Social Anxiety Formulation
People suffering from social anxiety disorder (previously known as social phobia) experience persistent fear or anxiety concerning social or performance situations that is out of proportion to the actual threat posed by the situation or context. They fear negative evaluation and worry excessively about social events and outcomes, both before social situations and afterwards. Common fears include speaking or acting in ways that they think will be embarrassing or humiliating, such as shaking, sweating, blushing, freezing, appearing stupid or incompetent, or looking anxious. They fear that other people will judge them negatively, for example that they appear anxious, stupid, crazy, boring, dirty, or unlikable. They therefore make efforts to ensure that their fears do not materialize, resulting in clinically significant distress and impairment, often across multiple domains of their life.
This worksheet is designed to help therapists and clients to develop an idiosyncratic formulation of a client’s social anxiety. The core purpose is to help clients to understand how their experiences map on to the cognitive model, and how their social anxiety is maintained.
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Introduction & Theoretical Background
People who suffer from social anxiety disorder (previously known as social phobia) experience persistent fear or anxiety concerning social or performance situations that is out of proportion to the actual threat posed by the situation or context. Situations that can provoke anxiety include talking in groups, meeting people, going to school or work, going shopping, eating or drinking in public, or public performances such as public speaking.
People with social anxiety believe that social situations pose a danger. They fear negative evaluation, believing in particular that “(1) they are in danger of behaving in an inept and unacceptable fashion, and, (2) that such behavior will have disastrous consequences in terms of loss of status, loss of worth, and rejection” (Clark & Wells, 1995). People with social anxiety worry excessively about these events and outcomes, both in anticipation of social situations and afterwards. Common fears include speaking or acting in ways
Therapist Guidance
“It would be helpful to explore and understand how your anxiety in social situations has developed and what is keeping it going. I wonder if we could explore some of your thoughts, feelings, and reactions to see what kind of pattern they follow?”
- Social situations. Help client to explore what situations lead to anxiety, and what aspects of these situations are most anxiety provoking for them. Prompt the client for a recent time when they stayed in a social situation despite feeling anxious.
- Can you tell me about a recent time when you have felt uncomfortable and anxious in a social situation? For example, when you were with a group of people, who were you with? Where were you? What was happening?
- What situations tend to make you most anxious? When you are at work? With friends? With family? With people you don’t know? Can you talk me
References And Further Reading
- Clark, D. M. (1997). Panic disorder and social phobia. In D. M. Clark & C. G. Fairburn (Eds), Science and practice of cognitive behaviour therapy. Oxford: Oxford University Press.
- Clark, D. M. (2001). A cognitive perspective on social phobia: In W. R. Crozier, L. E. Alden (Eds) International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness. Chichester: John Wiley & Sons.
- Clark, D. M., Wells, A. (1995). A cognitive model of social phobia. In R. Heimberg, M. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press.
- Warnock-Parkes, E., Wild, J., Thew, G. R., Kerr, A., Grey, N., Stott, R., ... & Clark, D. M. (2020). Treating social anxiety disorder remotely with cognitive therapy. The Cognitive Behaviour Therapist, 13.
- Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester: