Effectiveness of CBT for Social Anxiety

This assignment focuses on evaluating the effectiveness of Cognitive Behavioral Therapy (CBT) as a treatment for Social Anxiety Disorder. It examines several research studies that compare CBT with other therapies like Interpersonal Psychotherapy and Mindfulness-based approaches. The analysis covers both in-person and internet-delivered CBT, highlighting its impact on social anxiety symptoms and long-term outcomes.

Running head: COGNITIVE BEHAVIOURAL THERAPY
COGNITIVE BEHAVIOURAL THERAPY
Name of the student:
Name of the university:
Author note:

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Background of the patient:
The client in the case study is called James. He is a thin guy without any mentioned physical
or mental disorder. However behavioural issues had been depicted by the client himself. He
lives a happy family life with his wife and three children. They have financial stability as
both are working. James work in a music company and his wife acts as registered nurse. Both
have been in a stable relationship from the time of school and maintain a comfortable life in
each other’s presence. However, most of the work in maintaining a proper social life is
conducted by James’s wife as he is not comfortable in socialising with people. He states that
he lacks the courage to communicate with someone new in his daily life. He faces anxiety
when any responsibilities on him regarding communication of performing any social duties
arise. Her wife is very helpful and therefore she does all the social duties of the family
without pressuring him or blaming him. He was working in small locally owned music store
where few members worked previously and he developed bonding with them. He was
comfortable with the slow pace of work and the warm relationships shared by all. However
the company has been now taken over by national music Chain Company and work culture
has changed. The fast paced work culture had become difficult for him to handle as it has
exposed him to a wide number of customers with whom he needs to talk properly. From the
childhood, his behaviour had not affected him much as he had been able to establish his
career and a married life. However coming to this age, the problems of his shyness and
inability talk at social level had aroused tension in him as he fears to lose his financial
strength and also fears the embarrassments he has to go onwards from now on.
Details of the problems and formulation:
From the evaluation of the symptoms of the patients, the client is diagnosed to be suffering
from social anxiety disorder. Dating back to childhood, it can be stated that he had suffered

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from selective mutism which is one of the forms of social anxiety disorders. As a phobia or
communication, a child or an adult with this disorder in front of an individual person or a
group of people is unable to speak properly although he has idea about what needs to be
spoken to them (Lischenring et al., 2013). In simple words, they are fully capable of speaking
but cannot speak in certain situations as they fear or become anxious before initiating the
speech. It usually begins form the age of 2.7 to 4.1 years of age which is long before the
mean age of social anxiety disorder arises. It gradually becomes apparent when the child
enters a communal environment outside the family home for first time (Goldin et al., 2014).
If not treated, it continues even to adulthood disrupting the development of quality life.
Researchers over the years have identified the main causes of the disorder. Different trauma
in childhood, minimal brain dysfunction or neuropsychological social cue processing disorder
may be a cause. However no such cases are reported for him (Lischenring et al., 2013). The
main causes which align with James ‘upbringing is particular parent profile and parent-child
relationship. As both the members have been reserved and his father was shy, he had adopted
the traits in his cognitive development as researchers state that children pick up traits and
characters form parents in their early life as they spend most of the time with them during
their cognitive phase of development (Goldin et al., 2014. Until these days, his wife had done
most of the work on the social front and therefore his symptoms of social anxiety disorder did
not affect his life. He also could not make friends due to his issues of shyness and anxiety to
speak to new people. However these are now affecting his professional life and he needs to
handle the symptoms effectively. He has always escaped the situations of social
communication as his wife had been proactive and considerate of his issues. However in the
professional front, he needs to communicate with customers effectively to maintain sales and
customer satisfaction. Therefore he has come to consultation centre. The different triggers
which have been identified for the client are being introduced to other people (Handling new

