonstrate how the downward arrow technique and thought challenging might be used in CBT for social anxiety disorder. The character of Hannah is played by an actor (Malak El-Gonemy), but the scene is not scripted, and as such it represents a natural therapeutic exchange.

The video was filmed and produced by Ishan Siddiqui and Christopher Werrett.

[veryemotionallyattachedtos]

the worst thing about social anxiety is that you know your fears are dumb but you can’t help it

[paulparker]

i commented on this page 3 years ago and to see my comment today really brough home how much i have overcame social anxiety over the last 3 years, i never thought i would get to this point but the only answer is to put yourself into situations that bring on the anxiety, if your mouth is trembling, hands sweating, you just have to push through it, if i can do it anyone can !!!!

[trentjackson]

Social anxiety comes from a deeper source that causes it, perception and perspectives. Expectations of others or self. Self image, and self worth.

[misseli]

I relate to that girl so much, it made me cry

[lillianinspace]

Social anxiety, I will overcome you. I swear it.

[ghostinthenetworks]

There’s a lot of shame around anxiety. It’s not just that you will be alone at work it’s also that you’re ashamed that other people don’t care about you

[barkerjonty]

I really struggled with Social Anxiety Disorder. It started when I was 18 at school, I became overwhelmed by humiliation and embarrassment. This caused a core belief to develop which was the fear of rejection and scrutiny of my perceived failures. This essentially creates a lack of confidence, or hopelessness. Prior to those years experiences like that were like a water of a ducks back. However, when the brain is exposed to fear the brain develops very strong distorted beliefs. The Amygdala part of the brain (Anxiety centre) has no sense of time, therefore it can feel you are stuck in time with your fears today. Similar actually to PTSD, you are reliving those experiences. So before I continue, go back to that event and try to see any distortions using CBT. Then after doing that, see where your generalisations are today, you might find you are repeating certain thought distortions like Emotional Reasoning and Mind Reading. Freaky!

To change your illness or neurosis, you have to change your core beliefs, which are only changed through repeated exposure to those fears you believe you cannot deal with. Like the fear of failure. I believe you can deal with them, you just need the right therapist to aid your self confidence in doing it. Think of it like a sport, the more you play the better you get. Or watching the 12 Monkeys with Brad Pitt. The more you watch it, the more you understand in it and your beliefs about the film or experience has changed.

Automatic thoughts are from your core beliefs ultimately. If CBT has failed you before, you are not alone. A therapist needs to tell you that in order to change a heavily ingrained anxiety disorder or depressive/personality disorder is to look for new evidence that your core belief is distorted. DBT can also be very good at slowing down and controlling your internal judgments. So when you are in the transition of changing your core beliefs, you can slow down and not react to the automatic negative thoughts. I really recommend that. This will give you a sense of self confidence which is really what has been lost, or never achieved.

The brains neuroplasticity will not change over night. Your brain will not believe the rational things you tell yourself when you create new experiences that may be true. This is so important to understand because this is why people give up. Have you Ever had CBT before experienced change then relapse. This is because your core belief is fragile and resilient to change. The brain will not give up sadly on your neurotic beliefs. If you stick with your own CBT and work hard you will change. If you find a very good CBT therapist who understands this, it will help you tremendously to move forwards and achieve new goals.

Another way at looking at changing your thoughts and beliefs when someone ever says you shouldn't be anxious over this or that, and they show you what your thinking is wrong. Then you know on an intellectual level its wrong, but you struggle with believing it. How could the human brain be so fallible! Only one reason why, that's because we are all fallible. So when you damn yourself because of your condition, learn not to you. This goes out to perfectionists. Sure, you can get one hundred percent on an arithmetic exam, but not forever on other exams. This would be God like, so when people troll me, or someone exceptionally talented like, "Lionel Messi" or for girls "Serena Williams" know that this unreasonable critic will fail and sadly will have developed a rotten attitude towards others failures. At school this is called a bully, they do not want to show their failures. If you can remain calm you might try to show them their own. If they become overwhelmed with anger or attack you then learn self-defence so you can show them their epic failure to attack you. Wow how humiliating!

The good news is that you can bring Social Anxiety back down to a manageable level. It would be perfectionistic of you to say I want to get rid off my anxiety. Mostly everyone has social anxiety at some point, however the difference is the core beliefs between the two extremes. One is at ease with themselves and remains in the social situation relatively unchecked. They believe they are confident with exposing their weaknesses, their failures. They know they are fallible and will make mistakes and others will scrutinise them. For them this is sometimes difficult to accept. Sometimes the scrutiny is correct, the difference? they will allow others to do that knowing they can always become better at something, while the latter will most likely be Personalising this. This is a thought distortion in social anxiety, it is when the fear suddenly becomes aroused and you become anxious, angry and very defensive. Something you will have to change, and you will. If you work on these core issues, you will be open to new relationships and be willing to show your true self under different circumstances. You may end up in a romantic relationship where you will handle conflict with ease, because your partner may be right about your failings. You will accept it and work on it. You will become better at that performance if you like. So good luck to all of you.

