Coping with Social Anxiety Group Manual - Steps 2 Wellbeing

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Coping with Social Anxiety Group Manual

Name:

Facilitators: Kelly Gear and Hannah Lale

Our phone number: 023 8027 2000 or 0800 612 7000

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Welcome to the ‘Coping with Social Anxiety’ course.

You may be feeling a bit anxious on starting the group, most others will be (maybe the facilitator

too!). However we’ve run similar courses many times, and found that most people who complete it

have benefitted in some way from it. The techniques included in the course are based on sound

evidence to prove that they are effective for people with problematic social anxiety. Here is some

information about getting the most from the course.

It’s a 12 session course, and to get the most from the course it’s really important to attend all 12

sessions. However we realise that from time to time things happen that may stop you making a

session. Firstly please ring in, ahead of the session if possible, and let us know; if we don’t hear from

you we will try to call you. If you miss more than two sessions you may be asked to leave the group,

but we will try to offer you an alternative, although you will need to start again. If you do miss a

session, make sure that you get and read the relevant pages of the book, and try to do any

homework tasks.

If things get bad:

If you experience suicidal thoughts at any point please ask to talk in private to the facilitator. If you

have ever experienced such thoughts before, think about making a plan, things people find useful to

include in a plan might be: how to look after myself (e.g. making a warm drink; eating hot food;

taking a bath or going for a walk or listening to music); seeking support from others (is there a

trusted friend or family member you can talk to?); and be ready to ask for professional support, this

would be your GP, or their out of hours service. Emergency psychiatric assessment is also available

from A&E departments. The Samaritans provide a listening service for those in need (0845 7 90 90

90).

Who are we?

Steps to Wellbeing is the local NHS service for people experiencing anxiety or depression. We’re a

friendly team of mental health professionals, and we provide a mixture of group work and one-to-

one work both in person or face to face.

This is a ‘Step 3’ group. Step 1 is your GP. Step 2 is mainly delivered by phone. Step 3 is for

problems that can’t be resolved at steps 1 or 2. If you have previously been to a Step 2 group the

main difference is that at Step 3, although there are some ideas that we will want to explain to the

group each week, the dynamic in the group comes from what the participants bring to it. We will

look to you to be willing to take part in exercises; and to share some of your thoughts and

experiences, both about how your problem affects you, and how you get on trying out these

techniques. However there is never any pressure to share anything you don’t want to.

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An Overview of the Course:

Week 1: Getting to know each other; how we’re going to work together; an

introduction to CBT.

Week 2: Hierarchy of exposure; Goal setting

Week 3: An introduction to anxiety and how it affects the body

Week 4: Spotting negative thinking; and an introduction to unhelpful thinking

habits

Week 5: Challenging negative thinking

Week 6: The Focus of attention

Week 7: The role of safety seeking behaviours

Week 8: Core Beliefs

Week 9: Introduction to skills work: Presentation skills; Introduction to the

‘The Project’

Week 10: Presentations week

Week 11: Feedback from ‘the Project’ & recap of skills

Week 12: Socialising skills: ‘online party’ and relapse prevention planning.

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Week 1: Ground rules:

In the first session you will be asked to take part in an exercise to generate some group ground rules.

These are about how to keep the experience of being in the group a safe, effective and pleasant

experience for everyone. Every group makes up their own ground rules, and each set is therefore

unique. This page is for you to write out what your group decides on.

Just in case you miss the first session the sort of things that it will probably include will be:

One person at a time to speak; no such thing as a silly question; show respect to each other; prompt

time keeping (especially coming back after coffee break); Although you can share the learning from

the group individual’s personal stories are not to be shared with anyone outside the group; switch

mobiles to silent; phone in to the office if you’re going to be away.

Our ground rules:

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Triggers are the situations that cause us fear. We interpret those situations with certain thoughts. If those

thoughts are negative thoughts they may cause anxiety. As we become more anxious there are a series of

changes in the body. The anxiety and the body changes may make the negative thoughts more catastrophic.

When people get caught in this vicious cycle they often adopt safety seeking behaviours: these are usually

about avoiding such situations; exiting; or neutralising (only focussing on the safe part of the situation, e.g.

talking to a known friend at a party).

Exercise: Can you match each of these parts of a problem to one part of the chart:

Julie watches all the soaps on catch up TV

Julie’s breathing is shallow and rapid.

Julie feels really tired.

Julie thinks about Stef’s brother, she hardly knows him, nor any of his mates.

Julie feels sick in the pit of her stomach.

Julie’s friend, Pat, rings to say that she is going out with her brother & some of his mates, & would Julie like to come along

Julie feels real fear

Julie rings her sister.

Julie has an image of herself with others laughing at her.

Changes in the body

Triggers

Anxiety

Behaviours e.g trying to avoid it

Cognitions

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1~3 Feel the fear and do it anyway.

Each time Max sees (or even hears) a dog she thinks the dog is going to attack her. She becomes

very scared (i.e. she has a ‘spike’ of anxiety) and she immediately runs away, and the anxiety

subsides.

Here we have measured the anxiety of three people who are scared of dogs,

Who is most scared of dogs? What will happen when they next see a dog?

Let’s assume that Max has done some work with their therapist and is now at Step 6, sitting with a

dog. We are going to ask her to spend a session sitting with a dog.

She is getting really anxious on the way to the room.

She’s on MAXIMUM anxiety when she sees the dog.

But the dog just sits quietly in the corner.

After a while it curls up in its basket. Max begins to think ‘if it was going to bite it would have done it

by now’, and little by little she relaxes. Look at the graph of what happened to her anxiety below.

What do the lines 1, 2, 3 etc represent here?

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Week 1 Task:

Diary keeping is an important part of CBT. Diary keeping has several

advantages:

It helps focus you on the things that you have learned, and thereby helps

learning

It boosts self-insight as you become more self-reflective

It helps to capture negative thinking as it’s then easier to challenge it.

This week we’re starting with a very simple diary.

Try to identify one situation in the week where you worried about what other

people thought of you and then fill this in:

What happened?

Where were you?

Who was there?

What did you notice about the situation?

What thoughts and images went through your mind?

How did you feel about that situation?

What did you do? How did you cope?

Did you do anything differently because you were feeling anxious?

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Week 2: Big fears and little fears…

How can we begin to bring about change, and help someone with an anxiety

problem?

Let’s start by thinking about the person who is scared of dogs.

One way to start would be to get that person to start ranking their most

feared dog encounter through to their least feared dog encounter. We could

do this on a 10 point scale, rather like a ladder with ten rungs on it:

Max is scared of dogs, and came up with the following list.

0: a picture of a dog in a book

1: A film about a dog

2: A very small dog on a lead in the park, a long way off.

3: A large dog on a lead, in the park.

4: A small quiet dog off a lead, in the distance, say in the far corner of the park, with its owner nearby.

5: A loud dog in the park a long way off, but barking and jumping around.

6: Sitting in the same room as a dog.

7: Sitting very close to a dog.

8: Touching a dog.

9: A dog running towards me.

10: Taking something out of a dog’s mouth.

This is Max’s ladder of feared situations. The technical name for this is a ‘hierarchy of exposure’.

The principle of Exposure and Response Prevention (ERP) is to get used to the trigger at

each step, through repeated exposure, before proceeding to the next step.

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2 Identifying triggers:

Before completing your own hierarchy of fears it may be helpful to do the following

questionnaire to identify how uncomfortable each situation makes you feel:

There are many differences between each person’s experience of social anxiety: the type

of situations that make you anxious may not make someone else anxious and vice versa.

