May 29, 2023
Cognitive Behavioral Therapy (CBT) for Social Anxiety: How It Works – Healthline

Cognitive Behavioral Therapy (CBT) for Social Anxiety: How It Works – Healthline

People often confuse social anxiety with shyness or introversion, but social anxiety, also called social phobia, is a mental health condition that often requires professional treatment.

Social anxiety involves extreme and persistent feelings of worry, nervousness, and dread. These feelings show up in social situations, or at the mere thought of social situations.

More specifically, you might:

  • fixate on how others perceive you
  • believe you’ll do something to embarrass yourself
  • feel very self-conscious around others
  • assume people will reject or laugh at you when you try to make friends
  • notice physical symptoms of anxiety in social settings
  • avoid most situations involving anyone beyond a few trusted loved ones

If you’ve noticed any of these key signs, you might start to wonder whether working with a therapist could help.

Therapy can absolutely have benefits for social anxiety. The most effective treatment approach often depends on your unique symptoms and therapy needs, but cognitive behavioral therapy (CBT) is one common approach known to make a difference.

CBT teaches you to identify specific thoughts, emotions, and behaviors fueling your distress. From there, you can begin to explore these feelings and reframe them into more helpful beliefs.

To put it very simply, social anxiety involves a desire for acceptance. You want others to like you and leave your interactions with a positive impression of you. At the same time, you hold a deep conviction you’ll do something to embarrass yourself, drawing negative attention and criticism instead.

As a result, you avoid those very interactions or, when that’s not possible, find yourself fixating on what people are thinking and how they really feel about you. These anxious thoughts can prompt sweating, blushing, and nausea or dizziness. You might have trouble making eye contact or speaking loud enough for others to hear.

Any situation that involves other people can become anxiety-provoking: purchasing groceries, asking for directions, or calling your landlord about a leak under the bathroom sink.

CBT for social anxiety aims to help you examine and change the behaviors driving the avoidance, self-consciousness, and physical symptoms you experience.

More specifically, CBT can help you learn to recognize distorted thought patterns and reframe them more realistically.

  • “I look so awkward” might become “Well, hardly anyone else dressed up, but that’s OK — I do look very nice.”
  • “Everyone’s waiting for me to mess up” might become “People seem really attentive. I’m glad I worked so hard on this report.”
  • “I’m so boring. Who’d want to talk to me?” might become “I’m not sure what to talk about, but I can always ask a few questions to get the conversation going.”

CBT also teaches coping skills to help you manage anxious feelings and related physical symptoms that come up in social situations.

These techniques can help you feel calmer in the moment, but that’s not all. They can also teach you to gracefully navigate blunders, like pronouncing someone’s name wrong or grabbing your dinner partner’s drink instead of your own, without feeling overwhelmed.

Here’s a more in-depth explanation of how CBT works.

CBT involves a number of different techniques, but CBT for social anxiety won’t involve every single strategy.

Many therapists treating social anxiety in adults operate from the Clark and Wells cognitive model of CBT. According to this model, social situations prompt negative beliefs and assumptions you hold about yourself. These beliefs trigger a sense of danger, which then trips an anxious response.

This response might involve:

  • safety behaviors, like dodging conversations, agreeing with everyone, or avoiding eye contact
  • physical and emotional symptoms of anxiety
  • shifting your focus internally

Your therapist will likely use some of the following techniques to help you address this response and navigate social situations more productively.


Learning more about the psychological components of social anxiety can help you understand how the beliefs that lead you to avoid social situations only limit you and make social anxiety worse.

Your therapist can also:

  • offer reassurance that your symptoms are both a normal part of social anxiety and very treatable
  • explain how therapy works to reduce anxiety
  • provide more information on how certain strategies work and why they’re effective

Cognitive restructuring

This technique encourages you to examine cognitive distortions, or the negative thought patterns that show up in social situations.

These might include, among others:

Identifying these unhelpful and inaccurate patterns is an important first step toward reframing, or restructuring them.

