Updated March 07, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Welcome back to the 16-week e-course with details about what to expect from cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). Last week we talked about fears of making conversation or small talk with other people -- one type of specific social fear. This week we move to a discussion of observational fears, or fears of doing things in front of other people. If you are meeting with a therapist for CBT, he might cover these topics in a different order.
If you haven't already read sessions one through nine of this series, please go back and do so before continuing with this week's article. Below is a list of the previous sessions, designed to be read at a rate of one per week.
Session One
Session Two
Session Three
Session Four
Session Five
Session Six
Session Seven
Session Eight
Session Nine
Remember that these weekly sessions are not a substitute for treatment with a mental health professional, particularly if you suffer from severe social anxiety. And if you are taking part in CBT with a therapist, know that the following provides an example of what you're likely to cover during each session, but the structure can vary considerably depending on the specifics of your disorder and the style of your therapist.
As usual, your therapist will review your homework assignment, as well as plot the progress that you have made on the SASCI graph. If you are working along on your own as a self-help series, evaluate how things went and any obstacles that you faced.
Remember that completing the exposure can be considered a success, and that your behavior doesn't have to be perfect.
Many people with social anxiety disorder suffer with observational fears -- such as signing your name, eating, or drinking in public. Usually your worry is that others will see your hand shaking or that you will do something to embarrass yourself, such as spill your drink. In this way, it is a fear of others judging you negatively.
Below are some common observational fears. Make a note of which of these situations cause anxiety for you and create a list of other observational situations that a problematic for you.
Observational fears become a self-fulfilling prophecy. If you don't think too much about writing, drinking or eating they all happen automatically. However, when you start to pay attention to your movements, they become difficult. Your muscles become tense in response to your anxiety and self-consciousness and your focus on negative automatic thought interferes with your concentration.
If your anxiety about these situations is severe, you might even start to avoid them. This can cause problems in daily life, as it is hard not to write, eat and drink in front of others -- without completely isolating yourself.
Just as in the previous session, you and your therapist would now engage in an in-session exposure, only this time you would be focusing on observational fears. The two of you would choose an observational scenario, such as pouring a drink for someone, and carry out the exposure just as you have done in previous weeks. Visit the session eight article for a reminder of how to complete an exposure.
If you would like to remind yourself of the principles from this article that was part of last week's homework, you could review it again.
This week your homework assignment is to complete an observational exposure in your every day life. Below are the steps to use to complete the exposure, as you have done in the past. Make sure that you choose an observational situation that causes moderate anxiety.
In addition to doing the in vivo exposure, this week you will continue to complete daily challenges to build self-esteem. Below is a list of ideas related to observational fears.
1. Drinking in front of someone.
2. Eating in front of someone.
3. Signing your name in front of someone.
That's it for this week! Be sure to complete these homework challenges and tune in next week for a discussion of public speaking fears.
Are you interested in weekly information and tips about social anxiety disorder? You can sign up for my free SAD newsletter here.
Sources:
Hope DA, Heimberg RG, Turk C. Introduction to Session Outlines for Managing Social Anxiety: A Cognitive-Behavioral Approach, 2nd edition Therapist Guide and Client Workbook. Accessed online September 12th, 2013.
Hope DA, Heimberg RG, Turk C. (2010). Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach. New York: Oxford University Press.
Hope DA, Heimberg RG, Turk C. (2010). Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach Workbook (2nd Ed.). New York: Oxford University Press.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Welcome back to the 16-week e-course with details about what to expect from cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). Last week we talked about fears of making conversation or small talk with other people -- one type of specific social fear. This week we move to a discussion of observational fears, or fears of doing things in front of other people. If you are meeting with a therapist for CBT, he might cover these topics in a different order.
If you haven't already read sessions one through nine of this series, please go back and do so before continuing with this week's article. Below is a list of the previous sessions, designed to be read at a rate of one per week.
Session One
Session Two
Session Three
Session Four
Session Five
Session Six
Session Seven
Session Eight
Session Nine
Remember that these weekly sessions are not a substitute for treatment with a mental health professional, particularly if you suffer from severe social anxiety. And if you are taking part in CBT with a therapist, know that the following provides an example of what you're likely to cover during each session, but the structure can vary considerably depending on the specifics of your disorder and the style of your therapist.