This questionnaire will help you to understand your type of social anxiety.

How anxious, on a 5 point scale, [where 5= very anxious and 1= not at all],

do each of the following situations make you feel?:

(NA=not applicable, if this is a situation that you never encounter & you don’t think you will ever need to)

1Going to a party or social event: 5 4 3 2 1

2Speaking up at meetings 5 4 3 2 1 N

3Eat or drink in front of people

you don’t know well 5 4 3 2 1

4 Start and maintain a conversation 5 4 3 2 1

5 Talk on the phone 5 4 3 2 1

6 Entering a room by yourself 5 4 3 2 1

7Talk to someone you find attractive 5 4 3 2 1

8 Give a speech 5 4 3 2 1 N

9 Sign your name when watched 5 4 3 2 1

10 Attracting attention 5 4 3 2 1

11 Making a complaint 5 4 3 2 1

12 Taking clothing back to the shop 5 4 3 2 1

13 Being interviewed for a job 5 4 3 2 1

14 Approaching a stranger 5 4 3 2 1

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2 (cont) Now you can create your own hierarchy of fears:

This hierarchy (or ladder) of fears will be an important tool for you to plan

your own therapy. If you keep ticking off when you feel that you have

achieved each step (i.e. that you can cope with that situation with anxiety of

30% of less), you will then know what challenge you face next.

What is important is that at each step you spend time acclimatising and

getting used to that situation or environment.

First identify the situation that you feel most uncomfortable with (this may

be your goal situation); label this as step 10. Then think about situations that

you are completely comfortable with, these may for example be spending

time with close friends or family, label this at the ‘0’ point. Then try to

identify at least 5 intermediate situations between these two extremes.

You may want to score each situation with the anxiety it currently causes

you, as a %, and how much you avoid this situation, again as a %.

0: What I’m comfortable doing

1:

2:

3:

4:

5:

6:

7:

8:

9:

10:

Your Goal:

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Week 2 Task:

Look at the hierarchy of fears that you have created.

Think about where you are right now.

Then think about what is the next practical step up the ladder, and think

about what it would be like to go there. For example if your Step 10 goal is

to go to a party where you don’t know lots of people, but at the moment you

are at the point where you’re only comfortable with one good friend, or your

immediate family (Step 1), then think about what Step 2 might look like.

You might, for example, that this might be going out for an evening with your

best friend, and his/her best friend.

This week’s TASK is asking you to experiment with going up your ladder one

step, and then recording what happens.

My next step – what does it involve? Who with?

My prediction about what it will be like:

How anxious I felt before the event:

How anxious I felt after the event:

What it was actually like:

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Week 3.1: How the body responds to anxiety

This week we are focussing on how the body changes when it experiences

anxiety. The way the body works is its physiology. Using the chart below as

a prompt, list all the ways that the body’s physiology changes when the brain

experiences anxiety:

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Week 3.2 : How the body responds to anxiety:

Rate of breathing increases, so oxygen levels in the blood increase.

Heart rate increases, the heart beats harder, and blood pressure increases.

Blood flow is diverted from the core (digestive organs) to the periphery (limbs,

skin)

Blood vessels near the skin relax, increasing blood flow moving to the surface,

leads to feeling flushed or hot (& blushing), this in turn leads to sweating, resulting

in dampness and rapid cooling, so there may be alternating hot and cold.

Digestive system is slowed or switched off.

Rapid ‘Mexican wave’ contractions in digestive system can lead to churning

stomach or butterflies

Increased desire to pee or poo as the body tried to ‘lighten the load’

Reduced bloodflow to salivary glands leads to dry mouth

All skeletal muscles tense up, which can lead to tremors or shaking; neck, shoulder

or chest pain.

Pupils dilate (to increase peripheral vision) but leading to a loss of focus, ie blurred

vision.

Brain function changes, we become more instinctive and less rational or cognitive

This whole process is initiated by the release of a hormone called adrenaline from

the adrenal glands.

Liver releases extra sugar for energy, but has to cope with reduced blood flow.

Immune responses decreases.

Sexual response inhibited.

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Week 3.3 The Fight or Flight Response.

When we were evolving and adapting as early humans the threats we faced were very

immediate and very real. We needed to be able to respond quickly and effectively. Those

who could survived and reproduced, so we have inherited the brain mechanism that they

had: the fight or flight response. Imagine you face such a threat: What do you want to do?

Our emotions have a purpose. Our most basic emotions like fear, anger or disgust are vital

messengers: they evolved as signals to help us meet our basic needs for self-preservation and safety.

It would be dangerous to be indecisive about a threat to our survival so the brain runs information

from our senses through the most primitive, reactive parts of our brain first. These areas of the brain

control instinctive responses and they don’t do too much thinking. This more primitive part of our

brain communicates with the rest of our brain and our body to create signals we can’t ignore easily:

powerful emotions and symptoms.

The fight or flight response is a physiological response triggered when we feel a strong emotion like

fear. Fear is the normal emotion to feel in response to a danger or threat. Fear also has a close

relative we call anxiety. The Fight or Flight response evolved to enable us to react with appropriate

actions: to run away, to fight, (or sometimes freeze to be a less visible target).

So it is important to think of this as a normal response, but one which can be triggered too often, by

things which we perceive to be a threat to us. A good analogy is the smoke alarm. A smoke alarm is

designed to alert us to the danger of fire but it cannot distinguish between steam from the shower,

burnt toast or a house fire. While the first two examples are not real threats the third is but the

response of the alarm is the same: an irritating, uncomfortable and difficult to ignore alarm!

But for most of us life isn’t about fighting or escaping predators or enemies anymore. The fight or

flight response was designed to deal with feeling fear for our lives, but it is much more likely to be

triggered by more complex and subtle concerns: internal threats in the form of appraisal of

embarrassment in social situations. When we feel anxious or fearful about a presentation, job

interview, exam, or meeting new people the fight or flight response is triggered in our body and we

experience a range of strong, physical symptoms designed to temporarily change the way the body

is functioning to enable rapid physical response.

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3.4 Using an understanding of the fight or flight mechanism

You might be wondering how understanding the physical symptoms of the Fight or Flight

response is going to help you feel less anxious. It is normal for the brain to register pain or

discomfort because these are vital indicators of threat and danger. The physiological

changes or symptoms of anxiety can be very uncomfortable, like pain, and can lead us to

conclude something is really wrong, a thought which increases our anxiety. So anxiety can

persist because we have both an emotional and a cognitive reaction to our anxiety which

keeps anxiety going. We get anxious about getting anxious or experience fear of fear. This is

even more likely if there is not an obvious source of physical danger in the vicinity which we

can choose to combat or escape from. Then when we can’t see an external danger we tend

to use our powerful imagination to search for the source of anxiety. In this way we start

responding to perceived dangers with a THOUGHT:

“I might make a fool of myself in the presentation”, or “I might fail the exam”.

We thereby create a reason to be anxious which, along with our physical symptoms, then

proves to us that we should be anxious.

The first step to breaking the cycle is to recognise the symptoms of anxiety, and to remind

ourselves that they are not evidence of something being really wrong: they are not in

themselves a reason to become more anxious.

The next step can then be to deal with the symptoms of anxiety as symptoms which can be

“treated”. Learning to calm down your rapid breathing with relaxation breathing can

counteract the Fight or Flight response and help to bring on its counter-balance: ‘rest and

digest’ – The Relaxation Response. Learning to relax your tense muscles can help to do the

same thing.

