“What do I do with these upsetting thoughts that make me socially anxious?”
In a pair of previous blog posts, I explain the role of two strategies used in cognitive-behavioral therapy (CBT) for dealing with upsetting thoughts that help cause our social anxiety: mindfulness and cognitive restructuring. Now I get into the nuts and bolts of exactly what to do when you’re feeling socially anxious and your mind is flooded with hot thoughts: upsetting words and images.
Thought Defusion: Ideas, Not Truth
This is a set of simple strategies aimed at becoming emotionally detached from our thoughts, and viewing them as passing ideas, not lasting truth. Here are a few tactics to try out:
— Whenever bothered by a hot thought, tell yourself a simple message that reminds you this is just an unimportant and temporary idea, eg: “That’s one of those old ideas that pester me from time to time. It will pass.” “Right now, I’m having one of my anxious ideas. It doesn’t matter.” “Nope, I’m not going to take that call” (referring to your hot thought as an unimportant call showing up on your phone).
Be creative. Come up with your own self-message that resonates with you. Just make sure you say it with a matter-of-fact, non-upset tone, since the goal is to become emotionally detached from your thought. Then, after calmly self-messaging your statement, refocus your attention mindfully (with interest) on an activity or conversation in the moment. Repeat as needed.
— When you are alone, occasionally do the following exercise: close your eyes and calm yourself with slow, deep breathing. Then mindfully observe whatever thoughts that happen to pass through your mind with an attitude of emotional detachment. Just notice these thoughts, be they words and/or images; don’t respond to them, follow them or try to change them. Just watch as they pass by, change or disappear on their own. If you want, try imagery: visualize your thoughts slowly moving away, like balloons, puffy clouds, fallen leaves, or cars on a freight train you are watching pass by.
Curiosity Training: Get Out of Your Head and into the Moment
Whenever you are feeling anxious around people, you probably are focusing on your thoughts and feelings. Doing so only makes you feel more anxious and hurts your conversation. Instead, refocus your attention on taking interest in the people, conversation or activity in the moment. Don’t try to silence your thoughts and feelings; that tends to backfire. Instead, treat your thoughts and feelings like unimportant background noise, and refocus your attention externally, with an attitude of curiosity. If you want, you can silently say a gentle, non-critical word or short phrase (eg. “mindful,” “curious,” or “take interest”) to briefly interrupt your hot thought, and then refocus your attention on taking interest in the people, conversation or activity in the moment.
Cognitive Restructuring: Realistic, Helpful & Compassionate
Chances are we won’t be able to use thought defusion or curiosity training very well if our hot thoughts are especially troubling, and we believe that they are true, could be true, or we just know how true they are. That’s where cognitive restructuring comes in handy. It helps us to see how reality-based or distorted our hot thoughts are, and then decide on a good course of action to take. The aim of cognitive restructuring is to come up with a constructive way of thinking which is more realistic, helpful and compassionate than our hot thoughts, and then to set behavioral goals to carry out.
This key step to helping you develop a constructive way of thinking is to ask challenging questions to help you debate your hot thoughts. There are many possible challenging questions you could use. Here are some that I find to be most helpful to challenge the hot thoughts that give rise to social anxiety:
— What’s the evidence supporting and refuting my hot thoughts?
— What’s the worst that could happen? What’s the best that could happen? What’s the most likely thing to happen?
— How likely is it that my fear will come true? If it does, what can I say and do to handle it? How bad would it be then?
— What would I say to a good friend who is thinking and feeling this way?
— Does this person’s opinion of me reflect everyone else’s opinion? Do others have different opinions toward me?
Here is an example of socially anxious hot thoughts about mingling with strangers in a social activity, and a constructive alternative that someone came up with using cognitive restructuring. Notice how the constructive thought includes answers to some of the challenging questions, and how it is also more realistic, helpful and compassionate than the hot thought.
–I might say something stupid or offensive.
–I might appear anxious and make a bad impression.
–S/he might think I’m boring or unattractive.
I seldom say stupid or offensive things. When I do, I can simply apologize and move on. Everyone says such things occasionally and, with a simple apology, no one seems to care. Most people don’t see my anxiety since it’s mainly internal. If they do, they may not care. If they do care, oh well, no one can please everyone. Some people find me interesting and attractive. I don’t find everyone to my taste. It’s all normal.
Short version: Who cares? Just focus on enjoying the conversation in the moment.
An additional step in cognitive restructuring is to identify behavioral goals that are a constructive alternative to the safety-seeking behaviors that we tend to use when we are believing and obeying our hot thoughts. Here are examples for the same situation of mingling with strangers in a social activity:
–avoid going to the activity
–if I do go: avoid making eye contact; avoid initiating conversation; script in my mind what to say next; ask lots of questions to keep the focus off of me; say very little when I’m asked something; focus on my anxious symptoms to try to control & hide them
CONSTRUCTIVE BEHAVIORS / GOALS:
–go to the activity; make eye contact and smile at people; say hi and introduce myself when someone smiles back; focus with curiosity on the person and the conversation, and treat my thoughts, feelings and symptoms like background noise; say more about myself; elaborate a little when I answer a question; if I say something stupid or offensive, quickly apologize and then continue the conversation
Notice: one of the goals in cognitive restructuring is to weaken our belief in our hot thoughts so that we can treat them like background noise and focus mindfully on the person, conversation or activity in the moment. In other words: you can use cognitive restructuring to prepare for an activity that makes you socially anxious. Then use thought defusion and/or curiosity training during the interaction as you work on your personal goals. Or use cognitive restructuring to help you process something upsetting that has already occurred, so you can feel better more quickly and learn something constructive from the experience.
Tools to Help You Do Cognitive Restructuring
— Cognitive restructuring worksheets (sometimes called thought records or mood logs). These take you through the process in a structured, step-by-step manner. Worksheets are a great way to learn this strategy. (Email me and I’ll send you the worksheet I use, along with a sample worksheet and instructions.)
— CBT apps: these help you do cognitive restructuring in a quick, abbreviated and convenient way on your smart phone or tablet. Here are a few examples (but there are many other good apps out there for Android &/or IOS): eCBTMood, CBTReferee, iCBT, CBT-i, Mayo Clinic Anxiety Coach, koko. Koko uses social networking where a community of people help each other challenge their hot thoughts. Look up CBT or cognitive restructuring on your app store to find many others apps from which to choose that are available on your devices, Android or IOS.
— Coping cards / recordings: write your constructive thought on a file card or in your smart phone, or create an audio recording on your phone reciting it with a confident tone. Then read or listen to your constructive attitude when you have anticipatory anxiety, including on your way to doing something challenging.
— Role plays: if you are doing cognitive-behavioral therapy (CBT), ask your therapist to help you conduct a two-chair role play in session. In one chair you portray your hot thoughts; in the other chair, you portray your constructive thoughts. Then go back and forth between the chairs and carry out an emotion-filled debate between these two perspectives.
— Experiments: conduct experiments in which you test your hot thoughts by using mindful focus and other constructive behaviors in situations in which you are anxious, followed by evaluating the evidence you gather from the experiments and modifying your hot thoughts accordingly. In this way, we are applying the scientific method in which a researcher tests a hypothesis (our hot thoughts) by conducting experiments, gathering evidence, and then revising the hypothesis as needed to fit the evidence. (Email me and I’ll send you the experiment worksheet I use, along with a sample of one filled out.)
Larry Cohen, LICSW
Cofounder, National Social Anxiety Center; Director, NSAC District of Columbia
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