Review Homework and Plot SASCI Rating
As usual, your therapist will review your homework assignment, as well as plot the progress that you have made on the SASCI graph. If you are working along on your own as a self-help series, evaluate how things went and any obstacles that you faced.
Remember that completing the exposure can be considered a success, and that your behavior doesn't have to be perfect.
Why Do You Fear Being Observed by Others?
Many people with social anxiety disorder suffer with observational fears -- such as signing your name, eating, or drinking in public. Usually your worry is that others will see your hand shaking or that you will do something to embarrass yourself, such as spill your drink. In this way, it is a fear of others judging you negatively.
Below are some common observational fears. Make a note of which of these situations cause anxiety for you and create a list of other observational situations that a problematic for you.
- Fear that your hand will shake when signing your name in front of other people.
- Fear that your hand will shake when writing on a chalkboard in front of other people.
- Fear that your hand will shake or you will spill something when eating in front of other people.
- Fear that your hand will shake or you will spill when pouring a drink for someone else.
Observational fears become a self-fulfilling prophecy. If you don't think too much about writing, drinking or eating they all happen automatically. However, when you start to pay attention to your movements, they become difficult. Your muscles become tense in response to your anxiety and self-consciousness and your focus on negative automatic thought interferes with your concentration.
If your anxiety about these situations is severe, you might even start to avoid them. This can cause problems in daily life, as it is hard not to write, eat and drink in front of others -- without completely isolating yourself.
In-Session Exposure
Just as in the previous session, you and your therapist would now engage in an in-session exposure, only this time you would be focusing on observational fears. The two of you would choose an observational scenario, such as pouring a drink for someone, and carry out the exposure just as you have done in previous weeks. Visit the session eight article for a reminder of how to complete an exposure.
Reading Assignment:
If you would like to remind yourself of the principles from this article that was part of last week's homework, you could review it again.
- How to Practice Exposure Therapy for the Fear of Eating in Front of Others
- How Do You Handle Writing in Front of Others?
Homework Assignment:
This week your homework assignment is to complete an observational exposure in your every day life. Below are the steps to use to complete the exposure, as you have done in the past. Make sure that you choose an observational situation that causes moderate anxiety.
Preparing for the Exposure:
- Describe the situation (for example, being observed while filling out a check).
- List any automatic thoughts about the situation and rate them from 0 to 100 in terms of your belief in them.
- List any emotions elicited by these thoughts.
- Identify thinking errors in each of these thoughts.
- Use disputing questions to challenge the most important automatic thoughts.
- Generate rational responses to combat each automatic thought and rate them from 0 to 100 in terms of how much you believe them to be true.
- List behavioral goals in the situation (something that other people can see you do).
- Carry out the exposure in real life, keeping your rational responses and behavioral goals in mind.
- Ask yourself: did you achieve your behavioral goal? (Did you fill out the check in front of someone?) Yes or No -- and if not, what prevented you from doing it.
- Which automatic thought was most distressing as you entered the exposure? Ask yourself whether it was proved true or false, and if your belief in it has changed. Re-rate your belief in the automatic thought from 0 to 100, and check if it has decreased.
- Ask yourself -- did I use the rational response? Did I find evidence that it was true? Do you need to revise it at all? Rate your belief in the rational response from 0 to 100 and see if it has increased at all.
- Summarize a couple of things that you learned from this exposure that will help you in the future.
- Congratulate yourself on a job well done.
Daily Challenges
In addition to doing the in vivo exposure, this week you will continue to complete daily challenges to build self-esteem. Below is a list of ideas related to observational fears.
1. Drinking in front of someone.
2. Eating in front of someone.
3. Signing your name in front of someone.
That's it for this week! Be sure to complete these homework challenges and tune in next week for a discussion of public speaking fears.
Are you interested in weekly information and tips about social anxiety disorder? You can sign up for my free SAD newsletter here.
Sources:
Hope DA, Heimberg RG, Turk C. Introduction to Session Outlines for Managing Social Anxiety: A Cognitive-Behavioral Approach, 2nd edition Therapist Guide and Client Workbook. Accessed online September 12th, 2013.
Hope DA, Heimberg RG, Turk C. (2010). Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach. New York: Oxford University Press.
Hope DA, Heimberg RG, Turk C. (2010). Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach Workbook (2nd Ed.). New York: Oxford University Press.
SHARE
