The effectiveness of interpersonal interactions is compromised by either a lack of skills, the presence of anxiety in socially threatening situations, or a combination of both. Young people who grow up in chaotic homes often miss out on learning interpersonal skills from their parents or other role models. Problems with social anxiety are common among children and adolescents from unstable homes, but often poorly recognised. The lack of social skills can contribute to fear and avoidance of socially challenging situations. Behaviour Therapy offers direct teaching of communication and social skills to compensate for these developmental set backs. Social anxiety can inhibit interpersonal effectiveness even when the basic skills have been learned. Cognitive Therapy offers methods for dealing with the fears underpinning social anxiety.
An important concept in CBT relevant to social anxiety is that cognitions can be grouped into three (3) levels: (i) automatic thoughts; (ii) assumptions and (iii) core beliefs or schemas (Leahy, 2003).
Negative automatic thoughts come spontaneously and appear valid on the surface, but can involve a range of specific biases or distortions such as mind reading, personalising, or labelling (e.g. “She doesn’t like me”). Emotional vulnerability to such thoughts is exacerbated by underlying assumptions or rules (e.g. “If I don’t get approval from everyone then I am worthless”) and underlying personal schemas (e.g. “I am unlovable” or “I am worthless”). Maladaptive assumptions are typically rigid, over-inclusive rules that are impossible to attain. In social anxiety maladaptive assumptions and schemas also refer to other people and the world (e.g. “Other people are very critical” and “I will never measure up to what other people expect”).
Another important type of process in social anxiety is information processing biases or attention biases such as excessive focus on the self and one’s own thoughts and physiological reactions rather than on the other person, the interaction or the environment (Hodson, McManus, Clark, & Doll, 2008).
The practice elements described below are organised around four areas of skill that are commonly included in communication and social skills training. These areas of skill involve building awareness of, and control over, various cognitive processes and behavioural responses. Some of these are implicated in social anxiety. Where relevant these implications are noted and appropriate techniques described.