USING VIDEO FEEDBACK IN CBT FOR SOCIAL ANXIETY

The Cost of Misperception

One of the key components that maintains Social Anxiety Disorder over time is a pervasive negative self-image and related self-critical thoughts that are activated in social situations. Once activated, this negative self-image often leads to overly negative misperceptions of how one is coming across to others during social contacts. Increased apprehension and avoidance of social interactions often increases from this habitual negative perception of oneself, perpetuating further the cycle of social anxiety.

Watching and Learning

Fortunately, several strategies have been developed within Cognitive-Behavioral Therapy (CBT) that are helpful to adjust one’s perceptions to a more helpful and realistic appraisal. A recent study by Warnock-Parkes et al. (2017) focused on the benefit of using video feedback in particular within CBT. They found that using video feedback with participants was highly effective in changing negative self-perceptions and was associated with a significant reduction in social anxiety. Participants reported an improvement in their self-perception as they learned that they came across to others more favorably than they originally predicted, once they viewed video of themselves during a social interaction. The author’s identified the following guidelines for using video feedback during cognitive-behavioral therapy:
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Setting up the Camera

Along with setting up the camera in an unobtrusive place, it is best to show both people in the interaction so the participants can focus on the overall context of the interaction (versus overly focusing on themselves).

Identify Predictions in Advance of Viewing

Identify what participants think they will see and what their self-perceptions are (eg. “I’ll look terribly anxious and shaky”).

Prepare an Unbiased Mode of Viewing

Individuals with social anxiety often use their feelings as a judge of social performance, versus concrete goals or how one objectively appears. Before viewing their video, help participants to distance from the videotaped interaction and appraise the video as if it were of a stranger, ignoring their feelings.

Compassionate Stance

Direct the participant to view the video from a compassionate stance, as if watching a close friend as a means of counteracting habitual self-critical thoughts.

Identify Impact of “Safety Behaviors”

Participants may intentionally respond to social interactions with ways to help reduce anxiety, such as avoiding eye contact. Watch out for the unintentional impact of these safety behaviors on the interaction.

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Compare and Contrast

Compare predictions and ratings of the interaction before and after viewing the video: participants reliably found they looked much better than they thought they would!

People with social anxiety can have great difficulty separating their anxious feelings and negative self-perceptions from what their actual behavior and presentation is in social interactions, whether they are in the therapy office or out in public. Utilizing video feedback within the structure of CBT offers a great strategy to move beyond these feelings and gain a more helpful and accurate view of oneself in social situations.

How to Get Help for Social Anxiety

The National Social Anxiety Center is a national association of regional clinics with certified cognitive therapists specializing in social anxiety and anxiety-related problems. Currently, we have regional clinics in San FranciscoDistrict of ColumbiaLos AngelesPittsburgh, New York City, ChicagoNewport Beach / Orange CountyHouston / Sugar Land, and St. Louis. Contact our national headquarters at (202) 656-8566 or visit our Regional Clinics contact page to find help in your local area or if your clinic is interested in applying for membership.

Article Reference:  http://www.sciencedirect.com/science/article/pii/S1077722916300232?dgcid=raven_sd_via_email

SUPPORTING A FRIEND WITH SOCIAL ANXIETY

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Have you ever suspected that someone you’re close to is avoiding a social situation because of anxiety? Feeling anxious in social situations is common for many of us, but for some people, it can be debilitating. Your friend or loved-one may be suffering from social anxiety. People often hide their symptoms, so if you notice that a friend is anxious, it might be a good time to help. Cognitive behavioral therapy is an effective treatment for social anxiety, and knowing some basic principles can help you be supportive. Here are the basics:

Be patient

Social anxiety can be the result of physiological factors, traumatic experiences, or both. With proper support, anxiety can be overcome. Don’t criticize, blame, or minimize feelings. It’s important to listen and be supportive so that your friend will be more likely to open up.

