Social Anxiety Disorder: CBT behavioural experiment case example



said that when you're in work you worry a lot about how you come across in social situations yet really makes me feel really anxious like what I look like and what people are thinking yeah you said that you worried that you and visibly shake yeah and are there any other things that you worry that people will notice I think obviously the shaking I think my hands and legs shaking and kind of going really red and sweating and just looking really weird so it sounds like you have quite a strong mental image of how you see yourself when you're in these social situations yeah you so you go red you shake so anything else that you think that you do I mean describe yourself how do you think you look when you're in these situations just like I think I just look really obviously weird and out of place and like really red and just visibly shaking and sweating and kind of not being able to communicate properly with people and is there anything that you do to try and kind of defend against these things to manage and these problems and I guess like when I'm holding the camera I just grip onto it really really tight and or I kind of clench all my muscles and just find something that I can focus on and to kind of try and make myself shake less and not it was red and stuff mm-hmm so you focus on something you grip onto the camera do you make eye contact with people no I just tend to just look down okay so you also avoid eye contact is there anything else that you do to manage the sweating for example I just as I said of looking down and like wearing all black so it's less obvious and kind of worrying yeah just more layers and all blacks is you just can't tell mm-hmm okay what'd you think would happen if you stopped doing these things if you stopped gripping onto the camera or you know you started making eye contact and not looking down and what do you think would happen I think it would be so much worse so yeah I think I just would just shake even more and be more anxious and look up more obviously kind of weird and out of place mm-hmm I'm what I'm thinking now is how would you feel about if we did an experiment to to test out your thoughts on what would happen if you stopped doing these things if we did a bit of a roleplay where we pretended to enact a situation at work okay and if we did this maybe twice and the first time you do all the things that you normally do okay and grip onto something look down and is there anything else that you do when you're in these situations these were conversations to try and cope and I just kind of all just like fumble and like kind of just clenched whatever whatever it is I'm holding just really tight and just make sure I don't make any eye contact all right that's all just kind of get through it okay so in the first time I want you to do those things as much as you normally would in fact maybe even slightly more than you normally would okay and then the second time I want you to drop doing those things all together okay is that sound okay try my best and and do how would you feel about if we filmed this so you could actually see what you looked like okay do you have a camera with you that we could video on yeah and Matt is my friend okay yeah yeah we'll use that in just a sec okay before we do this then we're just going to fill out this form it's sir because what we're doing now is an experiment we call it a behavioral experiment to see what happens when you change the way that you're behaving okay so the first column says I need to fill out an experiment test this thought that you have so that our experiment is going to be that we do a conversation at work and who should I play if you're playing yourself in this role play who should I be and maybe like a client at work I always have to sit down with clients before we do the shoe and kind of get to know a little bit more about what they want okay so would it work if I was maybe having a wedding and I was hiring yeah wedding photographer yeah what kind of problems do you see coming up in this conversation that we have like what we see yourself doing on camera I'm shaking like being really obviously shaking and okay bright red and okay so visibly shaking so how how much will you be shaking 400 is like shaking uncontrollably and zero is not shaking at all how physically shaking will you be 90 okay and but sorry what was the other thing that you just said and okay go really red okay so I'm gonna go red yeah and how red will you go I mean if we look around this room and probably like the chairs okay thanks hello yeah you're going to be as kind of brightly pink as these chairs are yeah okay so out of a hundred then how how pink would you say these chairs are ninety how hundred okay and what else you worried is going to happen when we have these conversations just worried I'll be safe like say something stupid and not be able to kind of get what I'm trying to say across properly okay and how stupid out of 100 if 100 is ridiculously stupid probably like similar 90 and created say and what I'll see you worried will happen when you have this conversation where else it might you see on the camera I think you'll probably be able to see the under it sweating and okay and how much will you be sweating and again 90 I think like weird like visibly sweating down the face oh yeah okay and what you think will happen the second time around when you stop kind of doing the things you normally do to cope when you maybe start to make eye contact and you're not gripping on something I think it'll be even worse nothing cool yeah how much worse slightly worse like twice as bad twice as bad okay yeah okay right if you can you give me a fine animal yeah okay should I just use this and yeah yeah it's probably best okay hmm okay hi so um I was just wondering if I could talk to you about maybe doing my wedding photography yeah Oh what kind of kind of what kind of things you see and how do you want it to be like I suppose I'd like lots of shots of our family and our friends quite a lot of natural shots you know people talking when they're having drinks oh yeah and you want it like do you kind of see it being outside is that something that you're interested in yeah shots it's going to be a summer wedding so we like like like a lot of outdoors shots and if possible you know if it's not raining that would be quite nice and yeah quite some arty ones if that's possible yeah and yeah that would be I've done quite a few things like that before so have you got anything that you could show me about your past work yeah I recently did them some sheets outside kind of in like a wood environment so that I could show you that maybe it would kind of help with some ideas okay great right let's do the second one now okay okay you're ready to put down the bottle and I take Mike I contact okay okay hi so I just worry if I could speak to you about doing my wedding photography yeah yeah and what kind of thing are you looking at how do you want it to be like and I'd like kind of lots of shots of family and friends and quite a lot of natural shots you know okay um are you interested in having things outside maybe and he said it was wanted it to be natural yeah it's going to be a summer wedding and okay you know whether dependent of course yeah it would be really great if we could kind of get lots of shots you know outdoors okay if yeah people chatting and maybe some quite arty ones as well yeah have you got anything that you could show me up your past work yeah actually it's kind of a lot of the things I do are outside and I'm really interested in getting natural shots so and I could show you some of my work and we could kind of see if we could kind of develop something from that could be quite good okay let's pause it there okay Ryan's gonna give you this back now to look at okay I know I just want you to watch that okay and then we'll chat about it in a moment okay it's weird think if so if we just go back to the things that you predicted then you said that you thought you were going to shake visibly shaked you see yourself shaking on a video and definitely not as much as I thought I think it's obvious that I'm obviously quite anxious but I don't think you can tell I'm shaking that much mm-hmm so you said that you were going to shake 90 out of 100 how much shaking would you say that you saw there and maybe like less than thirty okay and you said that you were going to go red or pink as pink as these chairs 90 out of 100 did you notice yourself going pink and not really actually definitely less than I thought and yeah not as much okay you said that you were worried that you were going to say something stupid you know at 90 out of 100 did you know yourself say anything stupid not really yeah yeah I was going to be a lot worse than actually it was so you thought you're going to be like 90 say something that was 90 percent stupid that's really quite strong I mean in the end did you pick up anything that so could we maybe put that as a cou maybe like less than 10 maybe here and you said that you thought you're going to be sweating yeah and that you're going to be visibly sweating did you did you notice yourself sweating in the end not really definitely not as bad as I thought again you thought you were going to be like 90 up and you're like seriously visibly sweating so what what school would you actually give it in the end maybe again less than 10 I don't think you could tell at all mm-hmm you also said that you thought it was going to be twice as bad when you stopped using your normal strategies yeah what did you notice watching that video it was actually probably better when I wasn't doing any of those things I think I looked a lot more natural and I was able to say what I was trying to say I think I just come across more personable when I'm not kind of looking down and stuff

