We try to make a point in each of our articles on social anxiety that a therapy program with a counselor is the best way to address your social anxiety disorder (SAD). And one of the most common methods of overcoming fear of social situations is through social anxiety cognitive behavior therapy groups.
It may sound contradictory initially. Many treatment methods focus on relaxation and/or mindfulness whereas in social anxiety group therapy you will be asked to be with other people which is where most of your anxiety lies. And while the advice “Face your fears” is as simplistic as it is unrealistic, group therapy can be a very effective treatment for social anxiety when done comprehensively.
In this article we will provide an overview of what cognitive behavioral therapy (CBT) in groups could do for your social anxiety and what its most important elements and benefits are.
Why Social Anxiety Cognitive Behavioral Therapy groups can help you?
One of the biggest benefits of joining a therapy group for your anxiety is the environment you will enter. In SAD group therapy, you would meet other people who may suffer from social phobia and who are looking for ways of challenging their negative thought patterns in social situations. Group participants would not only have the same problem but would also be at the same stage of making steps to overcome it. This usually creates an environment of trust and strong support.
You will not be alone in this. And doing experiments (or exercises) together often reinforces this notion over time. The term ‘safe space’ tends to be thrown around a lot. But often these groups develop genuinely strong trust which can be great for building your confidence and assertiveness in ‘real life’.
This is not to say that social anxiety group work is not a part of the ‘real world’. On the contrary, the people opposite you will be real people who you may develop very real and warm relationships with.
According to practitioners, social anxiety therapy groups tend to be the most effective when composed only of people who suffer from SAD. If people with other mental health conditions– obsessive compulsive disorder, generalized anxiety or panic attacks– are included, this changes the dynamics of the group and fails to meet the participants’ needs.
On the other hand, a social anxiety behavioral group helps build the members’ self-esteem, as they are exposed to others’ perceptions of them in a structured, hierarchical way.
What happens during Social Anxiety Group Therapy?
Group CBT therapy varies from one group to the next depending on the needs of the group members. This is a good thing. But there are a few characteristics that tend to apply to most group practices.
- The group would usually be led by one or two therapists. Group counselors will often have struggled with social anxiety in their own lives. It is important that you see the group leaders as motivating and encouraging. Otherwise, you may not be comfortable and might not get the most out of your therapy.
Having more than one leader allows each member to receive more personal time and attention. To ensure this, SAD therapy groups usually wouldn’t consist of more than six people.
- While group therapy helps reduce social anxiety the most when the group is fairly small, it is usually beneficial that members are diverse– of different age/gender/race. This will further reduce the number of differences between therapy and ‘the real world’.
- As mentioned above, your group should consist only of people with social anxiety disorder. The mutual understanding of what people are there for and looking for is essential for therapy. When absent, it can compromise the comfort of the environment.
For example, if participants are asked to work with someone with generalized anxiety disorder, this might trigger strong anxiety symptoms and coping mechanisms, which can be very counterproductive. The purpose of social anxiety cognitive behavioral group therapy is to provide what each individual needs to overcome their phobia.
- Sessions would be structured around the individual problems each person faces. People’s social anxiety comes out in different ways and it is important that each member is given the time to work on the areas they find the most hurtful.
For some these may be giving presentations and speeches. For others, it would be making introductions, especially to potential dating interests. Small talk with strangers is also often brought up in group therapy. Often, all participants will participate in the same experiments and the counselors should allow everyone’s specific fears to be given ample time, attention and guidance.
What makes group CBT helpful for social anxiety?
The cognitive behavior model of SAD consists of two main components: cognitive restructuring and exposure. In social anxiety group therapy, you will be walked through both and will be asked to take part in exercises/experiments to address them. In addition, you may be assigned homework, which usually involves more exercises to do in your own time.
Taken alone, neither the cognitive nor the behavioral components of CBT can be effective in helping to overcome social anxiety. Cognitive restructuring without exposure cannot provide relief because the restructured thought patterns will not have been challenged against the real world.
And exposure alone does not work either as it is insufficient in rearranging patterns of negative thoughts. They have to be done methodically and together so that one can reinforce the other.
So let’s go over what these components of CBT mean.