‘there is something wrong’

The symptoms of anxiety Feel anxious

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3~5 Two counter-balanced systems:

It’s not simply a matter of the fight or flight system being ‘on’ or ‘off’.

The body has two counter balanced systems, each with their own pathways and neurotransmitters.

Just as the ‘fight or flight’ response is the response to anxiety, so there is the ‘rest and digest’ system

(sometimes called the ‘breed and feed’), which is linked to a relaxed emotional state. By and large

the ‘rest and digest’ system simply does the opposite of the ‘fight and flight’, which includes:

• Activating normal digestion

• Relaxing the sphincters in the digestive tract

• Slowing heart rate

• Slower breathing

• Relaxed muscles.

As one comes on, so the other goes off, and vice versa. It works rather like a see-saw:

Summary:

This means that if we can change some elements of the body’s fight or flight

response (e.g the breathing and the muscle tension) to the relaxed state,

then we can help shift from an anxious emotional state to a more relaxed

state.

Learning the skill of relaxation is an important tool in helping you to take the

next step up the ladder of fears that you constructed in Week 2.

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Week 3: Homework task 1.

Next week we are going to turn our attention to how our thoughts affect the way that we

feel. It would be really helpful if you continue (or start) your diary.

You need 4 columns:

The ‘trigger’ – by this we mean noting the situation which has made you anxious, and all

the aspects of it that are triggering your anxiety – e.g. is it the number of people that

concerns you; or the fact that they seem older/younger than you; or that you don’t know

them. It may also be useful to note down the day and time, and what you were doing (or

thinking) immediately beforehand.

The Thought: Try to capture the thought(s) or images that have led to the anxiety.

The emotion: try to score the anxiety that you experience out of 10, where 10 is the worst

anxiety that you have ever felt.

What did you do, how did you cope?

You can set it out like this:

Trigger Thoughts Emotions Behaviour

Homework task 2: Practising relaxation. There are lots of apps and websites

with good relaxation scripts. Try a few and find one that you like, be ready to

talk about how it helped you.

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Session 4: Spotting negative thinking.

One of the useful observations of CBT psychologists is that the way we think influences the way

we feel. That means that when we feel anxious, it isn’t just the situation that has made has

anxious (there is no immediate danger, like the tiger we talked about last week, in most social

situations), but rather it is the way that we are thinking about the situation that makes us feel

anxious. Read the following story and see if you can underline all the phrases that describe the

way the person is thinking (beware some are quite hidden!):

Imagine you arrive at a friend’s house for a meal and you find the room full of people you do not

know. There is a pause in the conversation as you walk in, and you think ‘everyone is looking at

me’. This makes you nervous, so you leap at the offer of a drink, but then feel hot and conspicuous

when someone asks you your name.

You think ‘they must have all noticed how nervous I am’, as you avoid catching anyone’s eye, and

you look for somewhere to put your drink down before you spill it. You wonder if you will ever be

able to think of something to say, and start to feel uncomfortably hot. The louder people talk, the

more you think ‘I really don’t belong here’, and ‘nothing I could say could interest these people’.

This makes it harder for you to join in the conversation, so you keep quiet and retreat into your

shell, aware of how inept you must seem in other people’s eyes. You look for a way of leaving

early, hoping you can slip away without drawing too much attention to yourself.

The next day you can’t stop thinking about how you must have appeared to other people there.

Images come to mind that bring back all the embarrassment and nervousness that you felt at the

time. You decide that you will never do the same sort of thing again. You end up reflecting on just

how hard it is to make new friends, and how inadequate you feel compared to other people. You

wonder if you can ever change, as you’ve always been shy. Other shy people seem to have

managed to grow out of it, so you ask yourself is there is something wrong with you. The longer

this train of thought goes on, the sadder and more dispirited it makes you feel. You conclude that

you’ll never do something like that again.

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Unhelpful thinking habits:

When we are anxious we are more prone to patterns if unhelpful thinking. These patterns both

cause anxiety, but they are also intensified by being anxious. Think of the ‘hall of mirrors’ from the

end-of-the-pier of the 1950’s: it was a series of convex and concave mirrors that led the viewer to

have a variety of exaggerated or distorted impressions of themselves. The unhelpful thinking habits

(sometimes called cognitive distortions) do the same thing in the mind.

We’ve identified seven main categories, however this list is not exhaustive, but instead is intended

to help give you an idea of how the patterns work.

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1 Jumping to conclusions (J2C)

This is where we take insubstantial evidence,

and go straight to a (usually negative)

conclusion.

2 Mind reading We might like to think that

we know what is going on in someone else’s

mind, but in fact we have no idea.

Everyone’s perspective on what happens is

unique, and we can’t guess it without asking

them.

3 Crystal ball gazing

Looking into the future is not as

reliable as we might like to think.

4 Catastrophising, or

making mountains out of molehills:

Problems aren’t always as significant

as they seem.

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6 Emotional

reasoning:

‘Things feel bad, so

they are bad’

5 Negative filter: Putting yourself

down, or only seeing negative

aspects of yourself or your

behaviour.

7 Historical reasoning:

Just because things were a certain

way in the past doesn’t mean that

things will always be like that.

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4: Identifying Unhelpful thinking habits

(also known as ‘Cognitive Distortions’ or ‘Wonky thinking’):

Looking through the list of cognitive distortions on the previous pages, and then try to identify which

of the habits you can recognise in each of these thoughts (there may be more than one).

1 My friend suggests meeting in a coffee shop. I am aware that I may arrive first.

My NAT is: ‘People will look at me and think I’m weird’.

2 I went to a network event and spoke to a number of colleagues from other branches.

Afterwards my NAT is: ‘I spoke too much, they must have been so bored’

And ‘they probably thought I was a bit stupid’.

3 I have to go and meet my spouse’s family and stay at their house.

‘I’ll do all the wrong things and embarrass myself and my spouse’

4 I’ve just reached the lectern to give a presentation to colleagues.

NAT: ‘This is going to be a disaster. People will think I’m an idiot.’

5. I’m at a party, my cousin introduces me to some of her friends.

NAT: ‘I’m going really red, everyone will see that, I look so silly’

6. I’m on a first date

NAT: ‘why did I ever go through with this, I’m going to dry up, have nothing to say,

…and no one would want to be with me long term anyway’.

Now try and identify the unhelpful thinking habits in NAT’s from your diary.

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Week 4: Spotting Negative thinking.

We all have a stream of thoughts running through our mind all of the time. We get so used to this

that it’s very easy not to even notice that it’s going on. One of the important tasks in doing CBT is to

be able to spot thoughts and notice them. It’s important to realise that ‘a thought is just a thought’.

Just because we think something, doesn’t mean that it’s true.

Sometimes those thoughts can become negative and will cause anxiety, or low mood.

Have a look at each of these situations and try to identify the NAT’s that might go through the mind

of someone with Social Anxiety, and then try to identify the unhelpful thinking habit:

Work in pairs and spend a few minutes considering:

You bump into a neighbour while out shopping. The neighbour greets you and seems to

want to chat.

You’re a student, it’s the start of the new term and you join a group of people from your

course in the canteen with your lunch tray.

You’re at a work departmental meeting. Your boss asks you to give an update to the

whole meeting on how you and your section have been performing over the last month.

You’ve been asked to give a work or college presentation. You know the topic quite well,

and you’ve got a week to prepare, but you know that you’ll be assessed.

You’ve been called to a job interview, you’re sitting in the waiting room waiting to be

called in.

