What is Social Anxiety Disorder (SAD)?
Social Anxiety Disorder (SAD) is a marked or intense fear or anxiety of social situations in which the individual may be scrutinized by others (American Psychiatric Association, 2022). Social interactions, performing in front of others, and being observed are all examples of situations in which such fear or anxiety can be onset. The fear of negative evaluation in SAD can vary in degree and type across different occasions as well as age groups. Anticipatory anxiety, for example, can onset well in advance of a social situation, while a panic attack can happen just before, or during, the social interaction.
Based on the features of the anxiety, perceived social situation, and intensity of the fear, avoidance of the social experience may be subtle or intense, while endurance of the experience is coupled with significant distress. In the United States, SAD typically onsets between 8 and 15 years old, with rates of remission suggesting different trajectories between short, fluctuating, and chronic (American Psychiatric Association, 2022). Social anxiety and diagnosed social anxiety disorder can both experience the stated symptoms and be treated based on intensity and severity. At New York Behavioral Health (NYBH), treating individuals with social anxiety is one of the many disorders we are able to provide care for.
Group Cognitive Behavioral Therapy (CBGT)
In group psychotherapy, the interaction between group members is considered one of the main vehicles of change. In group Cognitive Behavioral Therapy (CBGT), it has traditionally been assumed that the cognitive-behavioral model taught to the group is more of an ‘active ingredient’ than the relationships between the group members (Bieling et al., 2006). That is, Cognitive Behavioral Therapy (CBT) interventions interplay with the group dynamics to yield group member outcomes.
In short, CBT focuses on identifying unfit thoughts, beliefs, emotional responses, and behaviors, then incorporating skills and techniques to replace these unfit patterns with healthier ones. In CBGT, the two primary elements that need to be present for an effective group are the group’s cohesiveness and task focus (White & Freeman, 2000). Here, group cohesion is a function of group psychotherapy and task focus is a function of CBT interventions.
CBGT for Social Anxiety
In CBGT, the environment itself is also a major function of the therapeutic process for individuals with social anxiety and SAD. Because the primary fears involved in social anxiety are encapsulated in social experiences themselves, the group serves as exposure to the anxiety-inducing event, but within the parameters of support and elevated safety for the client. The group is composed of individuals experiencing the same, or a very similar social phobia, which allows members to bond over like-minded tendencies and work through issues collaboratively.
Through this lens, group members are able to begin processing their fear, in the presence of the fear itself, within the security of a non-judgemental environment. Other interventions that would be used in a CBT group include working on unfit thought patterns that provoke anxiety, processing imaginal scenarios of exposure, and developing coping skills and higher levels of tolerance when it comes to stressful social situations.
Is CBGT the Best Treatment for Individuals with SAD?
There is much research to suggest that Cognitive Behavioral Therapy is the most effective type of psychotherapy for Social Anxiety Disorder, with evidence pointing to the exposure-based components that CBT utilizes to help individuals gradually reduce their anxiety provoked by the fear-inducing event, in this case, social situations. In one randomized trial comparing group and individual CBT approaches, results suggest that both treatments were equally effective in reducing symptoms in patients with SAD (Neufeld et al., 2020).
In the same study, CBGT is cited as being more cost-effective than individual, which can be noted as a positive element to treatment. However, CBGT also involves a higher social cost than individual therapy sessions, which might feel like a difficult element for clients to consider, but this social cost is paired with researched social benefit, making it another positive element of CBGT.
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CBGT Treatment Challenges for Social Anxiety
The challenge to treatment in group cognitive behavioral therapy for individuals with social anxiety is the structure of treatment itself. CBGT for other anxiety disorders and phobias have fewer challenges to do with the actual process. However, by nature of the primary fear elicited by individuals presenting with SAD, the most prominent challenge is often agreeing to, and going to, the group therapy process.
Because there is anxiety wrapped-up in the therapeutic treatment experience, the group counselor or facilitator can arrange for informal meetings or other tailored strategies prior to the group’s official start to help mitigate stress-inducing tendencies that would be triggered by the first (and subsequent) meetings. Getting past this barrier and helping group members associate such a group with safety and security rather than fear and anxiety helps to alleviate this challenge from the process.