Cognitive restructuring (CR) is often the first step in cognitive behavioral therapy for social anxiety. CR asks you to practice noticing your dysfunctional or negative automatic thoughts (cognitions), disputing them and, finally, rationalizing them so they become more realistic.
The first step is to isolate the negative automatic thought. This may initially be a challenge, especially if the person has become habituated to self-defeating thought patterns. With time, however, noticing these patterns can become as habitual as the original negative thoughts were. In fact, making this act automatic is one of the goals of CBT for social anxiety disorder.
In the second part of the process, the person is asked to assess the accuracy of the thought. Oftentimes we can be quick to go down irrational thought paths. These may include magical thinking, over-generalization, emotional reasoning, magnification and all-or-nothing thinking. All of these are commonly associated with mental health disorders, including SAD.
The third part of CR involves developing a rational response to the automatic thought. This tends to soften up the tension that the original thought may have produced, so this step is very important when employing cognitive behavioral therapy for social anxiety.
Finally, the person develops a rational rebuttal to the automatic thought.
Right, but this process has defeated just that one thought. But the more often cognitive restructuring is employed, the more habitual this process becomes. The ultimate aim is to turn negative thinking into adaptive, realistic thinking.
When treating social anxiety with a cognitive behavioral therapy group, your counselor will lay all of this out and will give you tips on how to approach this task. In addition, they will help you with walking through the individual steps involved in cognitive restructuring. This would usually be the first part of social anxiety group cognitive behavioral therapy.
Cognitive restructuring presents the rethinking component of CBT. Exposure is typically explained as the behavioral part of it. This is where people with social anxiety would be exposed to fear-producing situations so that they slowly become used to them. Over time, people learn to be more comfortable in social situations.
Social anxiety CBT groups can provide a very good environment for this type of learning. A common approach to achieve this is through ‘systematic desensitization’. It involves a step-by-step, hierarchical, repetitious (and patient!) approach to exposure. Treatment through systematic desensitization should never ask of patients to do things they are not ready for. Forcing through often backfires. It has the potential to take people stages back in their therapy and, more importantly, to damage their lives.
Unstructured, haphazard approaches to exposure in the context of group social anxiety therapy could be extremely counterproductive. This is why it is very important to find the right counselor who can earn your trust.
Experiments are central to this kind of therapy. They usually consist of role-playing, through which the group recreates a social situation which one of the participants has to navigate. This would normally involve pre-experiment warm-up (going over what the experiment will involve and what one can expect) as well as debriefing at the end of it. Both should be put in place to ensure that the experiment is interpreted rationally and productively.
Experiments can be done both in-session or as a field trip. Examples include having to listen to “Happy Birthday” sung out for you in public, going “down” the up escalator in a shopping mall or public yelling. And while these examples may feel a little random, when these situations are fitted into the right context, they can be immensely helpful for overcoming social anxiety.
In addition to experiments as part of your social anxiety group therapy, your counselor will also likely ask you to confront real-life situations between sessions. These assignments will go beyond the role-playing experiments during therapy and will ask you to handle your anxiety in new ways. It may be helpful to journal after completing a homework assignment. And don’t forget to pat yourself on the back.
How to Find a CBT group?
If your therapist has established that you meet the DSM diagnostic criteria for social anxiety disorder, they may recommend a therapy group to you.
Individual and group therapy for social anxiety have been shown to be equally effective in helping people overcome their disorder. If your doctor or counselor do not recommend a group to join, feel free to ask them about the best way they think you can challenge your SAD. Don’t forget to take your feelings into account as well!
When to choose CBT Group Therapy?
If the following apply to you, you may find that social anxiety group therapy can be a good option for you:
- There will be more pressure in-session, which could provide a very good environment for overcoming your social anxiety step by step.
- There’s usually a very strong sense of support between people who attend the same anxiety group therapy.
- It’s a good opportunity to become friends with group members, who would tend to be very sympathetic to your experience.
- SAD group therapy is usually less expensive than individual treatment.
When not to choose Social Anxiety Group Therapy?
- If you feel that you may not be ready for the additional pressure of group CBT therapy.
- If you feel that you require more personal attention and assistance from your therapist.
- If you require the additional scheduling flexibility that individual social anxiety disorder treatment offers.
- If you feel that you would require more time to bring up other issues which may or may not be related to social anxiety.