Find out what they’re thinking

Physical feelings of anxiety usually start with thoughts. The first step is to ask your friend what he or she is worried about. Get as much detailed information as possible. Remember that no matter how unlikely or inconsequential these thoughts seem, they are real for your friend. Meet them with curiosity, not judgement.

Help reframe

Once anxiety hits, it can be very difficult for someone to get perspective on the situation. You can “widen the lens” by asking: what’s the worst thing that could happen? What’s the best thing that could happen? What is likely to happen? Have they ever felt this way before, and survived? Looking back on this situation in five years, what will they think about it?

Be a cheerleader

When helping a social anxiety sufferer, CBT therapists often ask their patients to imagine what a good friend would say to them. Here’s your chance to be that friend! Remind them of their strengths, whether it be a winning smile or a great sense of style. Remind them of the benefits of being social: reinforcing friendships, meeting new people, making connections, and having interesting experiences.

Avoid avoidance

Avoiding a social situation is what is known as “safety-seeking behavior.” Safety-seeking behaviors reduce feelings of anxiety, but they are a quick fix that actually worsens the problem. Once a certain pathway in the brain is reinforced (ie. avoid socializing = relief) it takes effort to create an alternative pathway (ie. socializing = fun). Even though avoidance is to be avoided, forcing is not the answer. If necessary, try to negotiate a compromise. It’s better to plan an exit strategy ahead of time than it is to avoid going in the first place. With any luck, once your friend is exposed to the actual
situation, it will be much better than anticipated.
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Reinforce the positive

Show confidence in your friend’s ability to cope. Just because they’re worried, you shouldn’t be. In the context of the social situation, give him or her opportunities to be independent and answer questions themselves. Afterwards, offer lots of positive reinforcement for making the effort to overcome the anxiety. Get help: If your efforts are not successful, don’t take it personally. Social anxiety disorder can be crippling, but it is treatable. Recommend that your friend get help from a certified CBT therapist.

How to Get Help for Social Anxiety

The National Social Anxiety Center is a national association of regional clinics with certified cognitive therapists specializing in social anxiety and anxiety-related problems. Currently, we have regional clinics in San FranciscoDistrict of ColumbiaLos AngelesPittsburgh, New York City, ChicagoNewport Beach / Orange CountyHouston / Sugar Land, and St. Louis. Contact our national headquarters at (202) 656-8566 or visit our Regional Clinics contact page to find help in your local area or if your clinic is interested in applying for membership.

PUBLIC SPEAKING ANXIETY AND FEAR OF BRAIN FREEZES

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The fear of public speaking is the most common phobia ahead of death, spiders, or heights. The National Institute of Mental Health reports that public speaking anxiety, or glossophobia, affects about 73% of the population. The underlying fear is judgment or negative evaluation by others. Public speaking anxiety is considered a social anxiety disorder.

The fear of public speaking is worse than the fear of death

Evolution psychologists believe there are primordial roots. Our prehistoric ancestors were vulnerable to large animals and harsh elements. Living in a tribe was a basic survival skill. Rejection from the group led to death. Speaking to an audience makes us vulnerable to rejection, much like our ancestors’ fear.

A common fear in public speaking is the brain freeze. The prospect of having an audience’s attention while standing in silence feels like judgment and rejection.

Why the brain freezes

The pre-frontal lobes of our brain sort our memories and is sensitive to anxiety. Dr. Michael DeGeorgia of Case Western University Hospitals, says: “If your brain starts to freeze up, you get more stressed and the stress hormones go even higher. That shuts down the frontal lobe and disconnects it from the rest of the brain. It makes it even harder to retrieve those memories.”

The fight or flight response activates complex bodily changes to protect us. A threat to our safety requires immediate action. We need to respond without debating whether to jump out of the way of on oncoming car while in an intersection. Speaking to a crowd isn’t life threatening. The threat area of the brain can’t distinguish between these threats.

