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What Keeps Social Anxiety Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, they provide an easy way for clients to understand at a glance why their disorders persist, and how they might be interrupted. What Keeps Social Anxiety Going? is designed to help clients with social anxiety understand more about their condition.

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A PDF of the resource, theoretical background, suggested therapist questions and prompts.

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Languages this resource is available in

  • Chinese (Simplified)
  • English (GB)
  • English (US)
  • Italian
  • Spanish (International)

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Introduction & Theoretical Background

Do you ever feel anxious when you’re around other people, or if you might have to be the center of attention? Do you worry that other people will notice something about you – or about the way you behave – and judge you for it? Social anxiety is the name for feeling these kinds of fears in social situations. Symptoms of social anxiety disorder include:

  • Feeling self-conscious and anxious in social situations where you might be exposed to scrutiny by other people.
  • Fear that you will behave in a way that will be judged negatively by other people.
  • Avoiding social situations, or enduring them with great difficulty.
  • Worrying about what other people think of you.

Research studies have shown that Cognitive Behavioral Therapy (CBT) is one of the most effective treatments for social anxiety (Mayo-Wilson et al, 2014). CBT therapists work a bit like firefighters: while the fire is burning they aren’t very interested in what caused it, but are more focused on what is keeping it going. This is because if they can work out what keeps the problem going, they can treat it by ‘removing the fuel’ and interrupting this maintaining cycle. 

In 1995, psychologists David Clark and Adrian Wells published an influential model of social anxiety which identified the key components that are thought to explain why some people’s social anxiety persists. The What Keeps Social Anxiety Going? information handout describes some of these key factors, which maintain social anxiety. It illustrates these maintaining factors in a vicious flower format in which each ‘petal’ represents a separate maintenance cycle. Helping clients to understand more about the cognitive model is an essential part of cognitive therapy for social anxiety (Warnock-Parkes et al, 2020). Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences of social anxiety.

Therapist Guidance

“One interesting way of thinking about social anxiety is to look at why, for some people, it does not get better by itself. This handout shows some of the most common reasons why some people’s social anxiety persists. I wonder if we could look at it together and think about whether it describes some of what is happening for you?”

References And Further Reading

  • 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 (pp. 69–93). New York: Guildford Press.
  • Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376.
  • 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.