First, Raj learned about what anxiety is and how to recognize it (see What is Anxiety?). Then he learned to understand the nature of social anxiety (see Social Anxiety Disorder). This included information about how people with social anxiety tend to fear and avoid social situations because they are overly concerned they will do something embarrassing or that others will judge them negatively.

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He also learned that it’s normal to feel anxious in social situations from time to time. For example, most people feel anxious when they have to speak in front of a large group of people. However, Raj discovered that social anxiety can become problematic when it causes a great deal of distress and gets in the way of enjoying life.

In order for Raj to manage his social anxiety successfully, he needed to understand it better. People with social anxiety tend to fear a variety of social situations (e.g., public speaking, being the centre of attention, eating in front of others, meeting new people) and experience different physical symptoms of anxiety (e.g., shaking, sweating, blushing, dizziness, dry mouth). To get to know his social anxiety better before applying strategies to manage it, Raj began to keep track of his anxiety.

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In a notebook, Raj made three columns: date, situation, and anxiety symptoms. He then spent a couple of weeks taking note of situations that caused him anxiety (such as talking to cashiers, making eye contact with strangers, saying "Hi" to neighbours) and what physical symptoms he experienced (such as rapid heartbeat, blushing, sweating). After learning more about his anxiety, Raj was ready to start applying some specific strategies for managing it.

 

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CBT- Personal Story - Raj

TOOL # 1: Relaxation Skills

Feeling anxious can be very uncomfortable. Raj learned about various relaxation strategies that could help him "turn down the volume" on anxiety and make it easier for him to face social situations. He learned about calm breathing, which involves taking slow, regular breaths through his nose (see How to do Calm Breathing). He also realized that the goal of calm breathing was not to eliminate or avoid anxiety (because anxiety is not dangerous, and part of overcoming fears involves allowing yourself to experience anxiety rather than fight it), but to make it a little easier for him to ride out his feelings in social situations.

Raj also learned how to lower his overall tension and stress levels (which can contribute to anxiety) using a daily muscle-relaxation exercise that involved tensing various muscles in his body, then relaxing them (see How to do Progressive Muscle Relaxation).

TOOL #2: Realistic Thinking

People with social anxiety tend to have negative thoughts about themselves (e.g., "I’m not likeable", "I’m incompetent") and about what will happen in social situations (e.g., "I’ll blush", "Others will think I’m boring", "No one will talk to me"). Raj learned that his thoughts were guesses about what would happen, not actual facts, and that he may be overestimating the degree of danger in social situations. An important step for Raj was to learn how to develop more realistic ways of thinking (see Realistic Thinking).

First, Raj needed to identify the kinds of thoughts he was having in social situations. For a week or so, he paid attention to all the thoughts he had just before entering a social situation and while he was in the situation. In order to help him identify his thoughts, he would ask himself, "What am I afraid I might do?" and "What am I afraid others will think about me?" Through this exercise, Raj realized that his main worries were that he would say something stupid, have nothing interesting to say or look anxious. He was also concerned that others would find him boring, judge his physical appearance negatively and dislike him.

The next step was for Raj to learn to evaluate his thoughts by examining whether his thoughts were balanced and based on facts. His goal was to try to identify more realistic and helpful thoughts. To evaluate the accuracy of his thoughts, he asked and answered the following questions about social situations he had to face:

What am I afraid will happen?
In this situation, I’m afraid that if I try to make small talk with others, I’ll have nothing interesting to say. I also fear that others will find me boring and won’t like me, as a result.

Am I 100% sure that I will have nothing interesting to say, or that others will be bored and dislike me?
No, I am not 100% sure.

How many times has that actually happened?
A few times, but not every time.

What is the evidence that supports my thoughts?
There’ve been several times when I was talking to cashiers at the grocery store and they were looking around like they were bored. A couple of times, I tried to talk to neighbours and they excused themselves in the middle of the conversation.

