The literature review of research has proven the positive effect of CBT on Social Anxiety Disorders (Donovan et al. 2015;2014; Goldin et al. 2016; Goldin et al. 2014). CBT strategies are usually clear and easy to implement by both parents at home and teachers at school. Hofmann and Otto, (2017) in their book give an overview of the treatment model for SAD. They believe that in the most straightforward term, treatment is designed to provide patients with the strategies to learn that social situations are not as threatening, social errors are not as dire, and social performance deficits are not as unyielding as they predict (pp.24-49). The model can be applied to both children and adults. I used the term “children” when explaining the model since my research is about children.
- Targeting Social Standards:
Social standards are the behaviours accepted by social groups. Those standards are an important way to recognize and predict other people’s expectations. children with SAD have high social standards and they think other people around them have the same high standards and expectations. Individual or group discussions and direct behavioral experiments can challenge these beliefs.
When children SAD are asked about the goal of a social encounter, they usually say “people need to like me,” “I have to perform well,” or “I have to make a good impression on people.” That kind of goal demands knowing other people’s thoughts. That is, without mind-reading, they could never validate her or his goals, and that is why they always try to look back upon themselves and make judgments of their own social performance. In order to help children with SAD, they need to select the potential realistic goals prior to each social exposure. Once social goals have been identified, we need to help them identify and evaluate the best strategy to reach that particular goal such as asking a particular question, showing or not showing a certain behavior, receiving a refund for a particular item that the person just purchased, or being able to arrange a first date with an attractive person. After the exposure, the event is to be evaluated based on whether the goals were reached, regardless of the subjective anxiety encountered in the situation.
- Modifying Self-Focused Attention:
If we focus our attention on ourselves, then we cannot pay attention to other things, such as the social performance task. The less attention for the task, the more mistakes we make, which can increase our anxiety. To help SAD, individuals are instructed before a social task to change their attentional focus and to observe their own level of anxiety. it means that we ask children before each social performance situation to direct their attention (1) toward their physiological sensations, (2) toward the physical environment, and (3) toward their speech topic (30 seconds each). After each instruction, they will be asked to rate their level of anxiety.
- Improving Self-Perception:
Many people with SAD report discomfort when they look in the mirror. Many also report distress when seeing themselves in pictures or video recordings or when listening to an audiotape of themselves. self-perception is The reason for this distress. This distress is not only because of their negative evaluation by the audience but also because of the negative evaluation of themselves. Hofmann and Otto, (2017) have found that reducing the amount of self-criticism (which goes along with self-acceptance) also builds self-confidence and improves self-perception. In this treatment model a core lesson learned is: Instead of trying to improve your social skills and the way you come across, simply accept yourself and your weaknesses, enjoy your strengths, and be content with the way you are while striving to achieve your goals.
- Targeting Estimated Social Probability and Cost:
we get anxious, angry, or sad when there is a reason for that. If a situation is really bad, and there is good reason to feel bad, then we should feel bad unless we refuse to face reality. For example, the loss of someone that we love, and serious health problems are all good reasons to feel bad, stressed, anxious, and sad. In contrast, giving a bad and incoherent speech in front of colleagues might be an unpleasant and embarrassing event, but it is not a catastrophe. Some children with SAD have great difficulty identifying these anxious and maladaptive thoughts. 1. We need to ask individuals questions to identify and challenge their exaggerated probability and cost estimation. For example: How likely is it that a mishap occurs? What would be the worst outcome of this situation? Why is this situation such a catastrophic event? How will your life change due to this experience? These questions are intended to illustrate that social mishaps are normal. 2. During the planning stage of the exposure exercises, we will ask children with SAD to create social mishaps in order to examine the actual consequences. For example, buy a piece of pastry at a café, “accidentally” drop it on the floor, and then ask for a new one. The specified goal of this situation may be to obtain a new piece of pastry without paying for it.
Anticipation of Social Mishap and Social Thread:
Children with SADbelieve that doing a mistake leads to a great consequence such as loss of worth and rejection. Now we need to ask some questions:
1. What evidence do I have that the belief is true?
2. Based on past experience, how often did this feared outcome actually
3. What is the worst that could happen?
4. If this worst outcome happens, would the person be able to cope
The goal is to make the child realize that unpleasant things happen now and then to everybody. It is impossible to prevent this from happening. The model introduces the fact that control can be gained by accepting the emotional experience. Also, they need to know that they are not consistently deficient in their social skills and they can do well.
- Safety and Avoidance Behaviour:
In this model children with SAD are instructed to identify and eventually eliminate any avoidance behaviors. The term avoidance behavior is broadly defined as anything the person does or does not do to reduce his or her anxiety in a social situation. Avoidance and safety behaviors maintain the fear of social situations, and exposure procedures can eliminate them. Safety behaviors are conceptualized as frequent and subtle forms of avoidance strategies. In order to identify them, children with SAD are instructed to monitor their social encounters. Repeated and prolonged exposure to the feared situation without using any avoidance and/or safety behaviors is one of the single most effective methods to overcome social anxiety.
Post-event rumination is a frequently occurring phenomenon after the asocial encounter, especially after situations that are associated with high-perceived social costs and negative self-perception because of the assumed catastrophic outcome of a social situation. Post-event rumination might
serve the purpose of reexamining the situation to evaluate the potential threat involved. We should help children with SAD to process negative social events more adaptively through. The goal is to help children consolidate useful information from their exposures.
- Putting it all Together: Designing Exposures:
Social exposures must be arranged to provide evidence to violate the assumptions that the social situation is socially or emotionally dangerous. This is achieved by helping children think through, define, and discover what constitutes adequate social performance while having adequate practice in social situations to allow anxiety to dissipate. Elements of exposure also help to realize how their anxiety changes as their attentional focus shifts and as they persist in once avoided social situations.
This model can be implemented by parents at home and teachers at school in order to gain the best result and support children with SAD.