CBT and Mindfulness are Effective for Social Anxiety

by Laura Johnson, Certified CBT Therapist on August 14, 2011

In today’s San Jose Mercury News, there was a front page article about a Stanford research study showing that cognitive-behavioral therapy (CBT) and mindfulness meditation can cause dramatic changes in the brain. The research is specifically studying how CBT and mindfulness meditation can change the brain in someone with social anxiety.

social-anxiety-self-helpThis is no surprise because there are hundreds of research studies showing that cognitive-behavioral therapy is the most effective type of therapy for social anxiety and other anxiety disorders. In addition, there is a lot of evidence that mindfulness meditation is effective in increasing empathy, attention and a sense of well-being. These changes in the brain can help people manage stress better and improve mental health.

In cognitive-behavioral therapy for social anxiety, there are several components of social anxiety treatment including cognitive restructuring (learning to evaluate your thinking more realistically), exposure to feared people and situations (staying in a situation long enough so your anxiety goes down), and elimination of “safety” behaviors that interfere with exposure.  A safety behavior is something you do intentionally or unintentionally to make yourself feel better in social situations, like going with a friend, holding a drink in your hand or arriving late/leaving early to avoid small talk.  While you may feel better in the moment, you don’t learn that you can tolerate your anxiety and, even overcome it, as you get used to the situation (i.e. habituation) and nothing really bad or scary happens. Another key component of treatment is social skills, assertiveness and communications training. If you have spent years avoiding people and social situations, you may not have developed the skills you need to feel confident and be effective in social situations. Sometimes, when social anxiety is extreme, you may need a more in-depth type of cognitive-behavioral therapy like core belief work and schema therapy.

There are several ways that mindfulness can be integrated into CBT. You can learn how to be mindful in the present moment and conduct daily activities with awareness and clarity. You may be asked to participate in activities that directly build mindfulness like a mindfulness-based stress reduction class, a yoga class or listening to mp3 recordings on your own.

The most classic form of mindfulness meditation is the mindfulness of your breath exercise, where you practice focusing your mind on your breath. You can use an anchor, like counting your breath, and bringing your attention back to your breath, without judgment, when you notice it straying. I tell my clients, “It’s normal for your mind to wander. That’s what our minds do. Your mind is like a puppy. It needs to be trained consistently or it will run wild. Your job is to just notice when your mind has wandered and it bring your attention back to the breath. With practice, your mind will learn to be more calm and settled.”

So how does mindfulness help with social anxiety? According to the Stanford article, mindfulness “appears to reduce social anxiety by interrupting poor self-judgments and rumination on self-defined negative traits.” Mindfulness seems to build positive traits like awareness of the present moment, non-judgmentalness, and compassion for self and others. This can help you be more gentle with yourself and worry less about what others are thinking of you.

For more information about Cognitive-Behavioral Therapy for Social Anxiety or Mindfulness for Social Anxiety, see the following books:

Managing Social Anxiety, Workbook, 2nd Edition: A Cognitive-Behavioral Therapy Approach by Debra Hope, Richard Heimburg and Cynthia Turk

The Mindful Path Through Shyness: How Mindfulness and Compassion Can Help Free You from Social Anxiety, Fear and Avoidance by Steve Flowers and Jeffrey Brantley

Laura L.C. Johnson, MBA, MA, LMFT, Cognitive Behavior Therapy Center of Silicon Valley, 1475 Saratoga Avenue, Suite 168, San Jose, CA 95129. Copyright 2010.