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customers and also making new friends), having to say something in a formal as well as
public situation (Like arranging and hosting social gathering), meeting people in authority
(like in case of handling parent-teachers meeting in school for his children). Other triggers
include feeling insecure and out of place in social situations and also getting embarrassed
easily. Moreover others noticed were not meeting eyes and also making phone calls and
others. All these need to be handled effectively to make him overcome the barriers.
Treatment plan:
Evidence based journals are of the opinion that cognitive development therapy has proved to
be exceptionally beneficial for handling social anxiety disorders. After the completion of this
therapy, people have been seen to suffer no longer from fear and anxiety before social
communications. Appropriate therapy has been found to be successful in modifying people’s
thoughts, feelings, behaviour as well as beliefs (Craske et al., 2014). While developing the
treatment plan, the expert should be helping the client to identify the anxious thoughts which
are contributing to the mute behaviour. He should be introducing strategies which would help
him to be aware of his thoughts (Kocovskil et al. 2013). The strategies should be including
recognizing his body symptoms of anxiety and identifying and challenging maladaptive
beliefs. Moreover a coping plan would be developed which would help him to tackle his
levels of distress (Mansson et al., 2015). Feelings of embarrassment, thinking himself to be
incapable, feeling insecure are mainly results of anxiety and feelings of worry and these
should be made to understand to the client.
James would be taught new information through encouragement about his social skills, his
inner powers, his capability to socialise well and empowering him with positive thoughts.
James need to taken in what is taught to him by practicing them in homes and other social
circles by means of continuous repetition. He would then be registering the new learning in

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his brain over and over again until it becomes automatic and habitual (Barlow et al., 2016).
When James would have learnt properly, he would be able to think, act and feel differently.
However this would take persistence, patience as well as practice. However the expert should
mainly pay importance to the fact that the client remains adhered with the fact and make it a
habit in his life to attain successful modifications of the behaviour.
Proposed treatment plan:
The treatment plan which should be followed by the expert for treatment of the client would
be according to the Heimberg model. This would mainly comprise of 15 sessions with 60
minutes duration for each session. It would also comprise of 90 minutes of 1 session for the
exposure. This treatment would require 4 months and would incorporate several important
phases. The first phase is called the ‘education about social anxiety’. However, before that
the expert should be sure that he has the ability to integrate the main elements of the
interventions like exposure as well as cognitive restructuring (Bogels et al., 2014). He should
make sure that he implements treatment in a manner which would not only be structured but
also responsive to the needs of the client. In the first few sessions, the client needs to develop
the ability to conceptualise his own social anxiety in the context of the model involving the
primacy of cognition as well as negative consequences of avoidance and habituation. This
would be completed in first two to three sessions of 60 minutes. The nest would be the
‘establishing the hierarchy of feared situations”. Here the client would develop the ability to
help the client in constructing the hierarchy of feared and avoided social situations. With the
help of the expert, he would rank them accordingly to establish the rate of degree or fear
associated with it (Hedman et al., 2014). This would require 3 more sessions. The third phase
would be the self monitoring phase where the client would be developing the ability to self
monitor their anxiety and mood and thereby trying to troubleshoot any potential barriers. He
should be doing this in his homework and it would require 2 sessions to confirm his

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adherence with the treatment model. The fourth is the step called ‘cognitive restructuring’
which would require the expert to offer him illustrative examples stating the fact that they are
not the events which are creating anxiety but are the interpretations of the events which are
doing so. Experts should also appraise the validity of the client’s thoughts rather than
considering them as wrong (Dagoo et al., 2014). He would also help the clients to make
connections between the emotions, behavioural and physiological reactions and help him to
challenge the automatic thoughts. The fifth step would be exposure of the client to real life
situations and debriefing after exposure ensuring that all the perceptions of the clients have
been explored and thereby providing feedback. This would require 2 sessions of 90 minutes.
The last three of four therapies would mainly address the core beliefs which would help them
to maintain their social anxiety properly in nature. One more 90 minutes session would be
important to assure the overall progress of the effect of the treatments and to make further
treatment based measures and discuss the issue of relapse (ElAlaqui et al., 2015). This also
helps James to employ skills which he has learned, after treatment ends.

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References:
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Emotional Disorders–Republished Article. Behavior therapy, 47(6), 838-853.
Bögels, S. M., Wijts, P., Oort, F. J., & Sallaerts, S. J. (2014). Psychodynamic psychotherapy
versus cognitive behavior therapy for social anxiety disorder: an efficacy and partial
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Goldin, P. R., Ziv, M., Jazaieri, H., Weeks, J., Heimberg, R. G., & Gross, J. J. (2014). Impact
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