Two books I recommend: The Anxiety And Worry Workbook by David A.Clark, PHD. Arron T.Beck, MD. And 2nd Ed Mind Over Mood for Self-Help.


"Initial changes are temporary.

Your brain first records the change, then determines whether it should make the change permanent or not. It only becomes permanent if your brain judges the experience to be fascinating or novel enough or if the behavioral outcome is important, good or bad."

[hypercortical]

I didn't expect this video to make me feel nervous.

[paulparker]

social anxiety or anxiety in general is horrible, im 29 and its really held me back, isolated me, i live such a mundane life, i cant walk down the street in my local area incase i bump into someone.ive blocked my friends out over the last few years and stopped going to things but one thing i know for sure is that i will i overcome to an extent where i can deal with.watch this space

[tt]

For me I feel like I burden my friends with constantly talking about feeling anxious or negative self talk that I don’t talk to them about how I’m feeling cuz I feel like they won’t like me if I’m constantly a negative person. That I’ll kill the party vibes. So I end up feeling alone with my issues which makes it worse.

Can anyone relate to the feeling of being isolated with your thoughts?

[immaculate]

I’m 27 now and social anxiety has absolutely held me back and was destructive since I was as young as I remember. I feel as if I’m maybe moving forward now as I’ve kicked a video game and almost a mad marijuana addiction I used to hide from social anxiety and recently started taking care of myself and being more mindful over the past 2 years. Just in the past few months I started challenging the fears as much as I could. I hope this is finally the direction towards healing and making it through this. it has affected my relationships with everybody including my daughter at times. Don’t stop moving forwards.

[IsaacCordingley]

love this exercise. I gave it a go tonight following the same method and went from 80% of feeling i'm weird, make people uncomfortable and are annoying to feeling more around 35%.

[beazuzmcceasar]

... we can't all be amazing. I think ACCEPTING that we are crap with some things and aren't afraid to admit it helps :) social anxiety is all about protecting our ego. Once we accept what we struggle with and can see it face on it makes things easier.

[cycleinspect]

I would avoid using the same 'what would be so bad...' line of questioning for this technique. If you use this repeatedly it starts to give the impression you are minimising your clients suffering. Consider using phrasing such as 'if that were true, what would that say about you?' or 'what does that suggest?' or 'why does that bother you do you think?

[cheyteav]

Wow, this made me tear up, it made me nervous and just.. very emotional. Diagnosed with social anxiety most of my life. It has been 4 years since I left my therapist, she left a bad taste in my mouth because she didn't keep things confidential that she promised to. Recently though, I have been considering trying another. It scares the hell outta me to talk to someone but I have been only getting worse and feel I need to push out of my safe zone. I have heard wonderful things about CBT and, this video helps understand what I will be getting into & makes me a bit less anxious..
I am just so bad at opening up, It will take time to trust a new therapist...

[milk]

Been feeling like this since 2nd grade. I’m a junior now. I feel like there’s no hope. I’ve built up this persona of the quiet/shy kid for years and even if I tried to break it all down it would be so hard

[javierpacheco]

I've been dealing with social anxiety since I started high school. I always feel like people will ignore me or judge me, since most people are fake in high school. I'm still struggling with it and I'm in college, I want to give my truthful opinion on things, but for some reason I get nervous and scared when that happens and I always get left behind. I want to change but it's really hard. I understand what that girl feels and says. I want to talk again, I want to enjoy my life again, I want people to know me and not know me as the quiet kid who is serious and strange. Thinking too much before talking and being socially anxious has negatively impacted my life. I'm meeting a counselor now and I'm getting better. Anyone that struggles with this, I hope you overcome it becuase it's difficult even as a young adult like me knows this is difficult. Good luck and take care guys and let's defeat our social anxiety.

[mariaolzoeva]

Thank you for this video! It might help me to overcome my fear and dislike of therapists, I've been skipping my sessions for a while now, and watching videos like this might help me realize it's actually not that scary and can be helpful C:
Also thanks to the patients, and this nice lady in particular, I imagine it might have been hard to speak about your personal matters on camera and having it watched by thousands :)

[ocaeocae]

As someone who doesn't actually have friends, this video was painful to watch and discouraged me from seeking counseling...I feel like it would just confirm what I am afraid of. Which, yes, I realize is probably even more of a reason to speak to someone to understand why I can't keep friendships, but the fear of having to confront that maybe I really am not worth a damn, is more than I can bear at the moment. I'll keep my head in the sand for now, thank you.

[nicoyadraws]

I’ve had social anxiety for most of my life but it was quite mild when I was younger and over the years it’s gotten worse and now even the thought of doing something like speaking in front of people sends me into a mini panic attack and it makes me scared for the future because I am unable to feel ok existing around people without feeling judged. I can’t live like this forever but I’m so scared to do certain things that I’d truly rather die. My family always says to take hold of my fears but I don’t think they truly know how hard it is for me to try and do that since if it were that easy I would have overcome it by now. I am also worried to seek professional support in fear of opening up about how I feel but I hope that one day in the future it won’t be as bad as well as the other many people who suffer.