CBGT Variations and Alternative Treatment Methods for SAD
Research has emerged to study alternative methods that might benefit individuals with SAD. One randomized controlled trial compared CBGT to mindfulness-based stress reduction (MBSR). In this trial, it was found that both treatments yielded similar improvements in social anxiety symptoms, self-efficacy, cognitive distortions, mindfulness skills, attention focusing, and rumination, however there were greater decreases in subtle avoidance behaviors following CBGT than MBSR (Goldin et al., 2016).
Another study sought to identify if imagery-enhanced CBGT versus verbally-based CBGT would be more effective for individuals with social anxiety disorder, concluding that both were safe without significant differences in outcomes (McEvoy et al., 2020). This indicates that some variability in CBGT treatment can be implemented based on the group members and outcome goals. A final study looked at the clinical effectiveness of internet- versus group-based cognitive behavior therapy for social anxiety disorder and concluded that both treatments were highly effective and internet-based CBGT was at least as effective as in-person CBGT at 4-year follow-up (Hedman et al., 2014).
Ethical Considerations of CBGT for Social Anxiety & SAD
One of the focal ethical considerations for CBGT is the exposure-therapy element of treatment. Group leaders must be mindful of each member’s sensitivity to exposure to ensure their levels of anxiety are not elevated to an unhealthy space, where exposure can cause more harm than help for the client.
Exposure techniques have been widely studied and are highly effective for the treatment of SAD and other anxiety and phobia disorders, however there is an element of care that must be considered for all individuals prior to engaging in treatment. At NYBH, our therapists assist clients in the highest level of care, ensuring ethical and cultural considerations are at the forefront of treatment.
How to Find Treatment for SAD in NYC
Individuals who have been diagnosed with social anxiety disorder, or believe they might have social anxiety disorder, as well as individuals who have a loved one who has/might have SAD have plenty of options for treatment in NYC. Aside from CBGT, which can be found at various locations and practices in the NYC area, CBT and other psychotherapeutic practices are widely available for individuals to find in NYC. If you or someone you know is experiencing or has been diagnosed with social anxiety disorder, reaching out to one of our qualified therapists at New York Behavioral Health to help assess your needs is a great first step to treatment. Any member of our team can assist you to help get your questions answered and match you with a clinician that suits your therapeutic needs.
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American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders
(5th ed., text revision).
Bieling, P.J., McCabe, R.E., & Antony, M.M. (2006). Cognitive behavioral therapy in groups (2nd
ed.). The Guilford Press. https://books.google.com/books?hl=en&lr=&id=ffB5EAAAQBAJ&oi=fnd&pg=PP1&ots=yw42xeKCA-&sig=BcVJnQDqxXokWgbyoAsbM52UFJ4#v=onepage&q&f=false
Goldin, P. R., Morrison, A., Jazaieri, H., Brozovich, F., Heimberg, R., & Gross, J. J. (2016).
Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial.
Journal of Consulting and Clinical Psychology, 84(5), 427–437.
Hedman, E., El Alaoui, S., Lindefors, N., Andersson, E., Rück, C., Ghaderi, A., Kaldo, V.,
Lekander, M., Andersson, G., & Ljótsson, B. (2014). Clinical effectiveness and
cost-effectiveness of internet- vs. group-based cognitive behavior therapy for social
anxiety disorder: 4-year follow-up of a randomized trial. Behaviour Research and
Therapy, 59(1), 20-29. https://doi.org/10.1016/j.brat.2014.05.010
McEvoy, P. M., Hyett, M. P., Bank, S. R., Erceg-Hurn, D. M., Johnson, A. R., Kyron, M. J.,
Saulsman, L. M., Moulds, M. L., Grisham, J. R., Holmes, E. A., Moscovitch, D. A., Lipp,
O. V., Campbell, B. N., & Rapee, R. M. (2020). Imagery-enhanced v. verbally-based
group cognitive behavior therapy for social anxiety disorder: A randomized clinical trial.
Psychological Medicine, 52(7), 1277-1286. https://doi.org/10.1017/S0033291720003001
Neufeld, C. B., Palma, P. C., Caetano, K. A., Brust-Renck, P. G., Curtiss, J., & Hofmann, S. G.
(2020). A randomized clinical trial of group and individual cognitive-behavioral therapy
approaches for social anxiety disorder. International Journal of Clinical and Health
Psychology, 20(1), 29-37. https://doi.org/10.1016/j.ijchp.2019.11.004
White, J. R., & Freeman, A. S. (2000). Cognitive behavioral group therapy: For specific
problems and populations. American Psychological Association.