Help for public speaking anxiety

We want our brains to be alert to danger. The worry of having a brain freeze increases our anxiety. Ironically, it increases the likelihood of our mind’s going blank as Dr. DeGeorgia described. We need to recognize that the fear of brain freezing isn’t a life-or-death threat like a car barreling towards us while in a crosswalk.

Change how we think about our mind going blank.

De-catastrophize brain freezes. It might feel horrible if it happens in the moment. The audience will usually forget about it quickly. Most people are focused on themselves. We’ve handled more difficult and challenging situations before. The long-term consequence of this incident is minimal.

Leave it there. Don’t dwell on the negative aspects of the incidents. Focus on what we can learn from it. Worry that it will happen again will become self-fulfilling. Don’t avoid opportunities to create a more positive memory.

Perfectionism won’t help. Setting unachievable standards of delivering an unblemished speech increases anxiety. A perfect speech isn’t possible. We should aim to do our best instead of perfect.

Silence is gold. Get comfortable with silence by practicing it in conversations. What feels like an eternity to us may not feel that way to the audience. Silence is not bad. Let’s practice tolerating the discomfort that comes with elongated pauses.

Avoidance reinforces. Avoiding what frightens us makes it bigger in our mind. We miss out on the opportunity to obtain disconfirming information about the trigger.

Rehearse to increase confidence

Practice but don’t memorize. There’s no disputing that preparation will build confidence. Memorizing speeches will mislead us into thinking there is only one way to deliver an idea. Forgetting a phrase or sentence throw us off and hastens the brain freeze. Memorizing provides a false sense of security.

Practice with written notes. Writing out the speech may help formulate ideas. Practice speaking extemporaneously using bullet points to keep us on track.

Practice the flow of the presentation. Practice focusing on the message that’s delivered instead of the precise words to use. We want to internalize the flow of the speech and remember the key points.

Practice recovering from a brain freeze. Practice recovery strategies by purposely stopping the talk and shifting attention to elsewhere. Then, refer to notes to find where we left off. Look ahead to the next point and decide what we’d like to say next. Finally, we’ll find someone in the audience to start talking to and begin speaking.

Be prepared for the worst. If we know what to do in the worst-case scenario (and practice it), we’ll have confidence in our ability to handle it. We do that by preparing what to say to the audience if our mind goes blank. Visualizing successful recovery of the worst will help us figure out what needs to be done to get back on track.

Learn to relax

Remember to breathe. We can reduce anxiety by breathing differently. Take slow inhalations and even slower exhalations with brief pauses in between. We’ll be more likely to use this technique if practiced in times of low stress.

Speak slowly. It’s natural to speed up our speech when we are anxious. Practice slowing speech while rehearsing. When we talk quickly, our brain sees it is a threat. Speaking slowly and calmly gives the opposite message to our brain.

Make eye contact with the audience. Our nerves might tell us to avoid eye contact. Making deliberate eye contact with a friendly face will build confidence and slow our speaking.

Join a group. Practice builds confident in public speaking. Groups like Toastmasters International provide peer support to hone our public speaking skill. Repeated exposure allows us to develop new beliefs about our fear and ability to speak in public.

The fear of our mind going blank during a speech is common. Job advancement or college degree completion may be hampered by not addressing this fear.

By John R. Montopoli, LMFT, LPCC

Cofounder, National Social Anxiety Center; Director, NSAC San Francisco

john@pacificcbt.com ; (415) 689-4131

How to Get Help for Social Anxiety

The National Social Anxiety Center is a national association of regional clinics with certified cognitive therapists specializing in social anxiety and anxiety-related problems. Currently, we have regional clinics in San FranciscoDistrict of ColumbiaLos AngelesPittsburgh, New York City, ChicagoNewport Beach / Orange CountyHouston / Sugar Land, and St. Louis. Contact our national headquarters at (202) 656-8566 or visit our Regional Clinics contact page to find help in your local area or if your clinic is interested in applying for membership.

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