CBT: Everything I've learned.

SA sufferers enter CBT generally with the goal to reduce their physical symptoms of anxiety as well as lower their (perceived) inhibitions. This is an appreciable goal, afterall seemingly the only thing separating us from "normal" people are the physical symptoms and inhibitions (although one might classify inhibitions as being apart of physical symptoms). However, this becomes a problem goal when one makes this the focus of their treatment. CBT does not directly address physical symptoms, nor does it directly address one's inhibitions.

The theory of CBT is simple. Your symptoms of anxiety are coming from your negative interpretations of reality. In this way, CBT goes for the "cause" of your anxiety. That is the magnitude and strength of belief you have in your negative interpretations. In the case of social anxiety, it is ALWAYS the case that you "fear" people noticing your physical symptoms. Your physical symptoms themselves are not generally distressing, you don't have them when other people are not around, they're tied explicitly to your interpretation of what other people think, react, and believe when they (might) notice your social awkwardness/physical symptoms.

In this way CBT addresses your "fear" not your physical symptoms, but your actual "fear" how afraid you are when a given situation occurs. The technique for this I will detail in later paragraphs, but I want to make it absolutely crystal clear what I'm saying here. I will restate it in two ways, once again another way, and once again in an example.

You're not addressing your physical symptoms/inhibitions during CBT, if you continued to experience physical symptoms of anxiety with the same intensity, but you were able to go to clubs, go to parties, talk with strangers, go on dates, etc. then you wouldn't be classified as having social anxiety disorder. I know that sounds odd but it's true! But actually what you'll find is that by focusing on addressing your "fear" instead of the intensity of symptoms, your symptoms actually begin to reduce themselves!

Now for an example. About a month ago I gave a presentation at a toastmasters meeting. This was to a large audience, and I wasn't given the topic ahead of time. I felt no fear before hand, I didn't even know when I was going to be called on. Because I had gone through CBT, and I knew that even if the worst thing happens, even if I become a blubbering idiot and pass out and urinate on myself and catch on fire, I WILL BE ABLE TO HANDLE IT! I'm perfectly safe! I didn't hesitate at all when they called on me to go up and present. I went up there, and I had a massive panic attack, I ran out of breath, and my heart raced and everything. But I wasn't accepting any ideas that I was being negatively evaluated or that what I was experiencing was making me a complete loser. I ended the speech, went back to my seat. Didn't reflect over it, because I was perfectly  happy with what I was able to do. I didn't care if other people thought of me negatively or not (none of them likely did) because I knew what I was there for, I want to get better and if people I never see again judge me negatively then they're heartless losers who don't know shit about me or my situation.

This past month I have felt my physical symptoms of anxiety and inhibitions begin to diminish dramatically. As my fear levels have gone down I have been going to clubs, going out with friends, making new friends, and even talking up girls!

So, this is how CBT works. It addresses your fears. It addresses your beliefs and cognitions. The most effective way it does this is by having you do extended exposures until you begin to realize that you're ok and safe in particular situations and when you remove your inhibitions. It's like learning how to swim, people take you slowly deeper and deeper and once you convince yourself you won't drown all of a sudden you're Michael Phelps!

There are medications that will speed up this process, but I don't want to talk about it here, it's something I need to have an extended conversation with.


Exposure exercises in my honest opinion must be begun in lab settings. You have to be able to be given discomfirming evidence. For me we repeatedly had audiences fill out "feedback" forms for me about how they were actually perceiving me. This helped so so so so soooooooooo much that I can't even begin to think how anyone can do CBT without this feature in their exposure exercises. It literally opens up your mind and lets you see this dimension that didn't exist before. Never in the past could I have imagined what I actually came across like and how people actually were perceiving me. So much of SA is grounded in this false idea on how you're coming across, how people are perceiving you. Well what better way to counter this than to get their actual opinions! Also, just doing extended exposures was an immense benefit because you begin to melt your anxiety away and it gives you this surge in confidence in your ability to handle difficult social situations.

During exposure exercises it is ABSOLUTELY imperative that you engage in "antagonistic" actions. That is, doing things your brain is telling you NOT to do. That is how you destroy inhibitions, and it's what allows you to experiment and discover just how safe you actually are in social situations and how much people appreciate your non inhibited self.

Also you must drop SAFETY behaviors. Things like holding your hands in your pockets, or modifying your voice to make you sound more confident, or listening in on your voice to make sure it sounds ok, or looking down... in fact one simple antagonistic action is to purposely look at people in the eyes when you're talking with them. Actually you'll find that dropping safety behaviors (and you need a therapist to help you identify your own particular safety behaviors) because everyone has their own unique brand of insanity. My own safety behaviors was rocking back and forth (fidgeting) avoiding eye contact, and paying large attention to how my voice was sounding. If you don't drop your safety behaviors during exposure exercises you will make no progress. NONE!

Cognitive exercises are useful in the sense that they keep you commited. I mean keep your thoughts committed, like filling out forms and identifying negative thoughts. But honestly, the only way to change your interpretation of reality and your fears is to aggressively expose yourself to the situations.