Crippling anxiety disorders often helped by behavorial therapy

Citing statistics that show that many people fear public speaking more than death, comedian Jerry Seinfeld once joked that if you’re at a funeral, you’re better off in the casket than doing the eulogy.

But for people who suffer from social anxiety disorders, one of which is public speaking, it’s no laughing matter. These people’s personal lives and careers can be sidelined by fear of certain social situations, such as speaking with a boss or authority figure, making telephone calls or attending parties.

A psychologist at Washington University in St. Louis says that people who suffer from social anxiety disorders can receive help through cognitive behavior therapy.
A psychologist at Washington University in St. Louis says that people who suffer from social anxiety disorders can receive help through cognitive behavior therapy.

The good news is that these disorders are highly treatable through cognitive behavior therapy, in particular, group therapy. The Psychology Service Center of Washington University in St. Louis is offering a new therapy group specializing in social anxieties.

“Cognitive behavior therapy is focused on the present rather than the past,” said Deanna Barch, Ph.D., an associate professor of psychology in Arts & Sciences at Washington University and supervisor of the social anxieties group therapy project. “It’s focused on the kinds of thoughts, beliefs, ideas that people have currently and how that influences their emotions and behaviors. It also focuses on what behaviors you are actually engaging in and not engaging in in the moment, in the here-and-now.”

Not to be confused with panic attacks or generalized anxiety disorder, social anxieties arise out of particular situations that can cause the subjects to feel intense fear, nervousness, racing heartbeat, blushing, excessive sweating, dry throat and mouth, trembling and muscle twitches.

Some other society anxieties include:

  • Being introduced to other people
  • Being teased or criticized
  • Being the center of attention
  • Being watched or observed while doing something
  • Having to say something in a formal, public situation
  • Meeting people in authority or important people
  • Feeling insecure and out-of-place in social situations
  • Embarrassing easily
  • Meeting other people’s eyes
  • Swallowing, writing, talking or making phone calls in public.

In everyday life, these fears can keep a college student from attending the first class of a semester to avoid that first-day tradition of students going around the room and introducing themselves. A student’s grades may be affected by inability to speak up in class. Fear of meeting new people can keep someone from attending parties. For some, a job interview is a terror to be avoided at all costs, and asking the boss for a raise or better work conditions is out of the question. Combine fear of making phone calls, meeting new people and talking to the opposite sex (or any potential romantic partner) and you’ve got a life without dating.

Treating the disorder

“To a certain extent, everybody has these concerns,” Barch said. “The question for whether or not people need treatment is the extent to which they feel like it’s impairing their lives or their function or makes them uncomfortable. It’s really how severe and how much it seems to interfere with your life or how much it distresses you.”

In the therapy sessions, the clients start to identify the negative self-talk that leads to their anxiety in certain situations. Then they challenge how realistic those thoughts are by asking questions like, “Is it really the case that I can’t do this? Have I ever actually seen anybody laugh at someone in this situation?”

Next, the clients will try to stop avoiding the offending situations.

“We never recommend that people try to dive into the worst possible scenario,” such as making a speech to 4,000 people, Barch said. Instead, the group starts with exposure to easier situations and gradually works up to scarier occasions. The clients first try out their new skills in the group setting, then graduate to real life exposure situations.

“So you start with things that are more likely to give people a mastery experience that they can build upon for future things,” Barch said.

Part of the therapy involves having clients stay in the anxiety-provoking situation long enough to get the experience that their anxiety reduces.

“If you do it enough or you stay long enough, eventually that anxiety reduces and you get the experience of doing that thing without feeling anxious, which is a very rewarding experience for people,” Barch said.

Another key to the success of group therapy is that clients realize they’re not alone. “We often find that many people with social anxiety disorder think they are the only ones who feel that way,” Barch said.

“There’s a lot of empirical data suggesting that cognitive behavioral treatments are effective for a range of anxiety disorders,” including obsessive-compulsive disorders and simple phobias such as fear of flying or heights, Barch said. In fact, there are no social anxieties that cannot be effectively treated this way, although some very widespread, long-lasting extreme social concerns may require more intensive treatment, she said.

Group therapy may not be easy to find in some areas of the country, but individual treatment using the same basic approach works well too, and that is easy to find in most major metro areas, Barch said.

People who are unable to find a suitable therapy group can try helping themselves get over a social anxiety by following similar steps:

  • Identify the situations that trigger anxiety.
  • Pay attention to the self-talk regarding those situations.
  • Challenge the validity of the negative self-talk.
  • Begin gradual exposure to the frightening situations starting from the easiest to the hardest.

More information can be found online at and

The Washington University Psychology Service Center group, with an optimum size of about six members, will begin weekly meetings in early March. For more information, call 314-935-6555.