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Shame and Blame:

Many shy people feel ashamed of themselves for being shy, as if it were their fault, and they were to

blame for not having overcome the problem. This is despite the fact that many shy people continue

to do things that they find difficult. Many shy people wage a determined campaign against their

shyness.

Shy people tend to ignore or discount their successes. They tend to think of things that went well as

‘lucky escapes’. They remember, and tend to dwell on, any information that fits with their sense of

being awkward or inadequate.

Shy people tend to interpret ambiguous remarks made to them or about them such as ‘You seem

rather quiet’ as if they were criticisms. They also remember such remarks more than positive

statements.

One of your TASKS for this week is therefore to compile a POSITIVE DATA LOG (PDL). This is a list of

all the things that you do during the week that you feel proud of; all the little compliments you

receive, no matter how small; and all the attractive personality traits that you observe in yourself

(e.g. showing kindness or concern for others).

It’s worth remembering that being shy also has positive aspects to it:

A mystery to be solved:

Shyness can be attractive to many people. It can be difficult to get to know someone who is shy, but

that shyness, rather than putting others off, can make people more interested to know more

The feel good factor:

A shy person can gradually warm to the attention that they are given, and open up as they feel more

confident. When this happens the other person giving the attention can feel that they have won a

valued confidence. They might then feel sensitive and attentive.

Admirable qualities:

Shyness is closely related to that much valued quality of ‘reserve’. Shyness can go with a gentle

modest that is the opposite of some less admired qualities such as arrogance, loudness self-

opinionated or pushy.

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Week 4 TASK:

This week we would like you to continue with your diary, but with a special focus on trying to spot

unhelpful thinking habits:

Situation: Thought: Unhelpful thinking habit:

What happened in your body:

Emotion: Behaviour:

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Week 5: Challenging negative thinking

Sally is 50 and married with two grown up children. She’s always kept herself to herself, but

since her children left home she’s found herself increasingly lonely and feeling isolated. Her

neighbours have invited her to a barbecue in their garden, and she has almost backed out

several times due to shyness, at last she decides to go.

Unfortunately when she arrives she finds she knows very few people. She spots someone she

knows from the local residents association she belongs to. Marta has always been quite

chatty and friendly in the past, and had asked her over for a coffee a few times. In return

Sally has babysat Marta’s 10 year old daughter, and been supportive when Marta was under

pressure and needed time out.

Sally decides to go over and speak to Marta, but after they’ve exchanged a few sentences,

Marta says that she has to get back home to check on her family, and she leaves abruptly.

Sally feels hurt and rejected and decides that what she had to say must have seemed very

boring. What’s more she decides that Marta never really liked her very much in the first

place.

First can you spot the Negative Thinking here?

Write out Sally’s NAT’s here:

What are the unhelpful thinking habits?

How accurate is Sally’s thinking here? Could we look at things from a different point of

view?

There are many ways of challenging negative thinking, but one of the most useful is the

Court of Law. The idea is that you are going to take the negative thoughts to court, and the

judge will hear ‘Evidence For’ the thought, and then ‘Evidence Against’. Take one of Sally’s

NAT’s and try out this process, sifting the facts from the story.

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Thought: ‘Marta never really liked me’

Evidence For the thought:

She didn’t stay very long today

Evidence against the thought:

She had a good reason for leaving

She has invited me back for coffee several times.

In asking me to babysit her daughter she clearly trusts me; and she is probably

very grateful for that.

It would be a bit premature to draw this conclusion on flimsy evidence.

Another good technique is ‘reframing’ – this is about seeing the issue in a

different perspective, an example might be:

‘I’m shy, so people will find me boring’

Now use the information from the page headed ‘Shame and Blame’ to help

you reframe this.

Another technique is the ‘time test’ – asking yourself ‘how much will this

matter a year from now?’. Do you think Marta and Sally will remember who

said what at this barbecue a year from now?

Another technique, where blame is a factor, is the pie chart of responsibility.

Imagine Sally had said ‘no’ to the barbecue, and then the next day got a

message to say the barbecue had been cancelled. Her NAT is then ‘it’s my fault

for pulling out’. We could then make a list of other factors (the bad weather

forecast; a case of D&V at the hosts’ son’s school etc) and draw a pie chart

attributing responsibility to each according to its significance.

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What could Sally do that would be helpful?

This is where the ideas of ‘Gathering evidence’ comes in - the best option might be for her

to suspend her NAT’s about Marta, and instead to carry on.

First of all that would allow her to enjoy the rest of the afternoon at the barbecue, without

getting caught up in negative thinking about what has just happened (‘retrospective

rumination’). She might find other conversations go better, and she may meet more new

people. These experiences will help her to challenge her negative thoughts.

Also she could then see what happens with Marta. If the next conversation works out in a

positive way (e.g. perhaps Marta apologises for rushing off, and suggests that they have a

coffee together some time), then this is powerful evidence against her negative thought.

The ‘car accident metaphor’.

We tend to see life, and all the things that happen to us, through our own particular lens.

We have our own point of view, and our own ‘take’ on events. If this angle is always a

negative one, it can lead to anxiety or depression. In cognitive therapy therefore we are

trying to help people to see things from a different point of view.

Imagine that you are looking towards a crossroads. You see a blue car suddenly screech to a

standstill in the middle of the cross roads. The driver of the red car coming from the other

direction has to swerve to avoid him. Who do you think is to blame?

Now imagine you can hover over the same scene from above. Now you can see that a small

child had wandered into the road right in front of the blue car. We sometimes call this

‘taking the helicopter perspective’. It’s nicely illustrated on a You Tube clip for the Guardian

newspaper from 1986 (‘Points of View’), which you may to look up.

Challenging your own thinking. TASK:

In the week ahead continue to use your diary. This week however we’d like you to include

an extra column to identify ‘possible alternative thinking’.

For example:

Upsetting thought: Possible Alternative Thinking.

I sound really stupid Perhaps everyone does this once in a

while.

Even if I did, it wouldn’t mean that I

was stupid.

Give yourself the benefit of the doubt. Try to imagine that you don’t have negative feelings.

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Week 5 TASK:

This week the focus of the diary is on challenging negative thinking:

Situation: Negative Thought:

Anxiety: Rescripted or alternative thought:

Re rate anxiety:

What you did?

29

Week 6: The focus of attention:

Sam was bullied at school. However he did well at school, went on to university, and then

decided to go into teaching. He knows that he’s got good rapport with the kids, and the

lessons themselves are fine, but when he starts to contemplate the obligatory observations

be becomes incredibly anxious.

It’s a Tuesday morning, and he has an observed lesson. As he explains to the children what

they’re going to do he can hear that his voice is shaking; he’s intensely aware of how hot he

is feeling. He’s now noticing that his legs are shaking, and he can feel the intense glare of

the expert observer. He seems himself, as if from a drone floating high in the room, as a

diminished stooped figure, hardly audible to the children, and mocked by the children. He’s

so busy thinking about these images that he loses his train of thought several times, and

stumbles on his words, and this seems to increase his sense of self-monitoring. He notices

the observer speak to a child who seems distracted, and he realises that he failed to notice

this.

When we become anxious our focus of attention shifts inwards. We become engrossed in

noticing the physiological changes caused by anxiety; and focus on distortedly negative

images of our performance. These in turn increase our anxiety, and thereby increase the

physiological symptoms. These distorted images also contribute to negative thinking.