23 comments

  1. I leant a lot from watching this on a condition that I know lots of people suffer from. Thanks for sharing 👍

  2. My defense mechanisms in the moment are similar to hers. But when I get home from work, is where the real defense comes in and where the real destruction is.

    I use porn, masturbation, tv/YouTube, isolation as methods to escape the world and get as far away from the awkward, insecure, social anxiety memories from the week of work. And I spend the weekend running and hiding, dreading Monday.

    Any suggestions?

  3. I've had social anxiety my whole life, it's gotten to the point where I can't go to school and talk in front of my classmates, my parents have no idea what's going on, I try my best to hide it, but when it happens I get extremely red, I shake like crazy, I start crying and I can't stop myself. It's really embarrassing and I'd give anything to make it stop. However, in this video it's different when she talks with one person and it's rehearsed, she tried to control herself and they had been talking for a while before so she probably started feeling safe talking with her at least a little. If she was in a group of people or one person, it doesn't matter, I think she would have really had those symptoms, but only if it was more natural so the mind could really think it's in danger (fff response as you all probably know happens).

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  7. I want to study this so that I can help people. It would be good to see the 2nd or 3rd session, this will let us see how CBT is actually used. But thank you for uploading!!!

  8. Thank you for your great videos. However, I'm not sure how realistic it is the recording and interaction with you with a camera in your office, since she's not really in her job setting. So, is this really a good sample to disproof some of her false beliefs?  What I mean: She will probably act different in your office than she would in her work setting, since she already feels comfortable with you etc. Thanks for the reply in advance, and keep up with the great work.

  9. I have spent months investigating best cure for shyness and found a great website at Sebs Shyness Tactic (google it if you are interested)

  10. I m really glad i watched your videos and i like it very much. Your methods are incredible and i feel relieved even after watching this video. It's like i m looking in the mirror. the patient talks about everything that is happening to me. You are an excellent doctor. Please do a lot more videos.

  11. I'm just about to finish my fda in counselling and was looking for an experiment for my cbt assignment. fantastic video has helped me lots.

  12. This was really good. I have SAD & could relate to the patient especially her memories of school. I would freak out when the teacher would tell us to get into groups & I had no one to join. You have the most soothing voice!

  13. Good on you hannah , you seem really great talking and not shaking or sweating etc , I suffer with social anxiety also.

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