Stages Of Social Anxiety

People who suffer from social anxiety disorder (previously known as social phobia) experience persistent fear or anxiety about social or performance situations that is out of proportion to the actual threat posed by the situation or context. Anxiety provoking situations might include talking in groups, meeting people, going to school or work, eating or drinking in public, or public performances. 

It is common for socially anxious individuals to worry extensively ahead of a social event, and to engage in safety behaviors. While in the situation, they usually focus on how they feel. This can backfire, causing them to miss important social cues and negatively affecting their social performance. After a social event, they often ruminate on how badly they believe they ‘performed’, which often leads to self-criticism. 

The Stages Of Social Anxiety worksheet is a tool to record unhelpful socially anxious responses to social situations, and to map alternative ways of thinking and responding at each stage (before, during, and after a social situation). In addition to behavioral experiments, clients may find it helpful as a form of treatment plan or therapy blueprint for social anxiety.

Would you be willing to work with me to map out how you respond to social situations? We’ll break it down into what you do before, during, and after a social event.

Step 1: The problem. Choose a recent or typical example of when the client felt anxious before a social encounter. 

Ask the client to describe a recent example of when they felt anxious. If the client struggles to describe a recent example, ask them to recall any strong memory of feeling socially anxious. This can be made more vivid by asking them to close their eyes and describe aloud what they can see in their mind. Note that anxiety is likely not the only emotion present: embarrassment and shame are equally relevant for socially anxious individuals.

• Before (Anticipatory anxiety). Ask the client to describe their cognitive processes before a social event.  
  • "Did you imagine the event going terribly? (catastrophizing, predicting the worst)"
  • "Did you find yourself rehearsing what you were going to say, or how you would respond to particular questions or silences in conversation?"
  • "Were there any other safety behaviors you used before the event?"
• During (Excessive self-focus). This links to the center of the Clark & Wells model (‘Processing Self as a social object’). Ask the client what types of internal information they paid attention to while the event was happening, and whether they used any safety behaviors. 
  • "What was going through your mind at that time?"
  • "What was happening in your body? Did you feel hotter or more tense than usual?"
  • "Was there anything you did to prevent your fears coming true? For example, did you only speak when spoken to, or find yourself checking your phone a lot?"
• After (Dwelling on what went wrong). This targets what Clark & Wells describe as the ‘post-mortem’, or ‘post-event processing’. Ask the client to write down what aspects of the event they focus on, how it makes them feel, and how it excludes positive or neutral information. 
  • "What were you dwelling on after the event? What did you replay in your mind?"
  • "What is your strongest memory of what happened?"
  • "What were the worst bits that you remembered?"
  • "What could you have done better?"
  • "What do you say to yourself when you’re looking back at the event and judging your performance?"

Step 2: The solution. Explore other ways of responding in that situation.

Use the lower section of the form to record alternative ways of thinking and responding to each stage of the social situation (before, during, and after). These might be strategies that have been explored in previous behavioral experiments, or planned / hypothesized approaches.

• Before (Calming down). Use Socratic questioning to help the client to find alternative ways of coping. 
  • "Before a social event, what are the other things that you could do apart from being in your head worrying?"
  • "Are these concrete worries that can be acted on, or are they hypothetical worries that need to be postponed?"
  • "What things have we worked on previously that could be useful in this situation?"
  • "What distraction techniques might be helpful here?"
• During (Notice what is actually happening). Encourage the client to switch their focus of attention from internal to external. Attention training or task concentration training are useful skills to assist with this. 
  • "What skills have we practiced that would help you to focus externally rather than internally?"
  • "Where will you pay attention to during a social situation?"
  • "What safety behaviors will you need to reduce? What will you do instead?"
• After (Focusing on what went well). After the event, the client should attend to what went well in addition to what didn’t go well. This can be done using a positive data log or by asking the client to attend to the positive aspects of the event, such as people giving them positive feedback, laughing at their jokes, or nodding with interest when they spoke. 
  • "What went well?"
  • "Would you be able to make a note of the best things that happened?"
  • "Sometimes the best way to ensure that you remember the good things that happened is to use a positive data log. Would you be willing to try using one about your next social event?"

Clark, D. M., Wells, A. (1995). A cognitive model of social phobia. In R. Heimberg, M. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press