We can change this pattern by shifting our focus of attention EXTERNALLY. In the example

above this might include: focussing on the children; focussing on remembering the lesson

plan; or focussing on observing the expert at the back of the room. This serves to distract us

from the internal focus. We sometimes refer to this as reducing self-consciousness.

We can also change moderate the imagery, by creating images of success: in this case

children engaged in productive learning, and good feedback from the assessor.

What else could Sam have done to reduce his anxiety?

A useful way of thinking about this technique of reducing self-consciousness is to think of

yourself as a scientist, or sociologist, but someone who is gathering data in a neutral

unbiased way. You can ask yourself: ‘Would another dispassionate observer agree with my

conclusions about this situation?’.

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Week 6: The two way experiment:

You will be set a whole group task. Group ‘A’ should then look at Step 1 first, and then Step

2; while group ‘B’ should tackle them the other way around.

Step 1: You will be given a task. Focus on yourself for the next 3 to 5 minutes.

Notice everything that is going on inside you. For example notice all the sensations that you

can feel; how cold or hot you are; whether you are tired or hungry; any aches or pains.

Notice how your clothes feel on your body. Notice your feelings, and any thoughts images

or impressions that come to mind.

After 5 minutes: How did you feel when focussing on yourself?

What did you notice?

Step 2: You will be given a task. Focus on the things around you for 3-5 minutes.

Notice other people, how they look, what they are wearing; what they may be feeling or

thinking about.

After 5 minutes: How did you feel when focussing on yourself?

What did you notice?

Step 3: Compare the two

What was the same?

What was different?

Step 4: Summarize your conclusions.

Which made you feel better?

Which gave you more information that would help you socially?

Was focussing on others difficult?

How did you do it?

Do you need more practice to achieve the desired result?

31

Week 6 TASK:

This week your diary is structured to help you notice where the focus of your attention was:

Situation: Negative Thought:

Focus of attention:

Anxiety: Refocus your attention:

Re rate your anxiety:

32

Week 7: Doing things differently

When you feel anxious in a social situation it probably means that your mind perceives a threat.

When we feel there is a threat around we instinctively act in ways to keep ourselves safe. The

problem with social situations is that we can’t predict what other people are going to do, like ask

your opinion; introduce you to the person you least wanted to talk to; or end the conversation

abruptly. We create safety seeking behaviours to minimise the risk from such perceived threats.

The problem with safety seeking behaviours is that we don’t know what would have happened if we

hadn’t used them. Indeed they actually give the impression that they have worked – for example

moving away from a conversation group when you feel anxious, and it feel likes your mind has gone

blank, means that the possibility of everyone realising this, and an embarrassing silence, has

therefore been avoided.

There are 4 steps to changing safety seeking behaviours:

• Step 1 is to identify what your safety seeking behaviours are (and when you use them)

• Step 2 is to identify your predictions for what you fear would happen if you didn’t use

them

• Step 3 is to find out what happens when you do things differently (i.e. when you drop

the safety seeking behaviour)

• Step 4 is to draw some conclusions from this.

Step 1: Identifying safety seeking behaviours

Here is a list of common safety seeking behaviours. Tick all those that apply to you.

• Looking down so that no one can catch your eye

• Wearing light clothing so no one can see sweat

• Leaving a meeting immediately it’s over to avoid small talk

• Being very busy at work so that no one will chat

• Smoking, so your hands are occupied

• Not sharing anything personal in conversations

• Talking very quietly

• Not talking very much at all

• Talking a lot

• Wearing a hat

• Having a fringe or flop of hair to cover the forehead and eyes.

Then try to think of some more things that you do that are SSB’s (inc things you DON’T do).

33

Group Task:

In threes you are going to discuss: ‘What I did at the weekend’ for 3 minutes each without

trying to drop your safety seeking behaviours.

One person is asking the questions; one person sharing their experiences; and one person

observing. Afterwards try and identify together each person’s safety seeking behaviours:

Now repeat the conversations, this time with a theme of ‘my worst holiday ever’, but this

time try to drop your safety seeking behaviours. Record what happened:

What conclusions can you draw about safety seeking behaviours?

Often people notice that the behaviour that they think makes them less conspicuous

actually makes them more conspicuous, e.g. looking away a lot may make someone look

covert and suspicious; speaking quietly may lead the other person ask them to repeat it all

again more loudly.

1

2

3

1

2

3

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7~2 Exposure

Here’s a snippet from a CBT therapy session. Jo has suffered from social anxiety since early

adulthood, and this involves her in a whole sequence of safety seeking behaviours, and her

(slightly smug) therapist has just explained that she needs to go into the situations she most

fears, and not do those things:

Jo: How is it that getting into my anxiety is going to help me after I’ve had it for so long anyway?

Therapist:

Because anxiety could not exist without avoidance. Do you know what I mean by that?

Jo: But how would I act if I’m trying to not make it go away? Do you expect me to say to myself: ‘Great,

I’m anxious again, this is wonderful, my mouth is really dry, I’m shaking, blushing, I feel awful and I want to run

away’. How can this help?’

Th: Good point. Do you remember our chart about the dog?

Jo: I remember that fear can decrease with exposure.

Th: Can you explain that a little more?

Jo: Anxiety goes down automatically after a while.

Th: Right, as long as you avoid, you will continue to have anxiety in this particular situation. And this is

not only true for anxiety, as soon as you try to control your emotions, your emotions will control you. The way

to get rid of your anxiety is to accept it, embrace it, welcome your anxiety, let it stay there if it wants to stay, let

it go if it wants to go. Eventually it will go away. And the more often and more intense you experience this in a

particular situation, the less anxious you will feel in the future. And there is nothing that you need to do. Just

experience your anxiety at its fullest, don’t do anything to make it go away or diminish it. I am not saying that

you need to enjoy the feelings of anxiety. What I am saying is that you need to learn to accept it, and let it stay

with you without trying to do anything to bring it down. Anxiety is a normal but very unpleasant experience.

No one likes to feel anxious. But anxiety is a temporary state. Eventually it will go down. So the best way to

deal with our anxiety is to experience your anxiety to the fullest, without you trying to bring it down with

avoidance strategies.

A good way to start practising being in social situations is through the technique of imaginal

exposure:

Imagine yourself in your most fearful social situations. Notice the sounds, notice the smells,

notice. What you can see and hear around you?

1 For the first 30 seconds focus on and describe anxiety symptoms. Now rate your anxiety.

2 For the next 30 seconds focus on and describe the environment around you. Rate your

anxiety.

3. Focus on and describe what you are saying/ not saying and then rate your anxiety.

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Week 7 TASK:

Set up one, or two, experiments in dropping safety seeking behaviours that you use in

particular situations. Record how you get on:

TRIGGER: The specific situation in which you use a SSB

PREDICTION: What do you think will happen if you don’t use the SSB

EXPERIMENT: How will you find out? What will you do differently

OUTCOME: What actually happened?

CONCLUSIONS: What does that mean or say about you or others?

36

Week 8: Core Beliefs

We’ve looked at how in social situations people often have Negative Automatic Thoughts:

I’ll have nothing to say

People will judge me

Others will stare and laugh

But where do these thoughts come from, and why do some people have them more, and

others much less? This story illustrates this:

Sam was the younger of two brothers. His dad was very sporty and loved team games and

going to football, as did his older brother Tom. Sam was quiet, and liked reading, and maths

in particular, but dad was dismissive of such interests. Dad encouraged Tom in every sport

he tried, but became increasingly critical and dismissive of Sam saying things like ‘stuck

behind your books again?’ in a sneering way. Their mum, who was very quiet, never

challenged this. Sam coped by building up a small circle of friends with similar interests at

school, but as he became more insecure, this led to him being bullied at school.