Your therapist may walk you through an imagined situation, or one that actually happened, to help you get more insight on distorted thought patterns. From there, you can begin to identify (and put into practice) alternate ways of thinking.

Restructuring won’t involve overly positive replacement thoughts. Rather, it aims to promote more neutral and realistic ways of thinking:

  • “Some people may not like me, but that’s OK — it’s normal.”
  • “I might feel anxious, but I can cope with it and the feeling will pass.”

Systematic desensitization

This approach to exposure therapy helps you confront feared social situations, beginning with those that inspire the least amount of anxiety and dread.

You don’t face your fears empty-handed, though. As part of systematic desensitization, you also learn various relaxation exercises. At the first whisper of worry or fear, you can reach for one of these techniques to soothe those emotions and ground yourself.

If talking to people you know fairly well is a low-level fear, you might start by greeting the classmate who sits next to you. When your heart begins to pound, you can take a few slow, deep breaths until you feel calmer. Within several days, you can say hello without the deep breathing.

Behavioral experiments

Experiments aim to accomplish two main goals:

  • identify unhelpful safety behaviors and self-monitoring
  • check and test negative self-beliefs and worst-case scenario predictions

Say you’re planning to go to a party. You worry you might end up saying something awkward, and you’re also afraid no one will even talk to you.

Experimenting might involve going to the party and talking to a few people, instead of sticking to corners and avoiding all conversations. At your next session, your therapist will ask whether what you predicted actually happened.

Your therapist might also record role-play exercises in therapy so you can review the video and observe how you actually come across in social settings.

Attention training

This strategy involves learning to shift your attention back to other people.

Focusing on yourself can help you monitor your thoughts, actions, and words, certainly. But this also tunes out the real reactions of others, which can effectively reinforce your negative self-perceptions.

Keeping your focus on others during conversations and other interactions helps you pay attention to the way they actually respond to what you have to say. You’ll probably realize pretty quickly that they don’t even notice the things you feel anxious about.

Learn about other common CBT techniques.

Quite a lot of evidence supports the effectiveness of CBT for social anxiety.

A 2014 research review evaluated a total of 101 studies that used 41 different treatment approaches, including medication, self-help, and other treatment approaches. According to the results, CBT appeared to have the most benefit for treating social anxiety.

Research from 2015 comparing CBT and exposure therapy suggests that while both can help improve social anxiety symptoms, CBT may be more helpful than exposure therapy plus applied relaxation.

A small 2015 study suggests even 6 sessions of CBT may help reduce feelings of self-consciousness and avoidance, though it won’t necessarily ease your fears of criticism or negative evaluation.

A 2016 study of 42 adults living with social anxiety suggests CBT could help treat social anxiety symptoms that don’t respond to antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are often part of social anxiety treatment, though, as this study points out, they may not always work.

Internet-based CBT (iCBT) appears to have some benefit for social anxiety symptoms.

With these programs, you use your computer or phone to learn and practice CBT techniques. Depending on the program, you might work with a therapist or coach or complete the exercises on your own. iCBT isn’t quite the same as teletherapy, though some programs do involve some interaction with a therapist.

iCBT may be ideal when:

  • Symptoms are severe enough that the thought of working with a therapist face-to-face overwhelms you.
  • You can’t find a local therapist who offers CBT for social anxiety.
  • You can’t afford to pay for in-person sessions, which may be more expensive than some iCBT options.
  • You feel more comfortable working your way up to in-person treatment.

CBT is widely recognized as an effective treatment for social anxiety. Still, that doesn’t mean it works for everyone.

At the end of the day, it’s just one potential approach. If it proves less than effective, it never hurts to ask your therapist about other treatments for social anxiety.

Crystal Raypole writes for Healthline and Psych Central. Her fields of interest include Japanese translation, cooking, natural sciences, sex positivity, and mental health, along with books, books, and more books. In particular, she’s committed to helping decrease stigma around mental health issues. She lives in Washington with her son and a lovably recalcitrant cat.


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