What is the evidence that does not support my thoughts?
I have had a few good conversations with cashiers. One man in my building always tries to start a conversation with me, so he can’t find me that boring.

What’s the worst that could happen?
I may run out of things to talk about or say something stupid.

How can I cope with it?
I could excuse myself or try to crack a joke about what I said. Or I could think of a question to ask the other person.

Is there another way of looking at this situation
? We can’t always have interesting things to say. I’m not the only one responsible for the conversation. I don’t find everyone else interesting all the time, and other people sometimes say stupid things too. It’s not such a big deal.

By re-evaluating his thoughts, Raj was able to "turn down the volume" on his anxiety in some social situations. Raj also found it helpful to remember that no one is a perfect conversationalist all the time, that everyone makes mistakes, and that we all feel anxious at times. He also realized that it’s unrealistic to think that everyone will like him; he doesn’t like everyone, either! He focused on accepting that being imperfect is part of being human.

TOOL #3: Test it out!

Sometimes it can be helpful to test the truthfulness of some of our thoughts and beliefs. For example, Raj was concerned that others would think he was weird if he was shaking. Raj assumed that it would be horrible if this happened, and that he’d be unable to cope. However, Raj needed to test this out. So, he purposely shook while talking to other people to see how they reacted. Although Raj admitted he was scared to shake on purpose, he tried it and found that other people often didn’t seem to notice, and when they did, they kept on talking as if it wasn’t a big deal. This experiment helped Raj discover the importance of testing out his thoughts.

TOOL #4: Facing Fears

It’s normal to want to avoid the situations that make us anxious. Raj found that this was a very effective strategy for lowering his anxiety in the short term. However, avoiding social situations was increasing Raj’s fear in the long term because it was preventing him from learning that his expectations were either unlikely to happen or weren’t as bad as he thought. He needed to start facing his fears (see Facing Fears: Exposure).

So, Raj made a list of different social situations that he feared and avoided (such as chatting with female cashiers, making phone calls, initiating conversations). Once he had his list, he rated them according to how much anxiety they caused him, from 0 (no anxiety) to 10 (extreme anxiety). He then ordered them from the least scary at the bottom to the most scary at the top.
Here are some of the situations on Raj’s list:

Starting with the least scary, Raj repeatedly entered that social situation until he felt less anxious doing it (on numerous occasions). Every day he made an effort to say "Hi" to at least one neighbour in his building. Every time he did it, he would rate how anxious he felt before and after in his notebook. Raj found that after a week or so, his anxiety in this situation had dropped to a 1 or 2. He was ready to move on to the next thing on his list.

TOOL #5: Eliminating Subtle Avoidance and Safety Behaviours

Rather than completely avoiding social situations, some people engage in subtle forms of avoidance. They do things to try and feel safer, or prevent their feared expectations from coming true. For Raj, he worried he would say something stupid or be boring. As a result, he would try to say as little as possible or rehearse what he was going to say before he said it. For a couple weeks Raj tried to pay close attention to the things he did to protect himself. He discovered that he would try to draw attention away from himself by wearing his baseball hat down low to hide his eyes, or saying very little. He also realized that he would try to hide visual signs of anxiety (such as shaking) by always keeping his arms crossed at his chest. Raj tried to stop doing some of these things when he was in social situations to see what would happen. He discovered that most of the time, nothing bad did happen and that his safety behaviours weren’t necessary.

Raj found that his CBT skills were helping him to better manage his social anxiety. However, he needed to remember that learning to manage anxiety effectively is a lot like exercise – he needed to "keep in shape" and practice his skills regularly. Raj tried to make practicing the skills a daily habit. However, he learned that sometimes during times of stress or transition (e.g., starting a new job), it’s possible to slip into old patterns. This is normal. It just means he needs to get out his social anxiety toolkit and start using the tools he learned (see How to Prevent a Relapse). Raj realized that coping with anxiety is a lifelong process. The good news is now he has the skills to do it!