On leaving school he joined a bank as a desk clerk, and he built up a good rapport with

regular customers. However as time went by the manager increasingly pressurised him to

sell products such as insurance. Sam found this excruciatingly difficult, and said to himself ‘if

I try this my regulars won’t talk to me any more’. Sam became more and more withdrawn,

and after two unsuccessful performance reviews he lost his job.

What were Sam’s early experiences?

What Core Beliefs did Sam establish about

himself

others

The world

What Rules for Living did Sam establish about how to cope with life?

If I… then I’ll be accepted.

What happened when these got broken?

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Week 8 TASK: Identifying Core Beliefs:

Think back to a recent situation that made you feel socially anxious, it should be one specific

situation, rather than a general type of situation.

Here’s an example from Joe, who’s 25 and works for a medium sized company, but has

social anxiety:

Your Situation:

Now think through the situation from beginning to end. Try not to avoid anything about it

that makes you feel uncomfortable. The idea is to face up to its full implications. Identifying

beliefs, assumptions and rules for living, can be a painful business, so try not to rush it.

Remember that many other people will have had similar beliefs about themselves and

others. You may want to talk yourself through the scene; write an account of it; or imagine

that you are watching it on a screen. Focus not only on the story, but the things you say to

yourself as you go through it such as ‘that was a stupid thing to say’.

These key questions:

What do you think were your shortcomings?

How are you judging yourself?

What did it mean to you? Why was it so difficult and upsetting?

What does it mean about you?

What are the attitudes of others?

What does this tell you about them?

Now look back over your answers, and see how you conclude:

I am…. Others are….

Use whatever words come to mind to express your inner beliefs.

‘I was really anxious when I went to speak to Caroline in Accounts. Actually I

wanted to get her into conversation because I like her a lot and wanted to

suggest having lunch together. Instead I couldn’t look her in the eye, mumbled

something stupid about a work problem, and left as soon as I could without

having suggested lunch.’

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8~2 Identifying and modifying core beliefs

We have already done some work on spotting and challenging Negative Automatic

Thoughts. These are the spontaneous superficial thoughts that seem to spring into our mind

in particular situations. Most people find that their NATs can be fairly readily challenged in

CBT. That leaves the question of where these NATs come from, what drives them, and why

people with problems such as social anxiety seem to have so many more of them, and more

negative ones, than the general population.

To answer this we need to dig down to identify our Core Beliefs. Core Beliefs can often be

expressed as short, succinct statements about ourselves (‘I am…’). In conjunction with our

assumptions about how the world works, they often serve as the basis, the foundation

stone, on which our NATs are generated.

Negative Automatic Thoughts:

Core Beliefs about self; others and how the world operates:

Rules for Living:

‘If I do ------------. Then I’ll get by/ be accepted’

It’s important to realise that Core Beliefs are not easily

changed. That’s why this page is called ‘modifying’ and

not changing. Think about a Saints football fan:

This fan has supported Saints for years, through thick

and thin.

What evidence might lead them to change their mind?

We can all probably think of people that have continued

to support teams (i.e. have positive core beliefs about

that team) even in the face of quite a lot of contradictory

evidence (e.g. a season of losses).

Therefore our expectations of making changes in our core beliefs, especially in a short course like this one,

have to be moderate. One good way of making change in core beliefs is through getting in the habit of

challenging your Negative Automatic Thoughts. If we begin to discover that our NAT’s can be challenged;

that when we look for it we can find firm contradictory evidence against them, then little by little our mind

may begin to feel that they don’t seem to seem to hold up to scrutiny, and this in turn will put into question

the core beliefs that generated them. So for example someone who has avoided presentations for many

years gives one well this may challenge her NAT’s: ‘no one will want to listen to me’ and ‘everyone will laugh

at me’. If she goes on to have a number of such experiences then this process will lead her to question her

core beliefs ‘I am dull and unworthy of others’ attention’ and her assumption ‘others are mercilessly critical’.

39

8 ~ 3 Searching out new information.

We all tend to look out for information that fits in with our core beliefs rather than

challenges it. These questions help you to spot information that challenges your core

beliefs.

You can set out about testing your beliefs in quite a systematic way. Start by writing down

your belief, then rate your conviction in it, that is how much you believe it. Then do a

forward search, thinking ahead to a situation in the coming weeks that will test it out, this

will make it easier to spot new information. Then ask yourself, on the basis of your belief,

what do you think will happen? This is defining the framework set out by your negative

thinking. Next you need to identify what you need to look out for, what will be the

hallmarks of whether the prediction is true or not. Then, after the event, write down what

actually happened. Finally re-rate your conviction in the belief, on the basis of what actually

happened. Here is an example (deliberately chosen from a distantly related field, cookery confidence, as it is easier to see patterns in other people’s ‘stuff’).

belief: I’m no good as a cook (95% conviction)

What’s the situation? My husband’s

birthday. I will have to make him a cake and

all the family will be there.

What is your prediction? I will not be able

to remember how to do it, and I will spend

hours finding a recipe. I will get in a horrible

mess in the kitchen, and something is bound

to go wrong. It will fall flat or be heavy and

sticky; or dry and hard. No one will want to

eat it, and most of it will be left over.

Search plan: What do you need to be

looking out for? Things I remember how to

do; being quick to find a recipe; the amount

of mess; the amount of time it takes; what

the cake is like; how much gets eaten.

After the event: what actually happened: Much better than I expected. Found a recipe ok.

I did make a horrible mess, but it looked good enough. Also most of them ate it and my

daughter said it was ‘good’. One person left a lot, but my husband asked for some more

the next day.

What conclusions can you draw from that?: It’s far less clear than I thought it would be:

good bits and bad bits mixed up. Probably a lot easier than I expected, and it tells me that

it would be a lot easier, if only I did that kind of thing more often.

Re-rate the original belief: 40%, because at least I now know I can learn.

How would you modify your belief: I’m not a very good cook yet.

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Week 8 TASK:

Your task this week is to set up an experiment to challenge a core belief like

the one above:

First write out the belief that you are testing out:

And how much you believe it (as a %)

Situation: Prediction: Search plan:

What happened?

What conclusions can you draw?

Re rate belief:

41

Week 8: Putting it all together.

We now have four strategies for tackling social anxiety:

42

Week 9 Workplace skills:

Many people feel particular anxiety about some of the situations related to work. In

particular presentations, interviews, and speaking up in meetings.

Here is our social anxiety model, we can use this as a basis for identifying why these

situations can become so stressful, and also the techniques used to challenge them. First

think about completing the model thinking about a situation where you are about to do a

presentation:

Triggers: About to give a presentation

What do you notice about the situation?

Negative thinking: what kind of thoughts are

going through your mind?

Increased self-focus:

What happens here?

Safety Seeking

Behaviours:

what might these

be?

Physiological symptoms of

anxiety:

What might these be?

ANXIETY

1

2 3

4

5 6

7

8

Body

changes 9

10

11

12

12

43

Mark onto the chart where each question fits:

A When you did your safety seeking behaviours, what effect did that have on your anxiety?

B When you thought that the feared event might happen, what did you notice happening in

your body?

C What went through your mind at that time?

What was the worst you thought could happen?

What did you think people would notice/think about you?

What would that mean? What would be so bad about that?

