Social Anxiety Formulation

This Social Anxiety Formulation worksheet is designed to help therapists and clients to develop an idiosyncratic case conceptualization of a client’s social anxiety.

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Editable version (PPT)

An editable Microsoft PowerPoint version of the resource.

Overview

People suffering from social anxiety disorder (previously known as social phobia) experience persistent fear or anxiety concerning social or performance situations that is out of proportion to the actual threat posed by the situation or context. They fear negative evaluation and worry excessively about social events and outcomes, both before social situations and afterwards. Common fears include speaking or acting in ways that they think will be embarrassing or humiliating, such as shaking, sweating, blushing, freezing, appearing stupid or incompetent, or looking anxious. They fear that other people will judge them negatively, for example that they appear anxious, stupid, crazy, boring, dirty, or unlikable. They therefore make efforts to ensure that their fears do not materialize, resulting in clinically significant distress and impairment, often across multiple domains of their life. The Social Anxiety Formulation worksheet is designed to help therapists in developing a nuanced understanding of the components underlying their client's social anxiety. Therapists can use this tool to help clients map their experiences and understand how their anxiety is maintained.

Why Use This Resource?

Using this worksheet can lead to more effective, targeted therapeutic interventions for social anxiety:

  • Explores the specific social situations that trigger anxiety.
  • Analyzes the client's negative thoughts and predictions.
  • Explores how the client's self impression affects their emotions and behaviors
  • Identifies safety behaviors that might be maintaining anxiety.

Key Benefits

Insight

Offers a detailed framework to understand the components of social anxiety.

Maintenance

Helps clients to understand why their experience of anxiety does not get better by itself.

Clarity

Helps in identifying patterns that sustain anxiety.

Process

Guides the clinician through the formulation process.

Who is this for?

Social Anxiety Disorder

Clients fearing negative evaluation in social or performance situations.

Performance Anxiety

Individuals experiencing disabling anxiety in situations like public speaking or group interactions.

Self-Esteem Issues

Clients who equate self-worth with social performance.

Integrating it into your practice

01

Assess

Gather information about specific situations in which a client's social anxiety is triggered.

02

Explore

Explore the client's negative self-perception, emotions, and behaviors.

03

Connect

Help your client draw connections between their cognitive processes, emotional reactions, and safety behaviors.

04

Identify

Collaboratively identify strategies to explore, test, or challenge unhelpful beliefs and behaviors.

05

Develop

Formulate a personalized treatment plan based on this detailed understanding.

Theoretical Background & Therapist Guidance

People with social anxiety believe that social situations pose a danger. They fear negative evaluation, believing in particular that “(1) they are in danger of behaving in an inept and unacceptable fashion, and, (2) that such behavior will have disastrous consequences in terms of loss of status, loss of worth, and rejection” (Clark & Wells, 1995).

People with social anxiety worry excessively about these events and outcomes, both in anticipation of social situations and afterwards. Common fears include speaking or acting in ways that they think will be embarrassing or humiliating, such as shaking, sweating, blushing, freezing, appearing stupid or incompetent, or looking anxious. They fear that other people will judge them negatively, for example that they appear anxious, stupid, crazy, boring, dirty, or unlikable. People with social anxiety make efforts to ensure that their fears do not materialize, resulting in clinically significant distress and impairment often across multiple domains of their life.

Clark & Wells (1995) proposed a cognitive behavioral model explaining the persistence of social anxiety. This model identifies dysfunctional beliefs, perceived social danger, and self-focused attention as central to social anxiety. It highlights how self-monitoring and safety behaviors can maintain anxiety by skewing perceptions and inhibiting corrective feedback. Understanding this model helps therapists address key components maintaining a client’s anxiety, aiding effective intervention strategy development.

What's inside

  • Comprehensive guide for formulating social anxiety.
  • Sections to document client's thoughts, self-impressions, and behaviors.
  • Prompts to encourage client introspection and therapist-client discussion.
  • Structured framework for therapy planning and intervention.
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FAQs

The worksheet breaks down social anxiety into its cognitive components, helping clients and therapists to develop a shared understanding the client's difficulties.
Begin with current experiences and gently guide them towards understanding how past events may influence their present thoughts and behaviors.

How This Resource Improves Clinical Outcomes

By clarifying the psychological mechanisms which are believed to underpin of social anxiety, this worksheet helps clinicians deliver more focused therapy, aiming for cognitive change, reduced avoidance, and improved social functioning. Therapists can develop tailored interventions that better address each client's unique challenges.

References And Further Reading

  • Clark, D. M. (1997). Panic disorder and social phobia. In D. M. Clark & C. G. Fairburn (Eds.), Science and practice of cognitive behaviour therapy. Oxford: Oxford University Press.
  • Clark, D. M. (2001). A cognitive perspective on social phobia. In W. R. Crozier & L. E. Alden (Eds.), International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness. Chichester: John Wiley & Sons.
  • Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press.
  • Warnock-Parkes, E., Wild, J., Thew, G. R., Kerr, A., Grey, N., Stott, R., ... & Clark, D. M. (2020). Treating social anxiety disorder remotely with cognitive therapy. The Cognitive Behaviour Therapist, 13, E19. https://doi.org/10.1017/S1754470X20000233
  • Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester: John Wiley & Sons.