How I Work

Cognitive Behavioral Therapy (CBT) for Social Anxiety

Can therapy help social anxiety? Yes! Social anxiety disorder responds very well to therapy. Many therapists simply rely on CBT, but I draw on three complementary approaches.

Cognitive Behavioral Therapy (CBT) for Social Anxiety

CBT is the most extensively researched treatment and evidenced-based treatment for social anxiety disorder. It targets the thought patterns and avoidance behaviors that keep anxiety running.

CBT is based on the idea that our thoughts, feelings, and behaviors are interconnected. In social anxiety, the brain generates distorted predictions such as the belief that others are constantly watching and judging. You believe that showing any anxiety will be catastrophic and the social failure will be permanent and definitive. These predictions feel completely true, but they usually aren’t.

In CBT sessions for social anxiety, we work on:

• Identifying the specific thought patterns driving your anxiety
• Examining the evidence for those thoughts and developing more balanced perspectives
• Exposure. Gradually and systematically approaching feared social situations rather than avoiding them. The key word is gradual! We will collaboratively determine pace that works for you.
• Dropping safety behaviors (the subtle strategies used to get through situations) that maintain anxiety
• Attention retraining. Learning to focus away from your internal monitor and toward the actual situation

Acceptance and Commitment Therapy (ACT) for Social Anxiety

ACT takes a different approach: rather than fighting anxious thoughts, you learn to change your relationship to them so they have less power to determine what you do or don’t do.

The core premise of ACT is that the struggle against anxiety is often more costly than the anxiety itself. When you avoid every situation that might trigger social anxiety, anxiety wins by steadily shrinking your life. ACT helps you move toward the things that matter, even while anxiety is present.

Core ACT skills for social anxiety include:

• Acceptance: making room for anxiety rather than fighting it, which paradoxically reduces its intensity and duration
• Present-moment awareness: developing the capacity to be in the actual conversation, rather than lost in self-monitoring
• Values clarification: getting clear on what actually matters to you and acting from those values
• Committed action: taking steps toward meaningful social goals even in the presence of anxiety, rather than waiting until the anxiety disappears

Psychodynamic Psychotherapy for Social Anxiety

For some people, social anxiety has roots in early experiences of shame or humiliation, in relational patterns learned in formative relationships, in a core sense of self that feels fundamentally inadequate or flawed. Psychodynamic therapy explores this terrain.

Where CBT and ACT focus primarily on the present, psychodynamic therapy asks the deeper question: where did this come from? Understanding the origins of social anxiety often changes it in ways that skill-building alone cannot.

In psychodynamic work for social anxiety, we explore:

• Early experiences of embarrassment, humiliation, rejection, or criticism and their lasting effects
• The relational patterns formed in childhood that contribute to current social fears
• The role of shame. A deeper sense of being fundamentally defective

I often integrate elements of all three approaches. This includes building insight through psychodynamic work, changing specific patterns through CBT, and developing acceptance and direction through ACT. The balance depends on who you are and what you most need.