D When you become more internally self-focussed does that make it seem more or less

likely that your negative thoughts or predictions will happen?

E When you are feeling afraid, what happens to your attention? Do you become more or

less self-conscious? As you focus your attention on yourself, what do you notice? Do you

have an image of how you feel you are coming across? What does that look like?

F As you did your safety seeking behaviours did that make you focus more or less

attention on yourself?

G As you became anxious, and thought that the feared event might happen, did you do

anything to try to prevent it from happening? Did you do anything to try to prevent people

from noticing?

(Based on Wells 1997, adapted by Louisa Stopa. Find the answers at: www.getselfhelp.co.uk

www.get.gg & follow the links to cognitive formulation for social anxiety)

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9~2 Preparation is key:

Let’s start by going back a couple of weeks to the day that Megan was asked to do a

presentation on how the new coffee shop in Southampton has been performing. Megan

hates presentations, and she has a memory of nearly drying up a few months previously

when she last had to give a presentation.

First it might be useful to try and soothe that traumatic memory. Here’s one way of doing

that:

Let’s go back to Megan, she probably goes away and begins to get anxious at her desk, what

do you think might happen to her now, as anxious thoughts swirl around her mind?

At this point many anxious people engage in one of two possible safety seeking behaviours:

Procrastination, leading to a last minute panic and being under prepared,

Or hyper preparation, where in a fear of not having enough to say, they prepare far too

much information, possibly putting too much information on each slide, making the

presentation too long, or writing it out verbatim (or possibly all three).

• What advice would you give someone in the preparation phase?

45

9~3 Immediately prior to giving your presentation:

Focus on challenging negative cognitions:

‘My mind will go blank and I’ll forget what I’m going to say’:

No, I won’t: I’ve got notes in front of me, and the slides are on the screen, so I won’t forget

what I want to say. Even if I need a moment to gather my thoughts, that can create a

natural comfortable pause in the presentation.

‘I will drone on and on and people will get bored.’

No, this is going to be good. I’ve practised varying my pacing, and this time people will be

engaged. (Actually I don’t have any evidence that they were bored last time, that was just

my hunch)

‘I will talk too much, and I’ll lose my key points.’

NO, I’m going to provide an overview to start with, so people can anticipate the structure;

the main presentation is short and snappy, with brief slides, and then I’ll recap at the end.

Replace negative cognitions and imagery with positive ones:

Imagine the engaged faces of the audience; rapturous applause at the end; a compliment

the next day from a trusted or senior colleague.

Distract yourself to avoid rumination or starting safety seeking behaviours.

Well before the session, check the equipment.

Keep a focus on your audience: ‘if I were in that audience, what would I be interested in

hearing?’

If practical move around a bit, and just before starting (in more informal settings) try to

move something around ‘shall we open the window?’

Relax!

Here is one quick relaxation exercise:

Stand in an easy position with your feet one pace apart, knees 'unlocked' and not rigidly pushed back, spine

straight, shoulders not tense and head balanced. Try to keep your face muscles relaxed by not clenching your jaw

or clamping your teeth together.

Now stretch SLOWLY upwards, aim to touch the ceiling but keep your feet flat on the floor. Then flop forward

from the waist bending your knees slightly as you go. You are now hanging forward like a rag doll - your arms and

head totally unsupported and relaxed.

Straighten up SLOWLY - almost vertebrae by vertebrae, as if you were puppet and a giant puppet master was

pulling you up by the strings keeping your head until last, when you are standing in your original easy position.

Repeat this exercise three times.

46

9~4 Giving the presentation:

Eyes focussed on audience:

Hands are ‘talking’, face

smiling

Start with a pause, look round at everyone and smile.

If some people in your audience don’t know you, then introduce yourself, the topic, and your

connection to the topic.

Confident body language will help to displace anxious body language: walk around, use your hands and

arms and face to communicate points.

Remember the people at the back, project your voice sufficiently so that they can hear too.

Vary your speed of delivery: for the important bits.

You can speed up over stories, anecdotes, historical background

A pause will help punctuate a change of topic, or create tension

(Think about how the results are read out on ‘Strictly’)

Keep your focus on the audience. Watch their reactions: you may even get a chance to comment on

this, and this demonstrates engagement:

‘I can see some people nodding when I say that customer service is core to strong sales’.

Don’t be afraid to tackle negativity either:

‘Okay, I can see some of you shaking your heads when I say that we need to increase the price of coffee,

however if we don’t…’

Sound enthusiastic. Positive cognitions, such as ‘this is an important topic’ ‘I’m really fired up about

this’, will help you to keep focussed on this, and communicate your enthusiasm to your audience.

Summarise before ending.

Be open to questions: but be ready to say ‘I don’t know the answer to that one’, you could always open

up a discussion: ‘I don’t know what other people think…’, or promise to get back to that person

47

Week 9 (or 10): Interview Practice:

Practice: This means taking every opportunity that you can find to be interviewed: this may mean

going to interviews for jobs that you are not too keen on to boost your confidence. Such interviews

may lead to unexpected ‘connections’ (e.g. they tell you about an opening in another department

more closely aligned to your interests). Practice may also include doing role play with a friend or

colleague, and getting feedback.

Preparation: Good preparation is key. It will ensure that you have plenty to talk about; it will help

you to feel more confident as you then have evidence to support affirmative thoughts such as ‘I’ve

done a lot of background research for this post’; and it will help you both anticipate questions, and

be better placed to answer them.

Deal with logistics early: Make sure that you have prepared what you want to wear; any papers that

you want to carry with you (for example many interviews require you to bring ID to the interview);

and directions for finding the interview location early.

Body language: Through feedback (either from these sessions, or recording yourself) try to become

more aware of any physical safety seeking behaviours you may be using (e.g. looking down); and try

to replace these with open confident body language. In an interview situation this would include:

Standing to your full height; making eye contact with everyone who is interviewing you; smiling; and

a firm handshake.

Relaxation Skills. It’s important to practise relaxation skills (slow breathing and progressive muscle

relaxation) frequently, and at times when you are not stressed so that you can do a quick 30 second

relaxation at a key moment, such as when you are waiting to be called.

Outward focus: Keeps your focus on the people interviewing you; and the questions you are asking;

to prevent your focus drifting back to an inward focus on your anxieties.

When things go wrong: It’s easy to get derailed by a tough question. Take a moment to compose

yourself. Try a mini relaxation. If still nothing comes to mind keep negative thoughts at bay. Try

‘commenting on the process’: ‘I’m really stuck on that one I’m afraid’. Or, if you feel you haven’t

understood the question: ‘could you rephrase that one for me’. Challenge your negative thinking by

reminding yourself how well you’ve done up to that point; and even if you don’t get the post your no

worse off than if you had never been to the interview.

What thoughts would be going

through your mind facing these

3?

What are your thoughts about this

candidate? What advice could you

give her?

48

Week 9 TASK is to prepare your presentation and remember to send it in to:

[email protected]

Please send it in by Monday midday at the latest.

Week 10 will start with an opportunity to give your presentation.

You can use the table below to make your notes about other people’s

presentations:

Content: Body language and any SSB’s: Use of the space:

Voice: Projection Variation in pitch and tone:

Use of AVs: Responding to questions:

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Week 10 & 11 TASK: The Project:

We are now looking for you to find an opportunity to put your new skills into practise.

Doing things differently is not only the best way of embedding new learning, but also further

practice opportunities will help to further reduce anxiety.

It’s also a good idea to practice over learning. This is where you do something on the course

that is more demanding than the things that you do in everyday life. This is because, almost

inevitably, everyone experiences a little back slipping on leaving therapy.

We are therefore asking you to think up a project that will help you to practise your new

skills. It is very much up to you how you choose to do it. You may do it on your own, or as

part of a group. The purpose however is for you to practise all the social skills that we have

looked at in the previous 9 weeks. Here are some ideas:

• Join a new social/ shared interest group

• Give a talk to a group of people

• Do some voluntary work

• Go on line dating

• Seek out more complicated information from companies or shops (e.g the best

savings account for you; the best mobile phone tariff)

• Do a survey among people that you don’t know too well.

• Join an evening class.

It’s up to you what you do, but we’re going to ask you to come and talk about how you got

on in 2 weeks time, so it needs to be something that you can progress (if not complete) in

that time. Your talk should cover both the outcome (i.e. what happened), but also the

process (i.e. what is was like for you engaging in that process, using all the boxes from the

social anxiety chart that we have used during the course).

We’ll check in for a quick progress report next week.

The Party:

This week, as many people want to build skills in social conversation, we’re going to set up a

simulated party. We’re going to invite a few other staff from the rest of the office, people

you have not met previously, to come and join the group. Your job is to ‘host’ the party –

offer round a few drinks! – and then to chat to the newcomers, make them feel at east, and

find out a bit about them.

We’ve talked about conversation being a bit like tennis where you alternative an open

question: e.g. ‘where do you like to go on holiday?’ with a bit of self-disclosure:

‘I love going to Greece because I’m interested in archaeology/ like sunbathing’.

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Week 11: Relapse Prevention

‘The strategies that have helped you to get better,

will help you to stay well’.

As the group draws to a close, it is important that you learn to become your own therapist. In order

to do this you will need to take on a number of different roles. You will need to:

• Monitor your social anxiety

• Assign yourself tasks

• Carry them out

• Monitor your progress.

For example you can work on correcting your beliefs about social anxiety; and apply strategies like

cognitive challenge and relaxation skills to situations that come up in your daily life, as well as

continuing to push yourself up your hierarchy of fears. Being your own therapist also will mean

regularly evaluating your method of reacting to difficult social situations, encouraging yourself to

persevere, even when things get tough, and congratulating yourself on all your successes, both large

and small.

It is important to have realistic expectations. The end of the group will not mean being social

anxiety-free (very few people in the population are in this group), but rather having a set of skills

with which to address the symptoms of social anxiety. The ultimate goal of daily maintenance is that

the skills learnt in therapy become automatic, but this requires practise over time.

There are four key areas to think about:

1. Daily maintenance: You will need to set aside time, ideally about 15 minutes each day, to

keep on top of your skills. We sometimes call this time the ‘self-session’. It is about doing all the

things we would do in the group together, with one difference: you’re on your own. The first thing

to do is ‘check in’: how am I feeling today?

Then you can try to identify all the situations in the week when you experienced social anxiety. Try

to draw out a formulation. Ask yourself the following questions:

Where was I? What was happening? What thoughts or images went through my mind? What did

that say about me? & others? Where was my ‘internal camera’? Where was my focus of attention?

What changes did I notice in my body? What were my safety seeking behaviours?

Situation analysis:

Place; NATs; Appraisal; Focus of

attention; Physio changes; Safety

seeking Behaviours

Apply therapeutic

technique: Challenge

NATs; shift focus of

attention; create positive

imagery; relaxation;

change SSB’s.

Check in:

How am I

today?

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2. Identifying ‘at risk’ situations: everyone will encounter times in their lives when there are

more stressors, and hence more worries: changes in the work routine; instability in housing; a build-

up of debt and ill health are all common stressors. It is important to recognise that everyone will

encounter such ‘ups and downs’ in their social anxiety. If, during such a stressful period, thoughts

such as:

‘this is a catastrophe, it’s all coming back, treatment didn’t work, I’ve gone backwards’

emerge, these need to be challenged. Experiencing a period of greater anxiety should not be viewed

as a failure or relapse; rather it is an opportunity to continue practising the skills learnt in the group,

that in the long term will give protection against social anxiety.

3. A lapse is not a relapse: everyone has ups and downs. A lapse is part of the normal

fluctuations caused by life, while a relapse would be a return to the level of problems encountered

before starting therapy.

4. What you do at home will have a big influence on longer term outcomes,

here is a checklist to keep in mind:

• Make a list in the next few days of areas where you’ve made improvement

• Think about the strategies that got you there

• Keep practising new skills

• Keep setting new goals to keep challenging yourself

• Remember you have to keep ‘goal persistent’ even in the face of anxiety

• Identify unrealistic expectations, such as ‘I’ll never have a panic attack again in a social

situation’

• Remember that other stressors in life will cause all anxiety to go up and down

• Decatastrophise lapses: it’s not ‘all coming back’.

• A lapse is an opportunity to practise or modify new skills

• Keep a written record at home of potentially problematic situations, and how,

with the new skills that you have learnt, you can cope with these.

Finally remember that some social anxiety is a normal part of everyday life!

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Week 12: The Quest:

‘it’s like a quiz, but it’s not a quiz…It’s like a test, but it’s not a test.’ Actually it’s more like a crossword, but

with one exception (the mystery word that you have to discover) it only works horizontally. On each line there

is a missing word. You have the clues to help you find those words. Write the first letter of that word in where

the number of the clue appears. Only work from left to right. You can shout ‘bingo’ when you discover the

mystery word.

1

2

3

4

5

6

7

8

9

10

1 The counter balance to the fight or flight system (4, 3, 6).

2 The structures that carry signals to and from the brain (7).

3 In the anxiety response blood flows to the periphery. Some people find their faces are very affected

by this (8).

4 The type of anxiety that can build up before a big social event (12).

5 Repeated ---------will help to reduce anxiety (8).

6 Sometimes anxious people are intensely watchful for what they perceive as danger (8)

7 One the common symptoms of anxiety. Feels like these are flying in your tummy (11).

8 We can challenge them (9).

9 When someone’s focus of attention is very internal we might call them ‘XXXX-XXX’ (4,8).

10 Growing a fringe that covers your eyes; making excuses in order to say ‘no’ to an invitation; and

leaving early are all examples of this type of behaviour. (6, 7).

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After the course:

We’d like to remind you about . It’s a peer support social group for people

who have used the Steps to Wellbeing Service. It meets fortnightly in Woolston [Monday

evenings 6-7:30] , Portswood [Monday evenings in the café above Sainsbury’s 6-7] and

Freemantle [Thursday mornings]. The agenda is set by the members, although there is a

staff member from our Peer Support Team present to help organise things. It’s a great

opportunity to continue to practise your skills, and to meet new people. You don’t need an

appointment, and there is no fixed number of sessions. Just turn up when you want to.

Useful books:

Butler, G (1999) Overcoming Social Anxiety and Shyness: A self help guide using Cognitive

Behavioural Techniques Published: London: Constable and Robinson

And:

Butler, G. (2007) Overcoming Social Anxiety and Shyness Self Help Course

Published: London: Constable and Robinson.

Useful websites for relaxation:

www.changingmindsenterprisecic.co.uk

http://wellbeing-glasgow.org.uk/audio-resources/

Self-help resource (this link takes you directly to the social phobia formulation)

http://www.getselfhelp.co.uk/docs/models/SocialPhobia2.pdf

https://www.getselfhelp.co.uk/socialanxiety.htm

We hope you’ve enjoyed the course!

Keep on practising and Good Luck!